“A few moments later, the anesthesiologist walks in the room and asks, ‘What do you got?’ Dr. Canby says, ‘Vaginal delivery. Uterine atony. External massage failed. Give her some ketamine.’”…I look at Mrs. Lopez—her eyes are half-closed and vacant. Dr. Canby instructs me to hold her knee. A fellow medical student holds her other knee….Canby then performs an internal bimanual uterine massage. He places his left hand inside her vagina, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That’s what I like. A nice, tight uterus.’ And the bleeding stops. The guy saved her life…But then something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.’ It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ And we stop.”
This is an operating room anecdote related in an anonymously authored article published this week in the Annals of Internal Medicine, a respected medical journal. The publication says that the piece is intended to shine light in a dark corner of the medical profession. Oh-oh. The essay is anonymous, I assume, because the author is afraid that there would be professional repercussions from his revealing this—what? Bad habit? Dirty secret? Crime? Reason for us to go stark, raving mad?
Dr. Christine Laine, the journal’s editor-in-chief, has said that idea of publishing the essay in the first place was controversial enough to have sparked a contentious debate among the journal’s editorial team. “We all agreed that the piece was disgusting and scandalous and could damage the profession’s reputation,” Laine and the editorial staff wrote in an editorial accompanying the piece. “Some believed that this was reason not to publish the story. Others believed that it was precisely why we should publish it.”
“This was obviously an extreme example,” Laine said in an interview. “It’s not common, but even if it only happens rarely, that’s too often. Our main motivation in publishing it was to prompt discussion. We didn’t want the journal to stuff this behavior under the rug.”
Wait…how do we know “it’s not common”?
This has certainly been a slowly unfolding ethics scandal. For decades there have been jokes, rumors and paranoia about doctors and nurses mocking or otherwise abusing unconscious and defenseless—and trusting—patients. From “The Simpsons”:
Nurse: Oh boy, what a mug!
Surgeon: Yea, you should see his genitals, would you like to see his genitals?
The Patient (Moe): I’m awake here!
In 2014, a doctor took a selfie with Joan Rivers while she was under anesthesia for what turned into a fatal endoscopy scheduled with a different doctor. In April of this year, I wrote about the Washington Post op-ed by a nurse who used serial rationalizations to defend such conduct, arguing that the ridicule acts to “rejuvenate [the medical personnel] and bond them to their teams, while helping to produce high-quality work. In other words, the benefits to the staff — and to the patients they heal — outweigh occasional wounded feelings.” In June, we discussed a Virginia case where a jury awarded $500,000 to a patient who accidentally recorded the verbal abuse he was subjected to while anesthetized for a colonoscopy. Now this.
I suspect such incidents are not as rare as we would like to think. I suspect that the medical profession has exploited its prestige, power and arrogance to allow an ugly practice to infect its culture, and that it will take a lot more than an anonymous medical journal article to purge it. This is a breach of trust and professionalism that violates medical ethics at their source. Quoth the relevant section of the ancient Hippocratic Oath...
“Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.”
Where’s that part that adds, “unless it’s a really funny gag, I’m compensating for my anxiety or if it rejuvenates the medical team”?
Laine argues that her journal aspires “to generate discussion that will empower people to stand up to colleagues when they see colleagues acting in a disrespectful manner toward patients.” Sorry, I don’t care to trust doctors and nurses to do that at this point, though of course their doing so is part of the remedy. Still, it is only part. I am unaware of such conduct ever being reported to authorities as a serious ethics breach, or of medical professionals being disciplined for it as a result of collegial reporting. It wasn’t reported in the instances related by the article, and the author wasn’t anonymous because he’s shy.
First, let’s have video cameras running every time a patient is unconscious and at the mercy of these merry pranksters with God complexes.
Then we can wait for the medical profession to clean up its culture and its ethics without fearing being made into puppets, props and victims in the operating room.
Pointer and Source: IBT
Graphic: Very Funny Pics
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