A Chance to Cut Is a Chance to Ghost

 

There's a Reddit thread where physicians are pretending to rate patients  like patients rate doctors, and this post from an alleged neurosurgeon caught my eye, particularly in light of the recent shooting in Tulsa.

(If you want to be really demoralized, go find the thread and see the miles of physicians making fun of patients who can't pronounce their medications. They want us ignorant. They mock us for doing any research. You'd think not being able to pronounce weird names of medications would be a good thing. Patients are just never dumb or smart enough for doctors. We can't win.)

This physician encapsulates a lot of what I experience with surgeons. Once they cut you, you no longer exist. If you have an issue, you're a problem patient. The best patient is an invisible patient.

My first reaction to that shooting was to wonder how much had been explained to the patient. Did they even know how bad recovery was going to be? I find I am often underprepared for the pain of recovery, intentionally so in my opinion, by the surgeon. After my liver resection, I just assume recovery is going to be absolute agony and am pleasantly surprised if it's not.

Obviously the shooter's approach to problem solving was unacceptable. I'm not suggesting it was, but when I contemplate a root cause, I have some questions.

In my experience, surgeons will promise you the moon to get you into surgery and then disappear never to be seen again after the surgery. They don't care about pain. They don't want to know about your problems. They're did their job which means you're fine. The patient is not allowed to have any experience outside the surgeon's expertise and authority.

I have a vivid memory of the liver transplant surgeon visiting me after surgery along with someone who was never introduced to me, but I sensed that it was a tour of some kind and I was on display. He came to my bedside, I can't remember what he was talking about, but it wasn't addressed to me. When I tried to ask him a question about my surgery, he sternly cut me off and told me that wasn't his job and then left.

I'd never been formally introduced to any other surgeon and told they were in charge. He'd been in the operating room when I was wheeled in. He'd also been the only one who ever spoke to me before surgery, the physician I made appointments with. WTF?

When I had my spine surgery, I was not warned that nerves really don't like to be touched and would be very painful as part of the normal recovery process.  At one point, I could barely walk and when I brought that up at my follow-up appointment with the neurosurgeon I was given the brush off. No attempt was made to try and improve my functionality (which was a real fall hazard) or comfort. 

They'd cut me and were very clearly DONE with me. I was dismissed. I went home and muddled through on my own, making up my own regimen of pain management with whatever I had on hand since no one else would. (In the future, I've resolved to just get some pot so I can control pain on my own...just have to test it to see if it even works since I get so little relief from opiates anyway.)

I hope I'm never as desperate as that shooter. I'm really thankful my nerve pain largely expresses as burning and is generally tolerable. Outside of surgery making everything way worse, the main problem for me was how it interrupted my sleep and the loss of function. My brain felt a need to constantly alert me to the burning or numbness in a loop. Like a malfunctioning alarm that can't be turned off. Even the tripping and falling wasn't as big of a problem as the impact on sleep.

No one should go on a shooting spree, but given the circumstances on this latest tragedy, I do wonder whether the patient was adequately prepared for how hard the recovery can be after spine surgery and whether better communication and more robust care would have made a difference. It's a significant surgery, with a lot of pain. That someone was so hopeless just days after surgery seems to signal that perhaps the patient didn't have the information they needed to have realistic expectations.

I see such a lack of communication and a lot of ducking of responsibility among surgeons I've had to work with that it has to be systemic. I can't be that unlucky. It seems they've created an echo chamber that justifies and rationalizes all their behavior as lawful good, and yet somehow they were also able to drive a patient over the cliff. 

And clearly this guy wasn't in a good place and quite possibly something else would've triggered him, but the fact is it was this surgery that was the final straw. I don't want to victim blame, I'm not trying to do that, but I also don't want to ignore that there are systemic communication and care issues that can push desperate people to do desperate things. And if we continue to let them fester, we will continue to reap what we're currently sowing.

A terrible tragedy all around.