Stalin, Heart Surgeons, and Ben Carson

 

DSC05950So as you can imagine, my family has been having a lot of conversations lately about cardiology and cardiac surgery. My father was already quite well-informed about the subject, because his own father suffered from cardiac disease (confirming the well-established wisdom that such things run in the family, and making me think it might be wise one of these days to have my own ticker checked out: What keeps me from doing it is not wanting to know, which I know isn’t the most courageous way to approach these matters. I’ll get around to it. I think I’m okay for now.)

Anyway, we’ve been talking about the personalities of people who go into cardiac surgery as a speciality. There are lots of stereotypes, of course: I liked this blog, written by a woman who in no way would I consult for any medical problem, given that she’s “a physician who is intuitive and a Reiki Master/Teacher discusses healing from ‘the front lines’ of the mind-body connection in the hospital setting.” But her description of the temperaments of cardiovascular surgeons seemed interesting to me:

Cardiovascular surgeons are the last of the “old boys school” for the most part. There are notable exceptions, which I will discuss later. They are emotional, angry titans who split sternums and work on some really sick people. Some contain it better than others. … I have seen patients die from pride of the surgeon and the anesthesiologist and the rest of the team. … Pride is an element in the heart room. Ego reigns. Dominance, aggression, control, continuity. There is no compassion. Not for anyone…

On this blog, Aaron Singh asks why surgeons have such big egos:

[The surgeons] were the ones who walked past you with a sense of purpose, with an expression that sent lesser medical personnel scurrying out of their paths in terror, and with eyes whose gaze could physically melt medical students if you weren’t careful. Several walked past us, instantly recognizable, and those who bothered to look at us did so with a disdainful expression, dismissing our existence as being too trivial to bother their exalted minds. They were Lords of their Domain; entire operating theatres were built as shrines to their greatness. Why shouldn’t they walk around as if they owned the place?

I’ve always wondered why surgeons seem to be more affected by the famous God complex that seems so prevalent in the medical profession. Recently, my cousin brother underwent surgery, as I talked about in my previous post, and the surgeon who operated on him, whilst perfectly competent, also demonstrated this uppity demeanour. She strode into the OT (fashionably late) without seeing him pre-op, and didn’t even check on him post-op. During the surgery she didn’t bother to reassure him; it was the nurses who did this.

Or take this quote from Frank C. Spencer, MD, FACS, Cardiothoracic Surgeon:

“Stepping into the operating room to perform heart surgery on a sick patient, being fully in control of the large team of people who are required to do the procedure, and feeling totally prepared to perform the task at hand is an unbelievable feeling that can barely be described.”

Or this one from Dr. Paul Corso:

Heart surgeons are aggressive, intelligent, driven people who have mental, emotional and physical endurance. We are born with all of these factors, but need to develop them into their highest form. Some people say heart surgeons are jerks, and we’re probably that, too.

“Cardiac surgeons,” writes Kathleen Doheny, “driven and dedicated, tend to see things in yes or no terms, says a physician in another specialty. ‘Fish or cut bait. They tend to be stalinpushy.’ When a cardiac surgeon decides it’s time to head to the operating room, stand back.”

Anyway, this morning my brother and I were wondering how this personality type — and it is, it seems, a distinct one — would translate into a politician’s leadership style. We were playing a little game, trying to decide which figures from history would have been good cardiac surgeons. Perhaps Stalin missed his calling: Might he have been a fine cardiac surgeon instead of a bloody tyrant?

What about Ben Carson? I imagine that neurosurgeons and cardiac surgeons share CarsoninOR-590x398similar temperaments, as a rule. Is a neurosurgeon’s temperament the right temperament for the President of the United States?

Are any of you cardiac surgeons? Neurosurgeons? Know any? Are the stereotypes true? Would knowing that surgeons share a personality type seem relevant to you in trying to figure out what kind of politician a surgeon might be? In Carson’s case, after all, knowing that he was a great surgeon is really all we know: So would that kind of personality be an asset in the White House or a liability?

(By the way, although I didn’t get to spend much time with him, my father’s surgeon seemed to defy these stereotypes: He’s a gentle and very devout Catholic who goes to Mass every morning, and seemed in no way a bully or a jerk. So obviously, there are exceptions.)

