‘I Had Never Faced the Reality of Death’: A Surgeon Becomes a Patient | Hacker News Reader

‘I Had Never Faced the Reality of Death’: A Surgeon Becomes a Patient

nytimes.com

75 pointsbookofjoe31 comments

For people interested in this area, I highly recommend When Breath Becomes Air by Paul Kalanithi. It is a very powerful and well written memoir of a neurosurgeon who battles with lung cancer.

I upvoted, but then I felt like that wasn't enough. There is something about this book that seems more real than life. The author not only was a neurosurgeon, but also had a Master of Arts in Literature from Stanford. He is an absolutely incredible and deep writer.

Couldn't recommend it enough.

I think readers might also enjoy 'the diving bell and the butterfly'. 'Tuesdays with Morrie' is another one in this "genre".

Agreed, excellent writing. Really made me think about my life priorities.

This is one of the best books I’ve ever read - very highly recommended. I knew Paul, and he was a truly special and incredible human.

Based on your review and the other replies in this thread I bought the book - I hate to say this, but, in my honest opinion, it was mostly a dull, arrogant and self-aggrandizing book. (Side-Note: I lost my mother at a somewhat young age to cancer and am no complete stranger to death and the process of dying).

https://archive.is/9myUQ

The ethics of requiring surgeons to undergo surgery as part of their training. It would be completely untenable from a ethical point of view to do unnecessary surgery.

But that said, the experiential knowledge they would gain from the process is huge. Being a patient is worrying, loss of autonomy, undignified (surgery/anaesthesia causes changes to digestion & bowel function) painful..

We sometimes say things like "I wish town planners had to spend a day in a wheelchair going around the streetscape" -well I wish surgeons had to deal with having somebody else wipe their bum, and live with nagging pain, and the after effects of opioid pain relief.

I'm glad I had my most recent bout of surgery. I left a lot of negative feedback on the hospital about their discharge policy and lack of physio consult for post-operative recovery, the IV drip, nighttime monitoring.. trivium they could fix in seconds which made my time in hospital sub-par.

That's an interesting idea. Similarly, I once misread a story in a French-language newspaper as saying new prison guards had to experience being a prisoner -- a really striking idea, if you could somehow keep the process blinded.

Sorry to hear of that lousy experience.

My experience with surgery was actually pretty good. The sedation worked well, and although surgery messed me up for a bit, what brought me into the office was much worse.

Mental asylums, suicide treatment, etc. - those are the doctors / nurses that should experience being patients. Fortunately I've never been committed, but I've heard horror stories even in modern times. Not to say I believe those places aren't necessary - they definitely are, and have helped / saved people lives to the point where they're thankful for being involuntarily committed - but those in power should have empathy for the people being treated.

Glad it worked for you. Some of us had less successful outcomes and years of pain, discomfort, disfiguration and the resulting depression and suicidal ideation. In my experience with surgery(one urology related, one shoulder surgery), surgeons over promise, under deliver, and are not at all compassionate when their magic fails to fix you.

I'm aware I've had good luck with regard to physical health.

Not getting into details, the main surgery I had was a routine operation which cured an otherwise life-threatening issue. So I'm a bit biased here.

Honestly I think mental health places should regularly experience "fake" patients. It's good for the students, but more importantly, I suspect that the Rosenhan experiment would go about the same today as it went in 1973.

If you haven't read about it, it was kind of amazing: https://en.wikipedia.org/wiki/Rosenhan_experiment

Basically a psychologist and his team got themselves admitted to 12 different hospitals by claiming auditory hallucinations. From that point on, they acted completely normal and claimed they no longer experienced any symptoms. The hospitals diagnosed nearly all of them with schizophrenia.

In the aftermath, one hospital demanded to be re-evaluated. The psychologist agreed. Over the next few weeks, the hospital found dozens of fake patients, despite the psychologist sending none at all.

Except that it's quite unclear if the experiment ever happened. Only one of the "pseudopatients" could be tracked down afterwards, and his recollection of the experiment differs markedly from Rosenhan's.

All the more reason to repeat the experiment regularly in an organised way.

I date a surgeon and this topic comes up a lot.

My question was always "why do transplant surgeons have two kidneys?"

