Doctors are often in the hot seat when addressing patients. It’s never good enough. Too little said, too vaguely, too harshly, too impersonal, too quickly, too confusing, too much medical jargon, not enough medical detail… the list is endless. Surgeons in particular are notorious for their…. abrupt bedside manner. The Don was different.
I remember being a surgical intern in a very busy unit. I was on call with The Don. The Don was a great surgeon and a man of just the right amount of words, not too many or too few.
I learned alot about what actual communication of patients looked like. The conversation between a patient and the man who would likely be carving his insides out shortly.
Doctors are required to take ‘informed consent’ from patients pre-op. This means explaining the benefits, risks, complications and alternates of the procedure. It also involves answering many questions that usually frustrate the general surgeons only because there’s just no time. The problem is patients don’t understand medical terms often and complicated procedures are often over simplified so everyone is on the same page.
It was a month end Friday night. Everyone in the medical profession knows exactly what that means, it’s usually more busy than the standard chaotic busy. Everyone’s excited that another mundane month has ended, there’s money in their accounts (not for long), emotions run high and pretty soon, fists and guns and pangas and knives and rocks and shoes too. It usually ends in some bloody way with an injured Casualty or two.
My phone rang as the first port of contact between the emergency department and the general surgeons. I listened to the casualty doctors referral and expected to hear some gruesome boring story I had probably heard before.
“Its a 12 year old boy with constipation and vomiting for 3 days, I think he is obstructed”. I stared into the blank wall in front of me.
I forgot for a second that in between gun fights, peoples bowels pack up too.
“Thanks. I’m happy it’s not a trauma patient. I’ll be there soon”.
“….er actually, we have 2 red patients who came in with the police. I think one is a gunshot. They lose the keys to the handcuffs so just waiting for him to be free”
I regretted my previous statement. I would not have stressed about what I didn’t know, and now I do know. Rookie mistake.
The Don met me on his way out of ICU and I relayed the message. He wasn’t surprised and looked a bit relieved.
“We lucky its just 2. For now…”
He gave me a side eye.
We arrived in Casualty and The Don’s bedside manners shined. He always greeted everyone in the room and spoke directly to the patient, no matter if it was a child or adult.
The parents were overly on edge, the mother sobbed in the corner and the father looked like he had been shot a few times. He was sweating bricks. I couldn’t read the room properly. Why was everyone over- performing for constipation??
I was confused.
The father interjected and distracted the Don from his direct interaction with the boy.
“The pain started 4 days ago and he hasn’t pooped in 3 days. He is in excruciating amounts of pain. I think he is nauseas as well, I can’t be sure. I know you doctors use pain scales and all that and his pain is a 10/10. I gave him panado and lacson but nothing happened..the chemist gave me something to put up his butthole but you know… I just could not bring myself to do it….”
The Don’s irritation was now growing. Very few things irritated him that people interrupting his potential patient. The only reason I knew that was because I had asked him if he had ever been angry or annoyed at anything because I had never seen it.
” The patient is in pain, he must express himself. I don’t want irritating parents, although well- meaning, obscuring my history with their own personal story” he told me before.
I could see he was not interested in the father’s story and wanted to speak to the boy himself. He wanted to develop a direct rapport and gain the boys trust and l respected that.
“uhmm, father, excuse me, but i did not ask you. i asked him.” He said pointing towards the patient with possibly too much of an arrogant flick of his head, turned his back toward the father and got closer to the boy.
The father was silent.
The Don went closer to the boy, put his hand on his shoulder and started explaing his examination procedure and possibility of xrays, drips, bloods and maybe just maybe surgery. He explained it so well, so articulately yet so simple. He reassured the boy with absolute certainty that he would be in good hands. He promised we would not poke more than once and the pain medication was on its way.
The boy was in agony but just stared at the Don in between.
The mothers sobbing stopped and she and the father came closer to their son after a good 10 minutes of the Don’s pacifying.
“Umm, doc, he has an intellectual disability and he can’t hear well..”
Awkward silence all round. The Don looked at me.
Now it made sense! The over protective parents, the insertive father… Poor Don.
The Don apologized to the boy and the father reminded him that he was deaf. The Don shuffled embarrassed and apologized to the father.
We stepped out to have a look at the Xrays.
” Why didn’t you tell me he is challenged and deaf?!”. As if I knew???
We looked at the Xrays and decided he needed surgery. Now the Don had to face the dad to get the consent.
The Don explained everything about the laparotomy in detail to the dad and drew many diagrams. The parents were silent, no sobbing and no drama.
“Before we go on, I have to say something to you”.. the father said pointing to the Don.
We were both waiting for this moment to come and I think the sooner the better. I knew he was unhappy about unceremoniously being shut up.
“I came here expecting professionalism and help and the moment you walked in and started talking…. directly to my son, I was very relieved that you are his doctor. I am very happy with the way my son is being treated and I know you are the right doctor to open his body up because you respect him…”
Sighs of relief. We were not expecting that!
The Don shuffled and thanked the parents and we left to prepare for the surgery which went well. The family thanked him again and the boy left well. Lessons were learnt all around.