On the Wrong Side of the
Scalpel: The Doctor as Patient

By

Leonard Zwelling

         Many books and articles have been written by doctors who get
sick. They each describe the experience of illness from the other side of the
stethoscope. Being on the other side of the scalpel is a bit worse. It really
does hurt more and for an internist, I always feel somewhat out of my element
on a surgical in-patient floor.

         Thus, it was with great trepidation that I entered Memorial
Hermann Hospital on Tuesday December 9 to get a large abdominal hernia
repaired. It appears to have been a result of the large hole made in my chest
12 years before to rearrange the blood flow to my heart muscle. That was no fun
either.

         Hermann
is like most hospitals nowadays. There is an electronic medical record, but it
is home grown. I cannot really tell who of the staff assigned to me is supposed
to do what. There’s a nurse, a patient care assistant, assorted orderlies and
of course, once a day, doctors.

         This is a very painful operation from which to recover.
There is a whole lot of fascia and muscle that needs to be moved to cover some holes
and strengthen the support for the underlying bowel. Mesh also needs to be
inserted for support. It sounds like it went fine, but was a far larger
operation than was anticipated. It was thus longer and I am thus sorer.

         The anesthesiologists now are miracle workers. I didn’t even
make it to the propofol in a conscious state as they had me at the Vercid. I
woke up clear with all extremities moving, my number one concern always and the
pain made me know I was alive. I never take this for granted when I enter an
operating room, although I have had pretty good luck so far as I am 11 and 0 on
that score.

         What did I learn from this experience?

         If I needed to be reminded of my mortality, this was an
effective way to do so. I even pulled out the folders with my will and funeral
instructions in them and left them in a prominent place for Genie to find. I
was taking no chances.

         Without the tumult of having a regular job, I spent the two
weeks between the decision of going to surgery and December 9 appreciating my
life, my friends, my family and those things that I truly love: my wife, my
music, my golf and my writing. I practiced dying. Why the hell not?

         But by practicing dying, I actually was practicing living
because I took in as much of the things I treasure knowing that they might be
gone, Many might call that morbid or fatalistic. I think it is realistic.

         We are not guaranteed tomorrow. We know this intellectually
but rarely in our gut. When we face a major medical procedure, death becomes a
reality. After all, you are depending on error-prone humans using toxic gases
and sharp instruments to put you back together again and that does not always
work. So far, so good.

         This little adventure was just practice for the Big Game
that may occur at any minute. I am glad the green hospital gown was not the
last thing I ever wore. That is no fashion statement.

         Being on the other side of the scalpel is both frightening
and humbling. I was very fortunate so far as things appeared to have gone well
for now. If I am lucky, I will get a few more cracks at practicing dying before
I make it to the Big Show. I am in no rush. But I am not in control either.

         One of my major points in my talk about health care reform
is that Americans behave as if they are never going to age or die. Old age is
thought of as an unproductive time of life, yet nothing could be further from
the truth. People can be creative at all times in their lives and what you lose in
reaction time you gain in wisdom when you age and I would not trade one for the
other even if I could.

         It is time to teach our children how to eat, cook, shop,
have safe sex and not use drugs or alcohol and to do so starting in kindergarten.
We also need to tell them that they are going to age and to die. There are many
millions of health care dollars keeping people alive in hospitals and ICUs who
will never recover any meaningful function because they didn’t have that
function when they were admitted to the ICU.

         Death is inevitable. Medicine fights against this
inevitability with all its knowledge and might. Yet, we lose every time.
Nothing gets this all in perspective better than a little trip to the OR on the
wrong side of the scalpel. Please consider this when you see that next patient.
He or she never wanted to be there, but you can make a difference in their
lives with honesty, integrity and caring. It’s what you would want when you
inevitably switch places from the person in the white coat to the one in the
green gown.

Leonard Zwelling