In a recent speech to the AAMC meeting in Philadelphia, Pulitzer Prize winning author and columnist, Anna Quindlen, gave the following Gold Humanism Lecure. In the opening statement, she highlights the importance anesthesiologists can have with regard to patient engagement and satisfaction with care. We should all think about how we discuss options with patients.
Me and My Epidural
BY Anna Quindlen
Some years ago I had some surgery at one of the best hospitals in the country. It was a revision of a surgery I’d had six months before, but I didn’t think much about that, although I had a few friends who were enraged about it, couldn’t understand how something could be done and then be undone so quickly. But I’d signed the release form in which I acknowledged that medicine is not an exact science, something I’d long understood, although I’d never gotten the impression that doctors did.
Same surgeon, same hospital, different anesthesiologists. The first two had been young women and these two were slightly older men and I tried not to let that matter. They tried the epidural once and it was no go. The second time only half of me got numb, although they acted slightly skeptical of my insistence that I could still feel my right leg.
“I think we should just go to a general anesthetic,” one said.
“I think you should try again,” I replied.
Afterwards, as he was leaving, he patted my finally numb leg and said, “Next time you’ll take the general.” And at that moment I came as close as I’ve ever come to saying the words that, spoken by an allegedly prominent person, seem to me to reflect that they’ve lost their mind, or lost their way. I almost said the words I’ve always promised myself I would never say, not to a ticket agent, a hotel clerk, a young reporter, anyone. I almost said:
Do you know who I am?
The answer to that question, I realize now, is a very important one as as far as all of you are concerned today. Not, do you know I won a Pulitzer, or have been on the bestseller list, or give speeches like this one? But a more basic question: do you know anything about me? Do you know why I’m having an epidural rather than a general? Have you taken any time to familiarize yourself with my history in any way shape or form?
Doubtless those doctors would have contended that they didn’t have the time, that there were many other cases for them to handle, that under the circumstances it didn’t matter. But that flew in the face of the behavior of the pair of anesthesiologists I had during my first surgery.
The young women sat down with me before we began, to explain the general anesthetic they though they were going to administer. I explained that I hated the idea of being unconscious, that I had chosen my surgeon in part because she was willing to operate with a local, that my doctor and I had discussed the use of an epidural extensively, and that I had brought along a CD player and an imaging CD especially designed for people undergoing surgery which I intended to use during the procedure. Which, by the way, I had heard about from my internist, who likes to play the east/west, mind/body angle a bit. Which is why she’s my internist.
“That’s all great!” said the more senior of the women. “You don’t really need a general anesthetic for this surgery, and I prefer to use the least intrusive kind of anesthetic if the patient is willing. And can I have the name of that CD? I’ve never heard of it.” Although she restrained my hands at the beginning of the surgery, 15 minutes in she released one so that I could scratch my nose, because it’s axiomatic that your nose is going to itch when your hands are restrained. “I can tell you’re not going to invade the sterile field,” she said.
Only a short interchange, yet in some fashion she knew who I was. And I assume she was at least as busy as her male colleagues.