Another tactic we often use to help us cope better is disengagement. We separate ourselves from some of the inherently distasteful things we’re required to do every day by mentally stepping back and viewing our actions from a distance. I'm not sure whether the process is partially under conscious control or if it's completely subliminal, but either way it’s a nifty trick. It doesn’t work perfectly every time, though. Once in a while I’ll be poised to begin a procedure when it will suddenly occur to me that my mind hasn’t yet slid into its neutral “physician mode.” In other words, the non-medical part of my cerebral cortex hasn’t politely stepped aside to let the Vulcan take over. Worse yet, occasionally the veil lifts right when I’m smack dab in the middle of something. When this happens I become a doctor with John Q. Citizen’s viewpoint. This has the effect of transiently turning my perspective on what I’m doing inside out, which can lead to some jarring observations. For example, when the biopsy scalpel I’m wielding punctures my patient’s skin and rivulets of blood start to flow, every now and then I think Holy crap! I just cut this guy with a scalpel! What’s that all about?
Sometimes this parallactic view makes me consider other procedures in my therapeutic repertoire in an entirely different light:
Rapid sequence intubations – I give critically ill patients drugs that completely paralyze every voluntary muscle in their body. I then glide a plastic ET tube past their inert vocal cords in order to manually take over the process of breathing for them. If I can’t get the tube in, their risk of a bad outcome increases exponentially. Zoinks!
Chest tube insertion – I dissect the chest wall of a conscious person down to the level of the lining of the lungs, then stuff a tube the size of a garden hose into their pleural space in order to drain air, blood or pus. Seriously?
Neonatal resuscitation – I try to insufflate life into floppy, blue newborns. Did I really sign up for this?
Lumbar punctures – I slide a four-inch needle between two of the lower lumbar vertebrae in order to obtain a sample of cerebrospinal fluid for laboratory analysis. Just think of it as the human equivalent of maple syrup tapping… .
Central lines – I insert sasquatch-sized IVs into people’s necks for better venous access. Ack!
Corneal foreign body removals – I use needles and spinning brushes to scrape fragments of metal and other embedded objects off the surface of patients’ eyes. Hold still now… .
Assisting at laparotomies – I help the surgeon open someone up and exteriorize their guts for inspection and repair. Are you kidding me?
Prostate exams – I…whaaat? Let’s not even go there!
Fortunately, these unexpected episodes of viewing things through non-medical eyes are so short-lived, they’re almost stillborn. Their evanescent nature allows me to quickly return to the strange realm of Asclepius where things that would under normal circumstances be considered outrageous are, for now, perfectly acceptable. I believe this mental sleight of hand is one of the Jedi mind tricks that allow us to perform unpleasant procedures without becoming overwhelmed by them. I also suspect it may help prevent us from getting hopelessly mired in an endless loop of recursive thoughts.
But then again, what the hell do I know?
Sometimes the Voices Are Real… .
Last Tuesday my morning office went into double overtime. When it finally wrapped up I went to the hospital to see some inpatients. My rounds there finished at 1:25. My afternoon office was scheduled to begin at 1:30, so I decided to skip lunch. Unfortunately, within a minute of making that decision I was feeling so wretched I could hardly stand myself. For those of you who don’t know me, just ask Jan - nobody does pathetic like I do. I hopped in my car and drove to Tim Hortons with visions of a chicken salad sandwich dancing in my head.
As I pulled onto the far end of the lot I happily noted there were no cars in the drive-through lane. What fabulous luck! I was cruising towards the microphone when suddenly Methuselah’s older brother shuffled out from between two parked cars and directly into my path. I mashed on the brakes. He stopped and turned to peer at me through incredibly thick glasses. I waited for him to give some modest display of apology – a nod or wave or perhaps a sheepish half-smile. Instead he curled his lip harder than Billy Idol and continued on his way. By the time he finished creaking past, another car glided in from the opposite direction and stopped at the drive-through microphone. I pulled up behind it, gnashing my teeth and cursing Geritol under my breath. I briefly contemplated leaving, but I was too hungry. I decided to wait and see what they ordered. If it was something quick like coffee, I’d place an order. If not, I’d leave.
I snuck a look at the person in the vehicle in front of me and recognized her to be Mrs. Hatter, a tenuously-controlled schizophrenic. As usual, she was busy taking enormous drags from one of her supersized homemade cigarettes.
“Welcome to Tim Hortons! Can I take your order please?”
Mrs. Hatter looked straight up at the sky for a few seconds. She then cocked her head to the side like a pigeon and scanned the horizon in all directions. When she was satisfied all sectors were clear she resumed puffing.
“Uh, welcome to Tim Hortons… . Can I take your order please?”
She did her sky inspection once again. This time she also checked the glove compartment, her purse and the back seat. She then stubbed out her cigarette and lit a new one.
My stomach grumbled loudly. I debated whether or not I should walk over to her and explain that this particular voice happened to be coming from the drive-through microphone. I ended up deciding to wait one more minute and hope she figured it out on her own. Are you there, God? It’s me, Donny. Help her figure it out, okay? And while you’re at it, would you mind encouraging her to order just a coffee? Much obliged.
“Hello? Anyone there? Would you like to place an order?”
“Yeah, I’m gonna take der chili deal an’ a big coffee. An’ maybe a couple of dem donuts. Hey, youse guys got any sandwiches? What kinda soups you sell ’ere, anyways? Anyting on special today? How much you tink dis is gonna cost?”
I burnt rubber out of the parking lot.
Status Interrupticus
Mr. Golding is a 50-year-old man with a strong family history of heart disease. His cholesterol is astronomical and dietary adjustments have failed miserably. I’ve called him in to get him started on a cholesterol-lowering medication.
“Hey doc!”
“Hi Mr. Golding.”
“I guess my cholesterol’s still pretty high, eh?”
“Yes, that’s right.”
“How high was it?”
“It was – ”
“I just can’t figure out why it won’t come down, doc! For breakfast every morning I eat a small bowl of Corn Flakes with skimmed milk. After that I have an apple or an orange, or sometimes I’ll take a glass of juice instead.”
“That’s good – ”
“Real juice, mind you, not fake junk like Tang. I can’t believe astronauts used to drink that stuff!”
“Can’t say I’ve ever – ”
“If I’m still hungry, I’ll have toast with margarine. Is that Becel stuff any good?”
“What?”
“According to the ads on TV, it’s really low in fat or something.”
“Most dieticians say – ”
“For lunch the wife fixes me a tuna sandwich. I must have told her a million times to go easy on the mayo, but she still slathers it on like crazy! Hey, doc, do you think she’s trying to kill me? Har-har!”