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  1. Lucy Pevensie Inactive
    Lucy Pevensie
    @LucyPevensie

    Vicryl Contessa:

    As Westman knows, we use a lot of checklists in the OR (anesthesia, time outs, counts before closing) in an attempt to avoid wrong site procedures and such. The counts are very helpful I’ve found (well, for the most part), but the time out process is largely for show. You can ramble through a time out without really paying attention. The thing that does decrease wrong site errors- being well rested (says the first assist who did a 10 hour microvascular case on three hours of sleep, and not because I was partying or anything). That’s why there’s been such a pushback against the crazy hours that residents were logging in the past.

    And yet the evidence suggests that the change in duty hours has led to an increase in error rate.

    I was a big advocate of work hour restrictions, until I had to start dealing with the huge mess of trying to find someone who was taking care of a patient, after work hour restrictions were introduced.  And until I became as tired as I am of hearing, “I’m sorry. I don’t know anything about that patient; I’m just covering.”

    • #121
  2. Lucy Pevensie Inactive
    Lucy Pevensie
    @LucyPevensie

    Tuck:As far as your silly claim that it’s part of the “promised progressive administrative utopia”, noted Progressive “President Ronald Reagan awarded [the popularizer of this approach] the National Medal of Technology in 1987.”

    I think what Civil Westman was talking about was the creation of ever more systems of rules and regulations by uneducated bureaucrats in DC.  It strikes me as rather peculiar for a self-proclaimed conservative to be promoting sets of checklists and rules so enthusiastically, knowing what you should know about who makes the checklists and rules.

    • #122
  3. civil westman Inactive
    civil westman
    @user_646399

    An example of bureaucratic guidance in health care: in the hospital where I work, posters appeared and handouts were given to all staff, which instructed us in how to approach patients. At 15 feet, we were told to make eye contact. At ten feet, we should begin to smile. Following were several dense paragraphs with admonitions as to cultural sensitivities.

    Could there be any stronger evidence that the incompetent state believes that every one of us is an incompetent social being? My distinct impression is that every regulatory body would prefer me to be a ventriloquist’s dummy, whose every word could be scripted and every step choreographed. The robots are coming. Such an ethos on the part of our betters makes it ever more difficult to keep actual “care” in healthcare. Ask any nurse. Ever adding more tasks and documentation has become the raison d’être of regulators, lest it occur to someone they are unnecessary. Most every task added takes us farther from our patients and some actually make us less safe by virtue of the distraction created by the sheer volume of often-meaningless tasks, whose real intent is to justify the existence of regulators.

    • #123
  4. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    civil westman:

    Could there be any stronger evidence that the incompetent state believes that every one of us is an incompetent social being? My distinct impression is that every regulatory body would prefer me to be a ventriloquist’s dummy, whose every word could be scripted and every step choreographed. The robots are coming. Such an ethos on the part of our betters makes it ever more difficult to keep actual “care” in healthcare. Ask any nurse. Ever adding more tasks and documentation has become the raison d’être of regulators, lest it occur to someone they are unnecessary. Most every task added takes us farther from our patients and some actually make us less safe by virtue of the distraction created by the sheer volume of often-meaningless tasks, whose real intent is to justify the existence of regulators.

    Oh my gosh, the story of my life! Double charting is the real life. I can’t tell y’all how many times I had to step away from the bedside of a patient that was struggling with their diagnosis, family dynamic, what have you so I could do paperwork/charting.

    Within reason, if administrators and the government would get out of the way and let us do our jobs patients, nurses, and doctors would be much happier.

    • #124
  5. Claire Berlinski, Ed. Editor
    Claire Berlinski, Ed.
    @Claire

    civil westman:An example of bureaucratic guidance in health care: in the hospital where I work, posters appeared and handouts were given to all staff, which instructed us in how to approach patients. At 15 feet, we were told to make eye contact.

    You probably don’t remember my writing this ….

    • #125
  6. Lucy Pevensie Inactive
    Lucy Pevensie
    @LucyPevensie

    Vicryl Contessa:

    civil westman:

    Could there be any stronger evidence that the incompetent state believes that every one of us is an incompetent social being? My distinct impression is that every regulatory body would prefer me to be a ventriloquist’s dummy, whose every word could be scripted and every step choreographed. The robots are coming. Such an ethos on the part of our betters makes it ever more difficult to keep actual “care” in healthcare. Ask any nurse. Ever adding more tasks and documentation has become the raison d’être of regulators, lest it occur to someone they are unnecessary. Most every task added takes us farther from our patients and some actually make us less safe by virtue of the distraction created by the sheer volume of often-meaningless tasks, whose real intent is to justify the existence of regulators.

