Pretty Little Butcher: Memoirs of a Female Thoracic Surgeon

Defense Medichanism

Disclaimer: I do really care about my patients and I wish the best for them. If I sound too cynical or unsympathetic, it’s purely for theatrical effect. I don’t mean to offend anyone.

Before I started working in the hospital, I honestly believed every word of The Hippocratic Oath. It’s basically a rite of passage we had to go through on graduation day. As we receive our white coat, we had to swear by this oath and promise to take care that the patients suffer no hurt or damage. I believed that we are a team; doctors, nurses, patients, and their family, and we have a common goal and to fight our mutual enemy: the disease.

I understand a little better now. In the hospital, it’s sort of like a James Bond movie: You can’t trust anyone. Your colleagues can stab you in the back, the friendly patient can turn vicious in a second, and family members you have never seen before will shoot up like spring grass the minute something goes wrong. They want concrete proof of your remorse and condolence: money.

The amount of medical disputes and cases of alleged malpractice is ridiculously high. Not all of them turn into lawsuits, because it’s not that easy to establish a case, but it’s enough to dishearten anyone. Imagine trying the best to save a life and fail, then on top of that frustration, add a pointing finger that calls you a murderer.

In order to prevent all the hassle, doctors build up their own defense mechanism. There are two kinds: the overdoing and the underdoing.

When I was doing my rotations in the ER, very frequently I’d come across babies that fell off the bed or toddlers who bumped their heads. Most of the time they are fine, but intracranial hemorrhage---bleeding in the brain---can occur anytime between right away and over a week. There’s no guarantee that the patient will be fine forever even if they shows no signs at the moment and are of relatively low risk. Some patients demand that doctors give them assurance.

“You said he’s fine. I’ll sue your ass if anything happens to him in the next thirty years. Can you guarantee he’s perfectly, one hundred percent fine to leave the hospital?”

What do you do? You can give the patient proper education on signs to watch out for and when he should return to the hospital. He lives only 5 minutes away, after all, and you think you are being considerate when you decide that he should have a much better time resting at home.

Or, you can give in to the patient’s demand. Order an x-ray for him, like ordering off the menu, although it can’t tell you much unless he has a cracked skull. They always feel so much better, safer, after getting an x-ray, that we jokingly call it Phototherapy.

Bring it up a notch and you can get him a CAT scan. It’s more expensive, takes more time with higher radiation dose, but at least you can actually see the brain. If there’s no bleeding at the moment, it means there’s no bleeding AT THE MOMENT.

Then you can ask him to lie in the ER for seven days, just to be sure.

That’s called overdoing it. But because human body is extremely complicated and you can’t promise anything, it’s safer to do everything you possibly can just to protect the doctors.

Picture another scenario:

A ninety-year-old man was brought in due to a perforated peptic ulcer, that is, a hole in the stomach. Usually it requires immediate surgery, but this patient was old, fragile, had a very hostile son, and on top of all that he was a cancer patient. He had low blood pressure, high fever, and was going into septic shock. You can fight for his life---and he might die on the operation table---or you can reasonably advise them, just let it go. Have him sign a Do Not Resuscitate form, give him some antibiotics and pain killers, add some vasopressors to keep his blood pressure and hope for the best. Surgery is very risky, after all, and you don’t want lawyers and judges to tear the medical chart apart after he dies and blame his death on one little mistake you made during the operation, such as choosing the wrong music to play.

That’s underdoing it to stay out of trouble. (The examples I gave were extremes, of course. Most of us still manage to do the right thing)

After a few years at the hospital, we learn to protect ourselves. I know about all the inspiring TV shows in which the hero gambles with all he has and saves the patient, but in real life, we just want to save our jobs and take home a decent paycheck to put food on the table. It is sad, really. The mistrust between doctors and patients is a lose-lose situation where we spend more health insurances on unnecessary procedures, to achieve a worse quality of life.

There are moments, however, that I feel like I’m part of a team and it restores my faith. I had a seventy-year-old patient with esophageal cancer, and the tumor was clogging up his esophagus. He went from eating soft food to liquid.

One afternoon while I was furiously typing up paperwork, a nurse asked me if I was free at three pm.

“You are cordially invited to a wedding,” she said. “The location is at bed 35.”

The cancer patient always had this one woman beside him. She was perhaps twenty years younger than him and had taken care of him for many years, but they were never married. Now that he felt his life was drawing close to an end, he wanted her to be able to inherit everything he left behind.

We all gathered around bed 35, and the nurse brought out a large cheese cake. “I asked,” she said to our patient. “The baker said that it’s so soft it can melt in your mouth, so you can enjoy this.”

We awkwardly started on a happy birthday song before realizing we weren’t celebrating a birthday, so we switched to the wedding march instead.

“I told him not be make a big fuss of this,” the bride said in embarrassment, but I could tell she was secretly very pleased. She smiled and I saw she was missing a front tooth.

They say that a bride is the most beautiful on her wedding day, and that afternoon, the bride with her toothless grin was the most beautiful bride I had ever seen.