Posts Tagged ‘industrialization of medicine’

SERMON: “A Hominin in a Hospital” by the not-so-reverend bob

Sunday, February 27th, 2011

Sitting for hours in a hospital, with not much to do except wait for one’s turn on the semi-industrial human conveyor belt that is contemporary medicine, I considered my surroundings.

The animal in me was comforted a bit by the occasional appearance of a nurse, and the regular rise and fall of the conversation at the nearby nurse’s station (that nevertheless reminded me that I was laying mostly naked in someone’s workplace).

I considered the mastery of mining, smelting and manufacture that had produced the precisely-graded needle that was inserted into my wrist, and the skill and training of the nurse that had so smoothly inserted it into the correct vein (without thought, I suspect, of the history of medical discovery that gave us a real knowledge of the human circulatory system).

This mammal was not always the good patient.

I looked with admiration on the conscientious efforts humans had made toward making the entire setting appear clean, sanitary and properly austere.  Every tile, machine and curtain fitting had been designed and manufactured by some individual or group of humans.  Some intelligence had paid attention to every detail.  Someone had even decided that the muted, mostly blue zig-zag pattern on the curtains (partially drawn around my bed in their smooth aluminum tracks) was, well, pleasing to the eye.  (I at least appreciated their effort, if not the end result).

The gurney I spent many hours on was more comfortable than I expected…for the first thirty minutes I spent on it.  And I willingly slipped into the role of “Patient”, doing my best to be chipper and agreeable as I put on the uniform of gown, blue cap and booties, and then attempted to gargle the anesthetic gel the nurse squirted down my throat.  This was something new to me and, once again, I thought of the trial and error and science represented by the thick, cool goo that challenged me to consciously override my naturally-evolved gag reflex.

The fluid dripped, dripped, dripped into my IV tube, and I considered asking the nurse about the physics of that, of why my own pumping blood wasn’t gurgling back up that serpentine tube.  I didn’t, in the end, ask her, though I knew that she would likely have had a factual answer explaining the mechanics of the apparatus.  (Earlier, I’d talked evolutionary perspectives on medicine with the doctor that was going to be snaking tubes through both of my available openings for today’s diagnostic explorations).

As the hours ticked by I noticed that my brain was eagerly gathering information, trying to build a workable picture of my new environment (so better to predict events, I think).  My ears were acutely attuned, it seems, to pick out bits of conversation from the nurse’s station, or from conversations with the other patients docked, like me, in other beds.  I found out I was “number four” out of seven patients waiting for similar procedures, and that things were off to a slow start.  I was fed bits and pieces of encouraging information by my nurse, such as “as soon as this woman goes, we’ll start prepping you!”.  These turned out to be unreliable promises, motivated as much (I suspect) by a desire to be helpful as a desire to keep the confined natives from getting restless.

As the hours mounted and even these unreliable encouragements thinned to silence, I felt a rising agitation in me, somewhat akin to when the waiter completely ignores you in a restaurant.  At the same time, I began to think of the oddity of me, a healthy hominid, submitting himself to an invasive medical procedure that, though “routine”, nevertheless had to entail a certain risk.  Suddenly, I was no longer as willing as I had been to undergo it, and made a mental calculation that the weight of having spent two days preparing for a colonoscopy was not enough to push me forward into something I now saw as more of a risk than a potential benefit.

I made a decision, and called the nurse.  But before I did that I attempted to employ the detached, rational part of my brain, to see if it could cut through the flood of emotion pumping out from both my survival and social brain.  In short, I asked myself the question of how foolish I would be for making this “gut” decision.

Perhaps that’s an impossible question to answer in such moments.  I had some evidence on the side of refusing the procedure: I was asymptomatic; my doctor was fishing for a possible cause of my food allergies, perhaps using the excuse of a condition it was very unlikely I had (it could even have been a cover for getting me the procedure that is recommended for anyone at age fifty); even the doctor doing the procedure said I had none of the major symptoms of celiac disease (not now, and even before I had changed my diet many years ago); and, on top of it all, I had developed a rather strong sense that a hospital is a very uncomfortable place to be, and should I ever prove to be in need of serious hospitalization, I didn’t know how I would physically and emotionally stand it.

