Friday, 20 July 2007

Communication, or lack of it

To illustrate a point, I am reproducing part of one of Papillon's earlier posts (the one where she meets Dr Icecube), with a comment from a later post, taking her to task for something she didn't say, and her reply, which does miss a point made by Guardian Angel.

I spent exactly 7 minutes with Dr Ice-cube. 7 minutes opposite an iceberg who started by taking my blood pressure in a heavy silence. Then he asked me some questions with an uncommunicative face (what medicines do I take? Do I have any allergies? Have I had previous operations?) He then examined the results of my blood tests, and told me everything was all right. Then he delivered a rambling speech in a rapid voice, explaining to me that I wouldn’t be intubated, but I would have oxygen from a mask, that I would be asleep for approximately an hour and a half.

Completely without a glimmer of sympathy, Dr Cold told me I would have to be fasting from midnight from the evening before the operation. He didn’t tell me but I read in the information leaflet that fasting eliminates the risk of suffocating from untimely vomiting. He also said not to take any aspirin.

He got his breath back and asked me, while filling in the patient consent form for the anaesthetic, if I had any questions.

I asked him what the sedative was for which is given before the anaesthetics. He explained that the sedative helped reduce my nervousness, natural when faced with surgery, and so to help the anaesthesia. I also asked about waking up, I wanted to know if I would feel dopey. He answered no, that I would wake up as if after a night’s sleep. If I take the prescribed medicines, he told me, I will feel no pain. I spoke to him about my patch and he assured me I could keep it when I enter the clinic.

7 minutes went by this way and he took me back to the secretary. I paid 28 euros, 4 euros per minute, for this rather frosty anaesthesia consultation. I was a little irritated. Not because of the price, no, because of Dr Snow’s temperature.

So, all right, kindness, human warmth and sympathy aren’t rights, nobody is obliged to be warm and kind (although for the medical professions that's debatable) but all the same, the coldness of the anaesthetist troubled me, if not annoyed me. And then to have been dispatched in seven minutes, that downright worried me. I reassured myself as well as I could by telling myself that I must be a commonplace and trivial case, but above all the fact that I know Dr Fold├Ęs will be there and that I am his patient and not Dr Iceberg's calms my distress.

This was commented on weeks later by a nurse who, I have a strong suspicion, knows the character involved.

Mr FOLDES is a pioneer in your reconstruction and those of all the other victims. Thanks to him and to the anaesthetist.

I am an anaesthetic nurse and so an assistant to Drs Snow, Icecube, DontGiveaDamn…

Without them, the operation would have traumatised you a second time. Happily, anaesthesia exists. Those who practice it are on the road to extinction. This speciality doesn’t appeal to young medical students. It’s not a game of poker where you have to pretend with a mischievous expression, or a half smile. It’s a matter of putting you asleep and waking you. It seems so simple.

Alas it’s far from that.

It's very challenging practicing this profession, very stressful, very demanding. Like the surgeon when he repairs you with his hands. The anaesthetist has a consultation with you for two minutes to see you. That's true. Your face, your neck, your general silhouette, your veins,... are warning indicators or signs for the progress of the anaesthetic. He can't tell you compassionately that everything will go well, knowing that zero risk of accident doesn't exist. Lowered eyes, writing, aren't signs of indifference but of concentration.

An anaesthetist who has just lost his mother after a long illness, or his son after a motorcycle accident, will be on duty for a consultation, for an expert look, or to watch for a problem for an emergency cesarean, to resuscitate the mother or the baby. This anaesthetist is a human being who has weaknesses, pain, tiredness... he won't tell you, he takes it upon himself and looks after you.

The consultation lasted two minutes for you, ten minutes for another patient. He has seen ten patients while one other consultant will have seen only five patients. It is public service which is larger and larger, and less and less recognised.

Waking up is a matter of a miracle in the face of the shortage of nursing staff.

I am subject to confidentiality but freely attacking anaesthetists makes me fly off the handle.

I hope you continue well.

Signed: A guardian angel who is at your disposal.

And Papillon's reply:

Dear guardian angel, far from challenging anaesthesia,I asked myself about the question (I was regretting not "being there" during my operation) and from my thoughts it emerged that it was without doubt good for me to have a general anaesthetic.

A large part of the psychological trauma from circumcision comes from the fact that it's done while conscious. So you can well imagine that I am not going to militate against anaesthesia. On the contrary, in view of my feeble resistance to pain, I am very happy that it exists and that there are (still) specialists who practice this discipline.

It wasn't the profession I was criticising here, but a man. Who happened to be an anaesthetist but could have been the surgeon or the nurse who met me on my arrival at the clinic. I found this man cold and distant. And that annoyed me.

There are surely warm-hearted anaesthetists, as there are no doubt surgeons and gynaecologists who are cold as ice. Equally, there are no doubt patients who are relieved that the consultation lasts only two minutes, as there are no doubt others who aren't reassured after a quarter of an hour.

I am not generalising, dear guardian angel, and I am not attacking all anaesthetists gratuitously. I'm talking about what I felt when I met that man, that day, and at that time.

The nurse appears to miss the point that Papillon was trying to make totally and then introduces all sorts of other questions, but Papillon also overlooks the fact that the anaesthetist may have had some personal issues which turned it into a bad day. Not that he appeared to be any warmer on the day of the operation.

There are other parts I thought interesting. France is often held up to be a great example of how a health service should be, but how many British people would like to be paying for each consultation as it comes? Yes you can claim the money back, but not always all of it unless you have extra insurance, and it often takes quite a while to turn up. And they appear to have staff shortages too.

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