What is the significance of that question?

I think the idea is that if they really cared about their patients, they would eventually find one they're a match for and donate it.

Not sure that necessarily follows, but I believe that is the point.

The chances of a transplant surgeon discovering that they’re a match for their patient seems exceedingly low.

Furthermore, assuming transplant surgeons are rare, then that surgeon is probably the only healthy person who can’t easily donate their kidney; after all, who would do the surgery?

It absolutely does not follow. Two kidneys are better than one, surgeries are not risk free, and to imply that a person has an obligation to give their organ to someone if they care about them is asinine.

Experience it's not the only path to empathy. We should be exploring more tenable paths and try to find some way of proving that people in authority actually empathize, or to give them consequences when they refuse to even try.

Seems similar to Mary's room.

Or could you ever really understand what it's like to lose a child if it never happened to you?

No, but thankfully empathy isn't an all-or-nothing thing. Even just putting in an effort makes a significant difference.

I mean the ethics seem to be analytically more complex.

If consenting surgeon A is to perform surgery procedure X on A such that the success chance of X on person i in the set of patients I (with the disease) is increased, then A necessarily has a higher chance of saving more lives in exchange for potentially accidentally killing/injuring himself.

So in fact, restricting X on A is analytically unethical when the set of patients i have a high probability of death or disability.

But it's also analytically unethical to perform X on A if X results in permanent damage (i.e. remove a kidney).

I've had a lot of surgery, and the best surgeons understand what it's like to be a patient, but perhaps things aren't as complex as it being totally untenable.

I can see an ENT undergoing a tonsillectomy that he doesn't need so that his friends can learn, and he can learn what patients go through. Or something else relatively minor - adenoids and so on.

I would say that further, doctors who prescribe medications that you can recover from (stimulants, ketamine etc.) should take them first so they know what their patients are going through.

In fact, I think most surgeons/doctors would agree with the above.

Sorry to hear about your bad experience but glad you said something.

My husband had a Whipple five months into our marriage. The surgeon was great. Empathetic. Responsive. Took all the time we needed. The nurses, however, were overworked which led to (not quite) inattentiveness. Thankfully, I stayed in the hospital with my husband for two weeks and did lots of things the nurses normally did (measuring urine output, etc.) and was an advocate for my husband.

It was only after he left the hospital that I learned all sorts of things I was entitled to: meals on the hospital, a deal on parking, etc. It would have been so much easier had I known this. We were fortunate not to have to worry about money. But it was annoying as hell and I wrote a letter about my two experiences. Heard from the surgeon. Not anyone else. And this was at Georgetown University Hospital. I expected more.

It always sucks to find out afterwards that certain game-changing resources were available and went unused.

I'm not entirely sure what kind of response would surpass the one that you received. I am impressed that the surgeon himself took the time to reach out, and I would value that immensely if I were in your shoes.

Here's hoping the surgery went far better than the hospital's communication of its resources. My layman's understanding is that pancreatic surgery is challenging.

>It would be completely untenable from a ethical point of view to do unnecessary surgery.

Doesn't stop doctors suggesting and performing "unnecessary surgery" knowlingly to other patients all the time. It's a booming business.

https://eu.usatoday.com/story/news/nation/2013/06/18/unneces...

Just one case of such a racket:

https://www.cbsnews.com/news/federal-prosecutors-target-phys...

They do sometimes get physicians and surgeons who have previous significant experience as patients before medical school. I've met a few over the years, and some are fierce about maintaining standards of patient care, and doing what they can to optimize care and comfort.

I also had "minor" complications after surgery & discharge. The IV was left in, and the bandage was too tight for the swelling. I had to return to the hospital the next morning.

Another time I spent 4 days in hospital with GI issues, after being sent home 36 hours earlier from overnight in the ER, and just being sick in hospital for the better part of a week was frustrated and tiring. I went home again (expected discharge)and recovered, got my energy back but it took a few more days.

You don't learn as much from using your own code as you do from sitting with someone who does.

Having to hang out with a patient the entire time might be an equal learning experience.

had a GF who is a GP doctor.

she never wore a seat belt.

Why? She's immortal.

Change that first line "Doctor ex girlfriend"

And you got yourself a nice haiku

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