Rip Cord
Voluntarily killing a patient has crossed my mind. Not in the morbidly fascinating way you hope I confess to, but in the more mundane and hypothetical manner. Similar to the way parents could kill their kids for sneaking out, smoking pot, or having premarital sex. I am 31, and although nonfunctional for a few years during adolescence, my inhibitive neofrontal cortex has been serving me adequately for the past decade. But without it, there is no question I would have offed a couple of assholes by now.
The stressed out, grasping for straws cancer patient is not who I am talking about. After all, there are some patients who deserve to be cranky. Even a degree of belligerence is acceptable if the patient is old and senile, or has some other circumstance that causes pity. But there are people out there who make hospital workers hate them. Nothing is worse than hating patients - they make you question your reactions and wonder whether you have become insensitive to the needy.
When a coworker complains about a patient they can't stand, I just listen. I've been there - instead of helping the patient, you'd rather go crazy on their head with a nerf bat. The number one thing not to say is, "How can you be so insensitive? How would you feel in his shoes?" That kind of response only makes the "hater" feel worse. It's best to stay neutral.
The only time I have seen a physical act of anger or hate directed at a patient was from a man everybody knows and likes, so the OR team didn't say a thing when Dr. Perseid pulled a patient's NG tube with enough force to start a lawn mower.
The patient was an addict. I think alcohol was his soup du jour that morning since he smelled like it, but in hindsight there was probably more onboard. We had just done an exploratory laparotomy (abdominal surgery) on what appeared to be a chronic etoh abuser at 2 in the morning. Most of us had worked a full day prior to getting called in for this emergent case, and we were in a sleepy state of grump. The patient was a hostile, accusatory jerk when the anesthesiologist put him to sleep. A typical functional alcoholic. Besides the name calling and complaining, he threatened everyone with lawyers. Nobody in healthcare likes that.
Dr. Perseid, the anesthesiologist, was having a hard time waking the patient up after the case due to the various nonmedical drugs in him, and was a little frustrated to start. Abusers are typically a headache for anesthesia due to their drug tolerances and interactions. This guy was no different. Right when he opened his eyes, both his hands went up to pull his NG tube out.
A Naso-Gastric tube is a little rubber hose that is inserted into the nose and rounds the back of your throat to descend into the esophagus and stomach. It's placed on suction and used to empty the liquid and air from the upper GI for a variety of reasons. In this case the tube was to be left in during recovery, but to remove it, a steady pull is necessary - taking too long is uncomfortable for the patient, while too fast is probably a little painful.
On par with a typical addict, he woke up fast and lucid. The foreign object sticking out of his nose was not appreciated, so the patient thought he would remove it. Dr. Perseid is a big man, and he instantly grabbed both the patients' wrists as I and a nurse pried his fingers off the tube. All the while we were yelling at the patient to stop. He relaxed his arms and let go. So we let go. Dr. Perseid was explaining why he needed it to stay in, when his hands shot up a second time and grabbed for his nose. This time we were ready, and I had one wrist and the nurse had the other. He cursed us all to hell and back.
While we held his straining arms, Dr. Perseid tended the anesthesia machines and monitors, explaining to the patient why he needs the tube in. The patient nodded and appeared calm. He slowly relaxed his arms, and we slowly relaxed our grips. He said he wanted a damn drink, cursed us all to hell again, and suddenly grabbed for his nose a third time.
This one caught us off guard, and a wrestling match ensued on the OR table with the patient realizing it was his will against ours. We were entering the realm of "patient rights", where an apparently lucid patient was denying medical care "AMA". This means Against Medical Advice. It was Dr. Perseid's call to determine whether or not the patient was mentally competent to make decisions for himself. It was a gray area since the patient was A, still drunk and B, still under the effects of anesthesia.
Everyone in the room was yelling at the patient and the patient was yelling and cursing at us. The patient became wild, and the OR tech, still in sterile gown and wrapping up his instruments, had to jump on the patient's kicking legs since they broke from the velcro safety straps. We managed to pry his dirty sharp fingernails off the little NG tube and hold his arms when the patient used us to lift his upper body off the OR table. Dr. Perseid pushed down on his shoulders with what looked like all his force. Maintaining him in this position, he again explained in a forced monotone voice how it was to the patient's benefit to keep the NG tube in place. Again, the patient started nodding and even smiling.
I remember thinking we should get the canvas bed restraint cuffs for the patient as I let go of his limp right arm. The patient began making conversation with the staff, muttering insults and other disparaging remarks.
The last words I heard him say were, "You'll can't tell me what to do!"
For the fourth and final time, he went for the tube. We went for his wrists, the tech held his legs, and Dr. Perseid yelled,
"YOU WANT THE TUBE OUT? FINE!!"
