Patient Modesty: Volume 22
The graphic is a Master and his Slave painted Silician pottery from around 350BC-340BC. I am using this graphic for Volume 22 to represent what seems to be a common thread in the discussions within these volumes of Patient Modesty: A feeling of inequality and perhaps even abuse between the patient (either male or female) (slave) and the healthcare provider (master) with regard to the matters of genital modesty. If I am wrong in this analogy, let me know. Nevertheless, continue on with the discussions. ..Maurice.
Graphic: A master and his slave. Side A from a Silician red-figured calyx-krater, ca. 350 BC–340 BC., Louvre, copied from Wikipedia.
ADDENDUM (August 23 2009):
Here is something special I discovered to add to the current patient modesty discussion. It is a story written by a second year medical student Asrei Beyewitz in Pulse, a medical humanities publication of the Albert Einstein School of Medicine in New York. This and a host of other stories and poems about medicine can be found at this link. I received permission by the chief editor of Pulse and also from Ashrei to publish the story on my blog. Maybe Ashrei will join us here and he can provide us with more insight regarding modesty issues associated with management of his chronic illness. ..Maurice.
Looking for Respect
This may sound strange, but I secretly looked forward to my colonoscopy.
I was excited to see the people in the colonoscopy suite--the receptionists, the nurses and my doctor. I knew that they would like me, because I would be brave and respectful. That's what's always happened since I was diagnosed with Crohn's Disease ten years ago. During my multiple colonoscopies and countless doctor visits and other outpatient procedures, I invariably build up a rapport with someone, be it a doctor, nurse or staff member. I've always been a good patient, and now that I'm a second-year medical student as well, I can understand their work a little better. I expect them to sense my goodwill and to treat me in turn with respect and caring.
This appointment got off to a good start: The woman who registered me seemed nice and appreciated my interest in the pictures decorating her cubicle wall. And I wasn't just being polite--I really did like those black-and-white photos of old TV and film stars. She even had The Honeymooners up there! I also got along well with the first nurse--we shared a laugh about the trouble I'd had finding a quarter to pay for my locker.
But a few minutes later, my interview with the intake nurse took me aback. Staring at her computer screen, she recited a series of questions. Seated facing away from her in a gigantic reclining chair that seemed cemented in place, I couldn't turn around far enough to catch her eye. The nurse's lifeless, monotonous tones conveyed zero interest in who I was or what I had to say. I'd never felt so unimportant.
To make matters worse, people kept interrupting us. The first time it happened, I thought that something serious must be happening--maybe a patient was having difficulties, or the computer system had crashed.
No. It was lunch time. They needed to coordinate their take-out orders, and my nurse, it became clear, was the lunch organizer.
Sometimes coworkers called her out of the room (but not out of earshot); other times they conversed right in front of me. Eventually I got so used to it that I began letting her know when someone was waiting for her.
Still, I felt stung at receiving so little respect. Was I invisible? Couldn't their lunch plans wait a few minutes? Nevertheless, I swallowed my pride, reminding myself that healthcare professionals are people too, with needs of their own. Maybe my nurse had found that distancing herself from patients helped her to do a better job. When she expertly inserted my IV line, I felt I'd taken the right attitude. Our relationship wasn't very satisfying, but at least she had technical skills.
Soon I was called to the procedure room and introduced to my next nurse, who would actually assist with the colonoscopy. She seemed down-to-earth and likable, but that's when things really started to go wrong.
For one thing, she'd forgotten to put a bed in the procedure room. Then, when she did bring it in, she had me lie on it facing the wrong way. After we'd fixed these details, I heard someone down the hall talking excitedly about a "scholar." There must be some talented pre-med students shadowing the doctors that day, I surmised. Feeling a sense of kinship with them, and renewed self-confidence, I hoped that they would stop by my room.
When my nurse brought in the student, I waited eagerly for her to introduce us. Instead, she started helping the young woman to put on scrubs. And while that was happening, I learned that this "pre-med" student was actually a ninth-grader.
My pulse quickened, and my mind raced. Was I some animal in a zoo for children to gawk at? I was having a colonoscopy--the procedure where they stick a tube up your rear end. Couldn't they ask my permission before inviting a spectator?
Struggling to sound calm, I asked, "Does my doctor know that a student will be watching my procedure?"
My nurse didn't seem too pleased: I'd breached the unofficial patient's code of conduct. She blinked and said, "This is a teaching hospital," adding that patients should expect to be observed.
I knew that this was utter nonsense. As a patient and a medical student, I care deeply about the principle that a patient's dignity should be respected at all times. I felt ready to fight for this.
"It's probably okay," I said, "but it would have been nice if you'd asked me first."
"Patients can always refuse being observed if they wish," she retorted, contradicting her earlier statement.
All I wanted was an apology and an acknowledgment that they weren't allowed to coerce or take advantage of me. After some more back-and-forth, my nurse conceded her mistake. But the whole exchange left a bad taste in my mouth.
When my doctor came in and learned what had happened, he told me that I was under no obligation to be observed. Before I'd even finished nodding, the student was taking off her scrubs; a few moments later, she was gone.
Ironically, I still liked the nurse. I felt sorry for her that she'd been making mistakes, and I appreciated that she'd apologized for them. And when she started telling me about herself, I liked her even more.
She'd had a lot of experience in surgery, she confided, but was still fairly new to the colonoscopy suite. She'd felt that she had to let the student observe because her boss had requested it. Although it didn't excuse what she'd done, I appreciated her candor. It was as if we were meeting for the first time.
An hour or two later, I was waking up in the recovery area. Looking across the hallway, which looked blurry to me without my glasses, I saw someone walk by with a friendly wave and a smile. I can't say for sure, but I think I know who it was.
About the author:
Ashrei Bayewitz is a second-year medical student at Albert Einstein College of Medicine and a summer intern at Pulse--voices from the heart of medicine. "I've been interested in writing since middle school, when I composed mock newsletters to celebrate the birthdays of friends and family. I am continually surprised by the interesting and sometimes humorous connections that I make while writing. Around the time that I chose to go into medicine, my love of stories evolved into a special interest in illness narratives. My honors thesis at Yeshiva University showed how these works can help doctors better relate to their patients."
NOTICE: AS OF TODAY SEPTEMBER 8, 2009 "PATIENT MODESTY: VOLUME 22" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 23.