On this last point I felt very much the human animal: it was unnatural for me to lay around so passively when I was not physically injured.  I couldn’t imagine doing it for days and days.  I reflected positively on the options I had marked on my advanced directive the day before, and was wondering if I even needed (or wanted!) to know if anything bad was going on in my gut, and further whether I would want to submit to a hospital stay to fix it if there was!

I decided to refuse the procedure and get the hell out of there.

The nurse answered my call in a heartbeat, and I was promptly joined by another, both trying to talk me out of my decision.  I saw a hand patting my leg.  She said they were now ready for me, and I had to let them know whether they should take the next patient instead of me.  I gave her an unequivocal answer.  I had now only to wait for them to pull out my IV, and I would go outside and wait for my ride home to Las Cruces.

I felt better.  I was okay.

Then my anesthesiologist came in, saying they were ready for me, and began gently imploring me to go ahead and “get it over with”.  I hesitated.  Then I asked her “Are you really taking me RIGHT NOW?”.  “Yes”, she assured me.

So, I went.

After my nearly 8 hours of waiting, six of which were spent on a gurney prepped for transport, I was wheeled into a high ceiling room packed with enough machines to populate a science fiction film set the likes which I’d never seen.  Within a very few minutes I was in position, exchanging scatological jokes with the doctor and technicians, and then I was drugged and dreaming of images of colons and caverns and smart-ass remarks and suddenly awake back in the room I started in, feeling in a really, really, really good mood.

My anger and anxiety were obliterated by some really effective drugs, skillfully applied.  I felt fine.

The hell of the waiting was capped by a heavenly twist.  I had made it through and could look forward to home and food.

But the impressions of the day remained with me, and though I made some apologies for my “melt down”, I don’t know that I was wrong to feel the way I did.  I now understand that part of my decision to refuse the procedure was a reaction to the powerlessness I felt in a strange environment.  Every day, it seems, I see more and more evidence of just how profoundly a social primate I am, and this experience was no exception: though I willingly submitted to all that was required of me (to please, in this case, doctors, nurses and others who were there to “help” me), there was a natural limit to my passivity, and my own personality and needs were going to demand their due.

I was probably most correct when I said to the nurse “I’ve had too much time to THINK about it”.  Part of what I was thinking about was the “industrialization” of medicine.  So much about the system is dependent on our social willingness to submit to authority, and yet the system is geared, clearly, to two other things: one being the management of nature (in creating an artificially sterile environment); the other being the convenience of the conveyor belt that moves bodies through the system (sticking me with an IV at 9 in the morning for a 3pm procedure was more about keeping me from going nuts from hunger and getting even more agitated that for any medical reason).  The nurses were the ones left to manage the psychology of the patients, but they had no power to move things along (as it is, I have to give them credit for remaining as personable as they do in such an environment).

In the end, we’re not much different than the other animals, except that we don’t require a literal tranquilizer dart to submit to a dental exam.  We have the capacity to over-ride our natural survival instincts to gargle a gel that deadens the gag reflex, to lie still while a stranger puncture a major vein with a steel needle, to submit to anesthetic that renders us unconscious so another stranger can run a roto-rooter tube down our throats or, well…

Modern medicine is a mix of amazing technology and biology and medieval barbarism; of cold technology and human social grooming.  It is a testament to our rational brains telling us that we can be civil and trusting of humans we have never met before because of their uniforms and training that signal certain norms of competence among the wider population of our culture and civic institutions.  But we are still animals, with animal needs of safety and flexibility of action.

But I’ll be wondering for a while about just what constitutes the most acceptable balance between the raw knowledge that modern medicine can offer and the emotional and psychological needs of the human animal, and what we, as a society made up of those animals, should do about it.

t.n.s.r. bob