He placed his left hand on the patient's forehead, and grabbed the NG tube with his right. And pulled. The hose elongated under the force as it was literally whipped out of the patient's face in a split second. Liquid splattered the OR lights and ceiling, and Dr. Perseid just stood there trembling, holding the two foot long rubber hose at his side. The tightly closed lips and the look in his eyes suggested insane victory.
The action had an opposite effect on everyone else in the room. The faces of my coworkers suggested frightened surprise. I think the patient's face was probably similar, but because we had let go of his arms, he was now covering his nose and mouth. I will never forget his eyes. What were previously half closed, shifty little beads, always scanning the room for moments of deception and rebellion, were now as wide as dinner plates. Genuine shock and fear were in those eyes, and from that moment on, not a peep was heard from the man.
Dr. Perseid mumbled something about "not needing the damn tube anyway", and sheepishly turned to his ventilator and monitors. The rest of us slowly turned and went about our work without making eye contact with one another. We definitely didn't look in the patient's eyes again. It was one of those occurrences which simply didn't happen. No one said a word about it to one another after the case and as far as I know, nobody complained about Dr. Perseid, including the patient.
It's without question that what Dr. Perseid did was wrong, yet at 3 in the morning, bone tired and full of resentment, part of me was glad he did it. It certainly shut the patient up in a hurry. Yet I call my ethical code into question when I recollect that emotionally ambiguous incident. To this day I wrestle with the terrible yet satisfying memory of seeing that asshole get what he asked for. I'm just glad I wasn't the one to do it. Dr. Perseid isn't so lucky, however, and will always remember that embarrassing lack of control.
It's easy for you to say that because he was wrong, he now deserves the guilt, but Dr. Perseid is not a stranger to me. He is a relief to see in the room during a difficult case, and would be among my top choices should I need anesthesia. His level of professionalism is higher than most doctors, and his easygoing humor lightens up a stressful OR. Interestingly, he is a double purple heart recipient and his military unit was recently depicted in a Hollywood war movie for its bravery and skill. Simply put, he is one of the hospital's best anesthesiologists.
But despite these attributes, Dr. Perseid has his buttons. And on that morning they were pushed. We all have our buttons and our limits, and the patients who seek to push them are hated for it. No one ever wants to feel like they shouldn't be doing their jobs, especially when pointed out by an asshole.
This incident happened a while ago, and he's never brought it up with me. He's embarrassed by it, although in my opinion, he shouldn't be. I used a little sarcastic medical humor to let him know I didn't hold it against him; about a month later, I told him that while perusing through some journal articles, I stumbled across a method of subduing a belligerent patient with an NG tube, known as the "Perseid Maneuver". He just laughed and rolled his eyes.
Let it be known, however, that I would not have made that off-color crack if I actually had an NG tube sticking out of my nose. Lord knows the man has his buttons.
The stressed out, grasping for straws cancer patient is not who I am talking about. After all, there are some patients who deserve to be cranky. Even a degree of belligerence is acceptable if the patient is old and senile, or has some other circumstance that causes pity. But there are people out there who make hospital workers hate them. Nothing is worse than hating patients - they make you question your reactions and wonder whether you have become insensitive to the needy.
When a coworker complains about a patient they can't stand, I just listen. I've been there - instead of helping the patient, you'd rather go crazy on their head with a nerf bat. The number one thing not to say is, "How can you be so insensitive? How would you feel in his shoes?" That kind of response only makes the "hater" feel worse. It's best to stay neutral.
The only time I have seen a physical act of anger or hate directed at a patient was from a man everybody knows and likes, so the OR team didn't say a thing when Dr. Perseid pulled a patient's NG tube with enough force to start a lawn mower.
The patient was an addict. I think alcohol was his soup du jour that morning since he smelled like it, but in hindsight there was probably more onboard. We had just done an exploratory laparotomy (abdominal surgery) on what appeared to be a chronic etoh abuser at 2 in the morning. Most of us had worked a full day prior to getting called in for this emergent case, and we were in a sleepy state of grump. The patient was a hostile, accusatory jerk when the anesthesiologist put him to sleep. A typical functional alcoholic. Besides the name calling and complaining, he threatened everyone with lawyers. Nobody in healthcare likes that.
Dr. Perseid, the anesthesiologist, was having a hard time waking the patient up after the case due to the various nonmedical drugs in him, and was a little frustrated to start. Abusers are typically a headache for anesthesia due to their drug tolerances and interactions. This guy was no different. Right when he opened his eyes, both his hands went up to pull his NG tube out.
A Naso-Gastric tube is a little rubber hose that is inserted into the nose and rounds the back of your throat to descend into the esophagus and stomach. It's placed on suction and used to empty the liquid and air from the upper GI for a variety of reasons. In this case the tube was to be left in during recovery, but to remove it, a steady pull is necessary - taking too long is uncomfortable for the patient, while too fast is probably a little painful.