    Oh my gosh, the story of my life! Double charting is the real life. I can’t tell y’all how many times I had to step away from the bedside of a patient that was struggling with their diagnosis, family dynamic, what have you so I could do paperwork/charting.

    Within reason, if administrators and the government would get out of the way and let us do our jobs patients, nurses, and doctors would be much happier.

    My poor mother spent time in nursing care toward the end of her life. I learned this about nursing homes: No nurse is ever involved in patient care directly. The nurses (LPNs) sit at the front desk and fill out paperwork for their entire shifts.  Nurses’ aides, and there are usually fewer than there are nurses, are the only people who ever have time to do anything for a patient.  I am not up on the floor in the hospital, but I know it works the same way.

    • #126
  7. Lucy Pevensie Inactive
    Lucy Pevensie
    @LucyPevensie

    And as for charting, here’s a favorite thing of mine:  EPIC, the poorly designed but now near universal electronic medical records system, evaluates me on my charting, gives me a number of minutes I spend per patient office visit and compares me with other people in my division.

    Please note: we are radiologists. We don’t see patients for office visits, nor do we chart anything. But there is some kind of mandate out of Washington that requires our employer to track some kind of office visit charting metric. So somehow they made something up, and we are being measured on something that does not exist to comply with a standard set by someone who has no idea what we do for a living.

    This is only one example of the life we lead, and it just occurs to me because EPIC flashed my “score” up at me today.  Tomorrow I will be just as impatient over something else.

    • #127
  8. The Reticulator Member
    The Reticulator
    @TheReticulator

    civil westman: anesthesia is about 80 times safer today than it was when I started in 1978. Anesthesia was cited by the Institute of Medicine as the specialty which has made the greatest progress in patient safety.

    I didn’t know that.  It was in 1978 that I had the first of several “Adventures in Anesthesia.”  The last was 13 years ago or so.  There was no pattern, just that something different went wrong each time.  Long before it was over I quit telling those anesthesiologist jokes that everyone has probably heard.

    • #128
  9. civil westman Inactive
    civil westman
    @user_646399

    Claire Berlinski, Ed.:

    civil westman:An example of bureaucratic guidance in health care: in the hospital where I work, posters appeared and handouts were given to all staff, which instructed us in how to approach patients. At 15 feet, we were told to make eye contact.

    You probably don’t remember my writing this ….

    Yes, when I first meet fearful strangers whom I am about to anesthetize and hope to not harm in any way, I am not in smiley-face mode and make no attempt to “fake it.” I am deadly serious and if they understand that I am serious about the undertaking, I think they are aware I share with them their sense of the gravity of the undertaking. I would treat the enlightened committee member who wrote up this nonsense the same way. To think this approach is appropriate in every circumstance conveys the extent to which regulators are out of touch with reality. The “one size fits none” mentality.

    • #129
  10. Kay of MT Inactive
    Kay of MT
    @KayofMT

    The Reticulator:

    civil westman: anesthesia is about 80 times safer today than it was when I started in 1978. Anesthesia was cited by the Institute of Medicine as the specialty which has made the greatest progress in patient safety.

    I didn’t know that. It was in 1978 that I had the first of several “Adventures in Anesthesia.” The last was 13 years ago or so. There was no pattern, just that something different went wrong each time.

    It’s been my experience that anesthesiologist don’t listen to the patient. For some strange reason, Valium has little or no affect on me, except make me cry. A surgeon one time stated he didn’t understand why I was awake and crying after surgery as, “you have enough Valium in you to keep you asleep for a week.”  On a different occasion I told an anesthesiologist not to use Valium to put me under and why. He did anyway, and at the first slice of the knife I tried to get off the table screaming.  The surgeon, who was holding me down, was screaming at him with a few choice words  to “put her out!” I later refused to accept his apologies and told him not to bill me for his services or I would see him in court. He didn’t bill me.

