Friday, October 31, 2008

Of pens and patients

Harold J. Wilson would make fun of my banality, but I'm continually amazed by how impersonal medicine is. And it's not like I'm expecting a B&B with chintz and ricotta pancakes. Josh (get well and get that sunscreen, buddy) offers a good rundown of the procedure experience here:
Another waiting room. 
Another long wait.
Another day fasting.
Another nurse with another medical history survey and a list of the same questions as I lay on a pre-op bed.
Another chance to teach a medical intern our history.
Another poke with a needle for another blood draw and IV.
Another time saying goodbye to Kim before going into another cold operating room.
Another set of vitals appearing on a monitor then shifting from one bed to the operating table, more faceless people behind surgical masks and doctors I don’t meet.
The patient's experience immediately before a procedure is an odd combination of being the center of attention and yet feeling almost completely irrelevant. (Is this how John McCain feels when he appears at a rally with Sarah Palin?) There are folks milling around chatting with each other and setting up the equipment, but usually only one of them is, at any given time, actually paying attention to you. As Josh points out, you sometimes find out who some of these people are only when you get the explanation of benefits from the insurance company. Weird stuff. Even weirder: Before one little ditty at Sloan-Kettering, my doctor was holed up in a corner feverishly checking his e-mail until about a millisecond before the anesthesiologist knocked me out.

For some reason, thinking about the ways that medicine can feel crude and inhuman made me think of pens -- specifically, ball point pens and Sharpies. It's often good practice for a doctor to write on a patient's body -- "amputate here," "x marks the spot," whatever -- and to do so, they typically use a regular pen. I would have thought there would be some special super-duper medical marking pen (and, in fact, there are), but the only thing anyone has ever written on me with was a Sharpie. 

Except once. 

When I was getting a lymph node biopsy, the guy doing the procedure (an inexperienced specialist your hospital gives gravitas to with the title "fellow") was having a lot of trouble finding the nodes with his ultrasound, so the big dog doc ambled in to set him straight. When he homed in, he reached into his pocket and pulled out a ball-point pen to mark their location and the needle insertion angle at one of the tenderest points of my inner thighs. Two observations: 1) A ball point pen doesn't write very well on flesh. Takes a lot of pressure; 2) The distinguishing feature of such a pen, as denoted by its name, is point.  As little T. would say, "Owwie."

I thought of this after reading this story investigating the possibility of germ transmission by hospital Sharpie pens. It turns out that they do not hold bacteria while the fancy, medical-specific pens do (both are supposed to be discarded after one use anyway). Score one for crudity, I guess. Maybe even score two: One sad aspect of the biopsy story just occurred to me. Even though I resented the oblivious scratchings of the ball-point-toting big doc, after 45 or more stressful minutes on the table while the young dude futzed around, I was pathetically grateful for his decisiveness.

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