As a surgeon, it is difficult to be a patient. Perhaps this is why there are so many comments about doctors and nurses being 'bad' patients. We know too much. Enough to be scared. We know about risks. After all, we talk about them everytime we consent a patient for surgery. We review complications and deaths with our colleagues in the attempt to improve care for future patients. And perhaps some of us went into medicine in the hopes of cheating death. But, everyone of us is human and subject to illness and death just like every other living being on the planet.
The fear is not limited to health care professionals. About a year ago, in a Morbidity and Mortality Conference, we discussed a patient who has had a bad outcome. He seemed to be
doing well before a routine surgery, and only hints of the problems to
come immediately after. Everyone on the surgical team agreed the
surgery was appropriate and indicated for the problem at hand. Everyone
agreed at the conference today. But, before the surgery the patient
was resistant until his family talked him into it, then he wanted to
proceed, and asked that it be done.
Many times I have had patients initially afraid of surgery then change
their minds and ask to proceed. Most of the time things go well, but
sometimes not. It seems reasonable to be a bit afraid to undergo
surgery. I know I was afraid before my knee surgery, but it went well.
I wasn't actually as afraid of the surgery as of the anesthesia. I was
afraid of losing control. I had some with my appendectomy as well, but fear of a repeated rupture and the associated pain pushed me to proceed. As a General Surgical colleage said, "So pain and fear is what's pushing you to surgery?" I responded, "Absolutely. Is there any other rational reason to have surgery?" With my last surgery, I was even more afraid. Afraid of dying. Either due to the surgery or the disease. I felt that I still had much to accomplish on this planet, but still I was afraid. My children were too young. They weren't ready to be on their own. And, while most things are settled, I hadn't had the time to settle everything.
So some preoperative anxiety is probably
normal. Anesthesiologists often premedicate the patient with an
anxiolytic (a drug to block anxiety) before they even come to the
operating room. This certainly makes sense. Seeing some of the tools we surgeons use might be even more frightening to a patient.
But what of the patient who is so afraid that he is prepared to sign out
against medical advice. What does that mean when things do go bad?
Did the patient have some sort of premonition? I have seen it often
enough that I sometimes wonder. One place where I worked had the
informal policy that a patient who cancels three times needs to see
another surgeon before being rescheduled. I have tended to follow that
policy with my own patients since.
Likewise, I have sometimes had a bad feeling before surgery when I am
the surgeon. It doesn't happen often, but when there is a problem, I
think afterward about my feelings. Was I ignoring something that I
should have paid attention to? Or am I simply over thinking the
problem? Remembering my own anxiety in the situation of a less than
perfect outcome? Are premonitions something real? Something we should
pay attention to? Is intuition just a subconscious processing of an
observation that can't easily be described?
When I think of the topic of premonitions, I remember the series of
dreams I had for months before my mother's death. She was not ill,
though had some chronic conditions. And she was well enough to travel
and walk for hours on cobblestones. Hardly, someone I would have
thought on the verge of death. Yet, I had dreams for months before her
death of trying to resuscitate a family member. The dreams stopped
immediately after her death. It was as though I was rehearsing
resuscitation techniques in my sleep for when I needed them to try to
save my mother. More of the details are published at: http://www.physicianspractice.com/work-life-balance/content/article/1462168/2041808
Yet, as I think about this topic, I am left with more questions than
answers. Premonitions certainly seem real to me at times, yet I cannot
come up with a scientific explanation. The closest I can come is to say
that I simply cannot put my observations into words, so get intuitive
feelings about something. Yet this doesn't apply in my mother's case,
since she had been living on a different continent for eight months and I
did not see her until about a week before her death. So what kind of
subtle observations could have prompted my dreams to begin two months
before her death. Yet, that is when they did.
So what do I do when I feel such a sense about surgery as the surgeon,
or when a patient expresses more than the typical anxiety? I listen. I
recheck everything to see if I am missing something. I don't rush to
the operating room. But, if I can't find a reason not to proceed, I
usually do if I think the procedure is indicated and the patient
agrees. And, most of the time everything is fine.
And, how do I feel as a patient? When it seems to be the best approach and I trust those caring for me, I have gone under the knife. But, still, I do so with some trepidation.