    • #130
  11. civil westman Inactive
    civil westman
    @user_646399

    It’s been my experience that anesthesiologist don’t listen to the patient. For some strange reason, Valium has little or no affect on me, except make me cry. A surgeon one time stated he didn’t understand why I was awake and crying after surgery as, “you have enough Valium in you to keep you asleep for a week.” On a different occasion I told an anesthesiologist not to use Valium to put me under and why. He did anyway, and at the first slice of the knife I tried to get off the table screaming. The surgeon, who was holding me down, was screaming at him with a few choice words to “put her out!” I later refused to accept his apologies and told him not to bill me for his services or I would see him in court. He didn’t bill me.

    Not having been there, I can only speculate. Valium (diazepam) has not been used for more than 25 years. It was very long acting and not soluble in water, so it was dissolved in glycol which caused terrible phlebitis. Versed (midazolam) replaced it. Having said that, there are a few people who have paradoxical excitation from benzodiazepines (the type of drug we are talking about. Maybe that played a role. Usually a combination of several drugs are used either for sedation of general anesthesia. I listen carefully to such histories.

    • #131
  12. Kay of MT Inactive
    Kay of MT
    @KayofMT

    civil westman: Not having been there, I can only speculate. Valium (diazepam) has not been used for more than 25 years. It was very long acting and not soluble in water, so it was dissolved in glycol which caused terrible phlebitis. Versed (midazolam) replaced it. Having said that, there are a few people who have paradoxical excitation from benzodiazepines (the type of drug we are talking about. Maybe that played a role. Usually a combination of several drugs are used either for sedation of general anesthesia. I listen carefully to such histories.

    Glad to hear it has been discontinued, the surgery I was relating happened in 1979. The last 2 surgeries I’ve had, there were no problems with the anesthesia, an MVD in 2007 and abdominal 2013. So glad you listen to the patient’s history.

    • #132
  13. The Reticulator Member
    The Reticulator
    @TheReticulator

    Kay of MT:It’s been my experience that anesthesiologist don’t listen to the patient. … The surgeon, who was holding me down, was screaming at him with a few choice words to “put her out!”

    I, too, had an experience him down where the surgeon yelled at the anesthesiologist to “Quiet him down!”  I had kept waking up on the operating table and each time I did I tried to get out.   The last thing I remembered was that yell from the surgeon.   Later I apologized to the surgeon, and he said, “Well, it is harder to hit a moving target.”

    My experience after that was that anesthesiologists listened to me very carefully, and I sometimes wonder if the next one overdosed me because of what I told him, even though the first time wasn’t a dosage problem.  Anyhow, I was supposed to go home the same day, but just couldn’t wake up. When they threatened to keep me overnight I made myself stay awake long enough to get poured into the car.  They said I shouldn’t drive for 24 hours, but it was several days  before I got over it enough to drive.

    • #133
  14. The Reticulator Member
    The Reticulator
    @TheReticulator

    The Reticulator:They said I shouldn’t drive for 24 hours, but it was several days before I got over it enough to drive.

    The last major event was a spinal headache following surgery.  I didn’t know what it was at first, and I called the surgeon at his home a few times, as he had said I could do.  After some internet searching (from a prone position) I figured out it might be a spinal headache from the spinal injection by the anesthesiologist. This time his wife answered the phone and said, cheerfully, “Yes, I remember you!”  And she passed on my information to her husband.  When he called me back, he said, “I think you’re right, because remember how…”  In retrospect I had shown early signs of this before I checked out.  And then we talked about what to try on my own before taking other measures.

    Later, on a checkup visit, I told him how I appreciated that his wife had been so cheerful and helpful when I interrupted her at home.  His reply:  “She knew what she was getting into when she married me.”

    So yes, surgeons can be like that.   He was a good one, and knew it, but that didn’t bother me because I had been working for prima donnas in another field for the past 20+ years.  As long as they really are good, I don’t care if they are like that.

    • #134
  15. Kay of MT Inactive
    Kay of MT
    @KayofMT

    The Reticulator: Later I apologized to the surgeon, and he said, “Well, it is harder to hit a moving target.”

    My experience after that was that anesthesiologists listened to me very carefully, and I sometimes wonder if the next one overdosed me because of what I told him, even though the first time wasn’t a dosage problem.

    You had nothing for which to apologize. It is their responsibility to sedate you properly, so the surgeon can do his job. Too much can stop you from breathing, not enough or the wrong drug you wake up under the knife. Surgeons just hate that!

