MEDICAL MADNESS

Not all gods were Greeks; some were hatched in med school from ethereal eggs. How some doctors and surgeons view themselves compared with their peers and patients is of interest here because of the behavioral predictability it signifies. They now appear suspended precariously on a bungee cord of medical mythology, characterizing the professionals and profession, with an aura of veneration no longer accepted or relevant, and in modern society, bordering on the preposterous.
Some in the profession appear to have been foisted upon an awestruck public with the indication that they possessed nearly superhuman intelligence, superb performance skills, endurance, and brilliance, corresponding to infallibility and meriting total trustworthiness. The following example, offered by Dr. Paul Ruggieri in his autobiography, Confessions of a Surgeon, is revealing because it comes from a doctor’s own published exposé. He shares some of his early perceptions as he entered this field of service. His book then depicts important behavioral corollaries—not all commendable. As we shall see, what one believes may make a difference.
Doctors or Deities?
A biography can excavate kernels of truth in a way that may seldom surface otherwise. There exists a presumed commitment to full disclosure, based on a presumption of a measure of immunity from moral responsibility for consequences, similar to that disclosed in the ritual of a religious confessional. Here I quote the good doctor’s autobiography: I could see that surgeons were independent thinkers, relying only on themselves for success. Surgeons were gods. They also appeared to make a lot of money. I wanted to be a surgeon. . . . I was in awe of the surgical residents’ stamina and ability to function on very little sleep. . . . It was twenty-four hours on and twenty-four hours off in the emergency room for six weeks. . . . I dared not ask for help in evaluating someone; it would have been considered a sign of weakness. It was never a spoken rule, but showing weakness of any kind was out of the question. It wasn’t an option. Everyone who wanted to advance understood it.49
Their medical deity is dead. This irrationality has become a casualty of transparency. The curious, archaic mythical creature of the past must go the way of other mythologies that have long outlived their usefulness. The notion of patient insignificance and abject ignorance is obsolete. The new mantra must be “by patients, for patients,” which can resonate as a contribution long overdue in supporting the inevitable coming systemic changes from without and within.
Feet of Clay
Encouraging mortals to assume the attributes of gods will expose in hindsight a most unfortunate medical failing with far-reaching negative side effects. Most, in the final analysis, will be proven to have feet of clay. Operating with very little sleep, constrained by fatigue, bound by unspoken pretenses of omniscience, doctors put patients’ lives at risk and the psyches of physicians in question. Most everyone outside the medical profession and hopefully on the inside, despite the apparent attempt by some at brainwashing, really knows that. A medical culture endorsing doctors’ presumed infallibility, not permitting them to expunge ignorance with enlightenment as the situation demands, thus repeatedly jeopardizing patients, is beyond foolish. It is despicable. A mythical medical culture that behaves in ways that put our lives in danger is immoral and irrational. Maybe a four-letter word is called for: sick. Small wonder they have developed a reputation for burying their mistakes, the deification of the doctor notwithstanding. Killing the living to preserve an unspeakable code of honor is hardly a virtue and is in fact itself in urgent need of a somber requiem and burial.
Allow me to share one more revealing and sobering episode from Dr. Ruggieri’s disclosures as he embraces his philosophy of medicine: I laughed as I cut another hole in Jane’s intestine. “Why are you laughing, Paul?” Dr. Jenkins was puzzled. I laughed because it took less energy than crying. “Erin, I trained in a totally different era and I am not that old. There was never a limit on the number of hours I could work. There was never a clock to punch. On the contrary, it was a sign of strength to stay up as long as possible. Sure, after about a hundred hours, everything was a blur, but it was a character-building blur. It may not have been good for my patients then, but it is good for them now.”50
This concise narrative is a brief segment of a dialogue that took place at 3:00 a.m. as Dr. Ruggieri, the general surgeon, responded to an on-call summons. He needed to remove adhesions from the patient of a surgical gynecologist who had found the patient’s ovaries encased by the adhesions, which laced around the intestines and thus blocked the path of the gynecologist, preventing her from completing her planned surgical procedure.
A Character-Building Blur?
The surgeon recounts how he accidentally cut a half dozen holes in the patient’s intestine, requiring sutures, as he clumsily extracted the adhesions to prepare for the planned original surgery. One puzzling comment I must repeat: “It may not have been good for my patients then, but it is good for them now.” In other words, he has the audacity to say that his recounted historical experience was good for present patients as he mutilated the intestines of the patient he was called upon to assist! It was a learning experience. What is important here is the account of this sobering visit to the OR and noting the risk incurred by the patient in this horrific incident involving the dead tired, belligerent, and bizarre general surgeon.
Transparency was desperately needed there. The medical community often vigorously denies fatigue’s debilitating effects, which we will address later. How much permanent damage was inflicted? Did the patient survive? If so, was the patient ever told of the harm she suffered at his hands? Why didn’t the other surgeon put a stop to the surgery? These necessary questions speak volumes about the lack of accountability in our system. The account also raises serious questions about the surgeon’s touted “character building” training noted in his rambling monologue. What has this to do with character?, And how many innocent casualties are required? How many mistakes did he bury from those appalling learning experiences? What he has shown us in this snapshot does not speak well for the education and practice that produced it.