On par with a typical addict, he woke up fast and lucid. The foreign object sticking out of his nose was not appreciated, so the patient thought he would remove it. Dr. Perseid is a big man, and he instantly grabbed both the patients' wrists as I and a nurse pried his fingers off the tube. All the while we were yelling at the patient to stop. He relaxed his arms and let go. So we let go. Dr. Perseid was explaining why he needed it to stay in, when his hands shot up a second time and grabbed for his nose. This time we were ready, and I had one wrist and the nurse had the other. He cursed us all to hell and back.
While we held his straining arms, Dr. Perseid tended the anesthesia machines and monitors, explaining to the patient why he needs the tube in. The patient nodded and appeared calm. He slowly relaxed his arms, and we slowly relaxed our grips. He said he wanted a damn drink, cursed us all to hell again, and suddenly grabbed for his nose a third time.
This one caught us off guard, and a wrestling match ensued on the OR table with the patient realizing it was his will against ours. We were entering the realm of "patient rights", where an apparently lucid patient was denying medical care "AMA". This means Against Medical Advice. It was Dr. Perseid's call to determine whether or not the patient was mentally competent to make decisions for himself. It was a gray area since the patient was A, still drunk and B, still under the effects of anesthesia.
Everyone in the room was yelling at the patient and the patient was yelling and cursing at us. The patient became wild, and the OR tech, still in sterile gown and wrapping up his instruments, had to jump on the patient's kicking legs since they broke from the velcro safety straps. We managed to pry his dirty sharp fingernails off the little NG tube and hold his arms when the patient used us to lift his upper body off the OR table. Dr. Perseid pushed down on his shoulders with what looked like all his force. Maintaining him in this position, he again explained in a forced monotone voice how it was to the patient's benefit to keep the NG tube in place. Again, the patient started nodding and even smiling.
I remember thinking we should get the canvas bed restraint cuffs for the patient as I let go of his limp right arm. The patient began making conversation with the staff, muttering insults and other disparaging remarks.
The last words I heard him say were, "You'll can't tell me what to do!"
For the fourth and final time, he went for the tube. We went for his wrists, the tech held his legs, and Dr. Perseid yelled,
"YOU WANT THE TUBE OUT? FINE!!"
He placed his left hand on the patient's forehead, and grabbed the NG tube with his right. And pulled. The hose elongated under the force as it was literally whipped out of the patient's face in a split second. Liquid splattered the OR lights and ceiling, and Dr. Perseid just stood there trembling, holding the two foot long rubber hose at his side. The tightly closed lips and the look in his eyes suggested insane victory.
The action had an opposite effect on everyone else in the room. The faces of my coworkers suggested frightened surprise. I think the patient's face was probably similar, but because we had let go of his arms, he was now covering his nose and mouth. I will never forget his eyes. What were previously half closed, shifty little beads, always scanning the room for moments of deception and rebellion, were now as wide as dinner plates. Genuine shock and fear were in those eyes, and from that moment on, not a peep was heard from the man.
Dr. Perseid mumbled something about "not needing the damn tube anyway", and sheepishly turned to his ventilator and monitors. The rest of us slowly turned and went about our work without making eye contact with one another. We definitely didn't look in the patient's eyes again. It was one of those occurrences which simply didn't happen. No one said a word about it to one another after the case and as far as I know, nobody complained about Dr. Perseid, including the patient.
It's without question that what Dr. Perseid did was wrong, yet at 3 in the morning, bone tired and full of resentment, part of me was glad he did it. It certainly shut the patient up in a hurry. Yet I call my ethical code into question when I recollect that emotionally ambiguous incident. To this day I wrestle with the terrible yet satisfying memory of seeing that asshole get what he asked for. I'm just glad I wasn't the one to do it. Dr. Perseid isn't so lucky, however, and will always remember that embarrassing lack of control.
It's easy for you to say that because he was wrong, he now deserves the guilt, but Dr. Perseid is not a stranger to me. He is a relief to see in the room during a difficult case, and would be among my top choices should I need anesthesia. His level of professionalism is higher than most doctors, and his easygoing humor lightens up a stressful OR. Interestingly, he is a double purple heart recipient and his military unit was recently depicted in a Hollywood war movie for its bravery and skill. Simply put, he is one of the hospital's best anesthesiologists.
But despite these attributes, Dr. Perseid has his buttons. And on that morning they were pushed. We all have our buttons and our limits, and the patients who seek to push them are hated for it. No one ever wants to feel like they shouldn't be doing their jobs, especially when pointed out by an asshole.
This incident happened a while ago, and he's never brought it up with me. He's embarrassed by it, although in my opinion, he shouldn't be. I used a little sarcastic medical humor to let him know I didn't hold it against him; about a month later, I told him that while perusing through some journal articles, I stumbled across a method of subduing a belligerent patient with an NG tube, known as the "Perseid Maneuver". He just laughed and rolled his eyes.
Let it be known, however, that I would not have made that off-color crack if I actually had an NG tube sticking out of my nose. Lord knows the man has his buttons.
posted by All Rounder | 12:59 AM
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