    • #135
  16. The Reticulator Member
    The Reticulator
    @TheReticulator

    Kay of MT:You had nothing for which to apologize. It is their responsibility to sedate you properly, so the surgeon can do his job. Too much can stop you from breathing, not enough or the wrong drug you wake up under the knife. Surgeons just hate that!

    Well, that was a long time ago, and as Dr. Westman says, things have changed since then.  But I had been running a fever, so as I understand and remember it, they gave me some sort of spinal instead of a general.   Maybe Dr. Westman would know how to interpret that.  Anyhow, whatever they gave me, it wasn’t doing the trick.

    I didn’t wake up fully when I was on the operating table.  I remember it was cold in there, and in a way I knew I should lie still but I was not in enough control of myself to do that. So I think they had little choice at that point but to resort to the more dangerous anesthetic.  And I was even aware of that at the time.

    So my apology was along the lines, “I hope I didn’t give you a lot of trouble when I kept waking up.”  His reply told me that no, I hadn’t imagined what was going on.

    • #136
  17. The Reticulator Member
    The Reticulator
    @TheReticulator

    Reminiscing about anesthesia is reminding me that, although somebody listed orthopedic surgeons as one of the prima donna types, the one I had in 1994 was not.  I tore a quadriceps tendon, though I think I did it more honorably than Bill Clinton did his about the same time.  Mine was from a bad slide into 2nd base; Clinton’s was rumored to be … well, let’s just leave it as another of those Clinton stories.

    I woke up in the operating room, though this time I don’t think it was unexpected.  The surgeon stopped what he was doing to come and  regale me with the story of how high the blood spurted when he stuck his scalpel in.  At each followup visit after surgery he’d tell the story again, and by the time of the last telling the blood had spurted all the way up to the ceiling.

    Instead of talking to me about my knee he preferred to talk to me about my workplace, where he had once spent an enjoyable summer taking classes before deciding to go into medicine – where the money was.

    I also woke up after I was wheeled into the operating room when I had my prostate surgery in 2002.  I asked, “Is this the operating room?”  One of the gowned men (not the surgeon) turned and looking at me more like a hunk of meat than a person, said, “Yes.” Then it was lights out for me.

    • #137
  18. Man With the Axe Inactive
    Man With the Axe
    @ManWiththeAxe

    Midget Faded Rattlesnake: I don’t see why the practice of medicine would ever be entirely dedicated to precisely administering scientifically-correct medical care rather than giving the people doctors  answer to (whether it’s patients, administrators, or government overlords) what they demand. I would naturally expect doctors (and nurses, and anyone else involved in caring for the eccentric creatures known as homo sapiens sapiens) to sometimes find it easier to give into demands that aren’t evidence-based, just to get on with the rest of life.

    This made me think of a scene in the film, “Man on the Moon,” about the comedian Andy Kaufman. Dying of cancer, and looking for any hope, Andy heard about a miraculous cure being offered by an alternative healer in the Philippines. He went there, waited in a very long line of people who were being “cured,” only to see that the “doctor” was using slight-of-hand to pretend to remove the cancer from the body, but was in reality just palming what looked like a giant prawn drenched in blood, and pretended it was the cancerous growth. At the same time he lost his hope for a miracle cure, Andy also had a good laugh. He was a showman who loved to con his audience, and so he appreciated another talented con man.

    • #138
  19. Tuck Inactive
    Tuck
    @Tuck

    Lucy Pevensie: …It strikes me as rather peculiar for a self-proclaimed conservative to be promoting sets of checklists and rules so enthusiastically, knowing what you should know about who makes the checklists and rules.

    Except all the links I posted were about doctors utilizing checklists to improve their own work product, not bureaucrats doing it for them.

    • #139
  20. Tuck Inactive
    Tuck
    @Tuck

    Tuck:

    Lucy Pevensie: …It strikes me as rather peculiar for a self-proclaimed conservative to be promoting sets of checklists and rules so enthusiastically, knowing what you should know about who makes the checklists and rules.

    Except all the links I posted were about doctors utilizing checklists to improve their own work product, not bureaucrats doing it for them.

    And for the record, I’m of the opinion that the Feds destroy everything they touch, so I’m on the same page with you there.

    • #140
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