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Thursday, January 26, 2006

How do I deal with it (II)

Desensitisation is a very slow process. In my previous post, I wrote about how I got used to working with dead bodies and being around dead things.

Another part of my medical training taught me how to depersonalise a patient - cutting up dead bodies is one thing...cutting up live bodies is a totally different experience.

During my surgical attachments, we often had the opportunity to assist the surgeons by holding optical equipment or metal retractors (used to pull stuff out of the way, so that the surgeon can get a better view).

The first operation I attended was a hip replacement. However, due to the age of the person having the replacement, it was done under spinal anaesthetic. This means that the person is paralysed from the waist down and cannot feel anything below the waist. Additionally, a sedative was administered to keep the patient relaxed. My job during the operation was to keep the patient occupied.

A green sterile sheet acted as a screen between the patient and the surgeon. The patient could not see the surgeon and vice-versa. I, however, could see both the patient and the surgeon.

Hip replacements are ghastly. By the middle of the surgery, we were all sliding about in pools of blood. The patient, however, was totally oblivious to what was going on - she was in fairyland as far as she was concerned, never felt better in her whole life, wonderful wonderful and you are all darling angels, absolutely darling.

I held her hand and smiled at her. In the corner of my eye, I could see chips of bone flying all over the place from the surgical saw.

Here was a laughing rosy-cheeked lady, with grandchildren in college and a lazy grey cat named 'George' whom she rescued from drowning a lake when he was a wee 'un, who was stroking my hand and telling me about how she'd met her poor dear husband...and we were recklessly turning her body into a battlefield with all the chopping and slashing and parts of her flying every which way. The dichotomy of it was horrifying for me. In the end, I had to leave before the end of the operation because I felt sickened.

Sometime after that, I was assisting in an operation to remove a diseased kidney. My purpose was to hold organs out of the way using my hands, which you might say was a more messy and involved job. The patient was asleep and covered by the green sterile sheets so that all I could see was a square of skin. During the entire operation, I had my hands in the depths of her abdomen but I never saw her face. At the end of it, I had her kidney in my hands, and it was horribly scarred and deformed, and I felt...nothing.

The patient under anaesthetic has as much feeling as the table he or she is lying on. When we talk about general anaesthetic to a lay person, we always talk about sleep. "You will be asleep the whole time," we say, reassuringly. This is not entirely true - a person who is merely asleep would never let anyone cut into them with sharp scalpels. Anesthesia is the art of successfully bringing someone to the brink of death and keeping them there for as long as necessary.

So, this kidney operation I attended...well, it was like working with a cadaver, a lifeless object. An entire patient, transformed into a 30 x 50cm block of meat by green sheets and the right drugs.

It's very easy to depersonalise a body when you have had no relationship with it and when it has no face. And by depersonalising a patient, I could concentrate on the task at hand because I had no feelings for them. It's all a matter of perception, I guess.

What is blood when you think of it as red water, rather than the life substance of a person?

Even now, when I'm trying to do something bloody or painful to a patient, I think to myself "it's for their own good" and shut out their cries and screams and anything else that reminds me that I'm dealing with someone who can feel.


Blogger trisha said...

This is why I faithfully read your blog everyday. You give us common non-medical people a glimpse into a world that we can only imagine, which is often influenced by what we see on TV ("ER" for me!).

I am totally riveted by what you just wrote. Can't imagine how you deal with such things on a daily basis.

9:59 am  
Blogger angry doc said...

The only operation I ever felt sick watching was an orchidectomy...

12:03 pm  
Anonymous jessica said...

that happens to me when i have to extract wisdom teeth..
i know about this whole holistic approach thing....but sometimes... it seems like the the only part of them...floating around as an individual entity...instead of belonging to a person...

10:19 pm  
Blogger tscd said...

trisha: Ooh, I used to love ER. My entire house used to congregate in the common room to watch it when we were in our first year - we were convinced that our lectures followed the series because we always seemed to be studying the same cases.

angry doc: Yeah? Ever watched a TURP? It looks painful.

jessica: Extracting wisdom teeth...argh! How do you practice during your dental training? Presumably there is very little room for mistakes in dentistry.

10:58 pm  
Blogger Tym said...

This series of yours should be required reading for all those people who tumble into medical studies only because their parents want them to.

10:44 pm  
Blogger tscd said...

tym: I always try and discourage people who don't really want to study medicine. The last thing a patient needs is to be treated by a doctor who has no interest in what they do and is only concerned with image and money. Unhappy doctor = unhappy patient.

12:32 am  

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