more than bruising was apparent. It wasn't until I became increasingly nauseous that a CT head scan was undertaken. After the scan had been done, I asked the ...
Research SURGEONS AS PATIENTS
DOI: 10.1308/rcsbull.2015.313
Looking through patient eyes One doctor refuses to let a dehumanising ordeal deter him from learning to deal humanely with patients. Olusegun Ayeko FY1 in Elderly Medicine at Blackburn Hospital, North West Deanery
313
O
ne Sunday morning in early March 2014, I woke up in a central Birmingham hospital. I had been subjected to racial abuse and physically assaulted the night before. Ironically, I had only commenced my trauma rotation of a surgical module at medical school the preceding week. The months following this initial experience as an NHS patient have vastly changed my perspective on healthcare and highlighted several key aspects of a doctor– patient relationship. I was a fourth-year medical student at the time of the assault, completing my surgical placement and two months away from taking my exams. After finishing these exams, students then go on a medical elective to experience a chosen specialty in a different environment and, perhaps, a different culture. The news that my injuries were greater than initially anticipated would put my summer – as well as medical school progression – in jeopardy. I have always been interested in surgery as a future profession. Any free time I had during my years in medical school was spent researching future careers and seeing procedures in theatre. I had even been fortunate enough to assist in a number of operations. Through this, I had met a vast array of patients: elective or emergency; terrified or calm; doubtful or optimistic. Each patient reacted differently to their diagnosis, explanation of prognosis and the subsequent steps to their recovery.
SURGEONS AS PATIENTS
The crucial part of the patient experience wasn’t always the significance of their injury, but the communication method. I had received a blow to the orbit, leaving me with a visually extensive orbital haematoma. The clerking team was ready to discharge me, as they believed nothing more than bruising was apparent. It wasn’t until I became increasingly nauseous that a CT head scan was undertaken. After the scan had been done, I asked the emergency registrar: ‘So, is it just badly bruised? Will I be fine in a few weeks?’. He bluntly replied: ‘No, it’s very bad. You’re going to need surgery’ – and promptly left the bay. My heart immediately began racing as every possible injury went through my mind. I felt nauseous again – not owing to a physiological mechanism, but rather because bad news had been broken to me in such an awful way. That was the first, but certainly not the last, bad news I was told with so little empathy. Having been seen by the ophthalmology department, I was discharged and referred to maxillofacial surgery for review within a week. It was during this appointment (conveniently scheduled on my birthday) that I was asked how I was coping for the first time by a healthcare professional. The surgeon asked what was ahead of me in medical school and said that he would do his best to make sure the operation was done as quickly as possible so there was minimal interference. He offered to talk me through the CT head scan, which I agreed to. This showed multiple facial fractures – the most serious being a blow-out fracture. The inferior wall had completely displaced and there were several fractures to the medial wall. The inferior rectus muscle had herniated and the orbital fat had prolapsed. As the registrar had said a week before, it was indeed ‘very bad’. Two days after my max-fax review, I was on the operating table. In those two days I had seen almost every video of the operation on YouTube and read numerous papers on the outcomes. The orbital floor repair involved removing the fractured inferior wall, raising the inferior rectus and fat, before
placing a titanium plate to support the orbit. As a medical student, I have had the opportunity on a number of occasions to administer the general anaesthetic agent to intubated patients and witness their subsequent loss of consciousness. But during my own procedure, I paid more attention to every detail for as long as possible, from the insertion of the cannula to the feeling of lightheadedness. The last thing I remember was the slight panic of realising I was about to drift off, as the light on the ceiling above me separated into two.
I felt nauseous again – not owing to a physiological mechanism, but rather because bad news had been broken to me in such an awful way This was the second time I'd woken up in an unfamiliar hospital bed. I was back on the ward with a sore throat and a heavily bandaged eye. My mother was by my side and within the hour so was the surgeon. He explained that everything had gone well and what would happen during the next few weeks. His confidence and politeness was comforting. This contrasted starkly with the surgeon whose clinic I attended for my postop follow-up. He was arrogant, brief and lacked emotion. He asked what career I wanted in the future, so I told him
a surgical career would be preferential. ‘You may need to think of alternatives.’ His words stung deep and are the only things I remember from the ten-minute review. Few experiences have equalled such a valuable lesson in patient communication. Another tough experience was the first ophthalmology review I had when I was able to open my eyelid. Seeing my shortcomings and deviations from normality, with diplopia and limited eye movements, made me very introspective. With the medical knowledge of my injuries I should have expected it, but being a patient seemed to require the hope that doctors know and do best. Shortly after these appointments, I returned to university to study for exams that were a mere month away. This period was the most difficult mentally and physically. Each day I attended my placement and went to the library, with the occasional appointment and review to break up the routine. The pain was intense, the codeine made me nauseous and I was coming to terms with the neuropathic pain resulting from inferior orbital nerve damage. Headaches were no longer an excuse but a constant reality. I spoke with peers, supervisors and family about pausing my medical degree. The motivation to continue came from the people around me and a self-proclaimed challenge to perform against adversity. I sat my exams and passed them, before enjoying a summer of orthopaedic surgery in Buenos Aires and firsthand World Cup experience across Brazil. I have recently completed finals and will be starting my career as a doctor this month. I have experienced depressing and uplifting results alongside poor and almost perfect communication. I have repeatedly learnt that it is crucial to employ empathy as a doctor in all situations, whether or not one considers them big or small. Each person perceives information and reacts differently. I have been inspired to be a better doctor, and strive to be a surgeon who communicates with compassion and care – unlike the clichéd stereotypes. 314
