Who Cares About The
Patient?
Daily Observer
S.Q.
Lapius came home, said not a word, closed his smoking
jacket, and stretched himself full length on the oversized divan.
He
fondled a cigar, and occasionally blew a plume of smoke at the ceiling. From my vantage point on the rocker, he
partially obstructed my view of his aquarium, and against that background he
looked like a whale that had surfaced to blow his spout.
“Clearly
you are upset,” I said.
“As
a matter of fact, Harry, I am. Something
happened to me today that never before have I encountered in my extended
medical career.” Then he lapsed into a
long silence purposely calculated to whet my curiosity. I decided not to pamper him, and returned to
my reading.
Finally
he said, “You’ll never guess what happened.”
“I
don’t intend to,” I murmured, pretending to be engrossed.
After
another prolonged silence, he spewed it out, like an infant ridding itself of a
mouthful of oatmeal.
“The
nursing department made out an incident report about me, can you imagine such a
thing?”
“It’s
the new look in medicine, Simon. You
will have to get used to it.”
Lapius because of his vaunted position, as sort of a dean
of the medical staff was unaccustomed to the new informality, to the breakdown
in hospital discipline. He was slow to
accept the new egalitarianism.
“Why
did they make out the incident report, Simon?
Did you fail to stand up and snap to attention when a nurse approached
you?”
“Nothing
quite as serious as that Harry. After
all a breach of etiquette of that magnitude would be grounds for summary court
martial, or whatever the hospital equivalent is. No, no, my boy. The incident report was for a lesser
offense. Do you remember that old lady
with the rectal abscess that I hospitalized recently? She was about 80 years old, and in a lot of
pain.”
“I
had incised the abscess in my office, but it was quite deep and surgical intervention
was indicated. I hospitalized her and
referred the case to one of the proctologists.”
I
riffed through my memory of the by-laws, and came up empty handed. “So far I can’t see that you have broken any
of the hospital rules, Simon. Surely there
must be more to the story.”
“Surely
there is my boy. She was scheduled for
surgery. However, the night before,
while I was making rounds, she appeared to be in excruciating pain. I inspected the area and found that the
abscess had closed over and was bulging again.
I asked the nurse for a scalpel blade and pierced the area, releasing
about eight ounces of pus.”
“So
far so good,” I noted. “That must have
relieved her considerably.”
“That’s
it,” he said.
“What’s
it?”
“Opening
the abscess. Believe it or not, the
nursing supervisor who happened to be on the floor at the time made an incident
report noting that I committed two breaches of the hospital’s administrative
law.”
“Let
me guess,” I interrupted, “You soiled the linen and kicked over the urinal.”
“I
did neither, Harry. The two items were
that first, I had performed a surgical procedure, which apparently is only to
be done by a member of the surgical department; second, I had performed an
operation without the written consent of the patient. It really created quite a stir. The chief of surgery took me aside and
suggested that the next time this happened I could be hailed before the
whatever committee; and the administrator of the hospital tried patiently to
explain to me that I had put the hospital in a vulnerable position legally by
operating without written consent. He
told me that such an oversight could embarrass the hospital in court.”
“What
the deuce did you do? Take out her
gallbladder?” I asked.
“I
merely pierced a bulging abscess with a sharp instrument. As a matter of fact I am nonplussed. Every day technicians and nurses thrust a
needle into patients to either give or take blood.”
“Technicians
and nurses operate on a higher plane than doctors,” I explained. “Thus they are immune to liabilities that
affect us ordinary mortals who had the misfortune to go to medical school.”
“Joke
about it if you like, Harry, but I was treated to lecture after lecture about
how I had placed the hospital in a vulnerable position, but not once, during
this insipid affair, did anyone ask whether the patient had been relieved of
pain. Instead they emphasized that I
should have called a surgeon, had the patient taken to the operating room, etc.
etc. We are sacrificing ourselves as
individuals in order to save our institutions.
No one seemed to care whether the patient lay in pain for two hours or
eight hours, as long as none of the rules or codes were broken. By God, I was brought up under the dictum,
‘to help, or at least do no harm. Primum non nocere.’”
“That’s
all changed now, Simon. The first dictum
now, is ‘watch out for No. 1. A lawyer
may be lurking in the background.’”