Hospitals, ‘Hallucinations,’ Torture and Pain
There are two kinds of suffering: the patient wrestling with more than he or she can endure. And the family watching, unable to help and also at the mercy of the medical staff.
Not long ago, an old friend died, and last week I was back in the same church again, another funeral. And as it happened, I ran into the wife of the friend who’d died, and it is fair to say that the setting and the circumstances had brought her own troubles back, fresh as new.
Here is the story she told me, and it is at the same time awful and not surprising at all, as I have spent my share of time in hospitals, and then some, and have seen this sort of behavior for myself more times than I’d like to. Names here are changed for legal reasons.
My friend Manny went to a hospital to have blood clots removed from his bladder. His wife is Lucy, his adult daughter is Priscilla, and they were left in a waiting room downstairs, where the surgeon said they’d be called as soon as there was news. It is part of the story here that Manny was not in great shape—he had heart trouble and lung trouble and kidney problems and prostate cancer—all those things that nibble at you around the edges before, inevitably, something comes along and takes the whole bite. On the other hand, even knowing he was headed the same place the rest of us are headed, more than the rest of us, you knew that Manny would dance right up to the finish, until there was no more dancing to do.
Manny was big—not his physical person, but one of those guys who knows something about everything, and it was all stuffed in there together, a million moving parts. He was also smart, and if he’d had more pure bad luck than most of us could handle, he never let go of the idea that play came into it too, that whatever cards you got, it was up to you to enjoy the game.
But back to the hospital. Manny’s Lucy and Priscilla are waiting in the waiting room. There is no place harder to wait than a waiting room. An hour passed, an hour and a half. Nobody had said anything about an hour and a half. Because of his heart and lung problems the house anesthesiologist decided to use a narcotic instead of a general anesthetic. If the anesthesiologist had asked, the family could have told her that Manny had recently undergone an operation with general anesthesia.
She also decided to use only about 30 percent of the amount that could be safely administered. Why? The anesthesiologist says Manny was apparently in more pain than she’d noticed.
Hearing nothing from anybody, Lucy and Priscilla decided to go back to his room and sit it out there. Meanwhile the surgeon, who had another patient waiting at another hospital, had left Manny in the recovery room, and left the hospital, without speaking to the family. The surgeon didn’t talk to them, none of the nurses talked to them. The “hospitalist”— a term for the doctor who is supposed to follow a patient’s case from the time he comes in door until he leaves—was nowhere around.
So here is how Manny’s wife and daughter were first apprised that something had gone wrong: they stepped off the elevator and heard him screaming. They ran the length of the corridor and found him all but unrecognizable, still on the cart they’d used to move him from the recovery room, lunging, biting at nurses, unrecognizable, wild with pain.
He told his wife they’d tried to kill him in the operating room.
By now, Manny’s stomach had begun to swell. During the procedure to remove blood clots his bladder had been perforated and air was escaping into his diaphragm. The surgeon was half way to another hospital when someone reached him, and for the hour or so that took for him to return to the hospital, Manny was in a kind of situation that if you are lucky you will never know anything about. Lucid, but crazy with pain.
As the doctor returned, one of the nurses in Manny’s room called a Code Gray—and in a minute, two large security guards appeared in the door. What they intended to do, nobody will say. Maybe nobody knows. There were by now four or five hospital employees in the room, and what followed was a standoff—the hospital security cops against my friend’s daughter. Priscilla would not let them touch him. In the end, after she’d threatened to call 911, they left.
The surgeon, meanwhile, was in the hallway with Lucy, telling her they had to go back in and repair the perforation. The “hospitalist”—who by the way could have ordered morphine during the hour of the worst pain but didn’t—also showed up in the hallway, wanting to talk about just letting him go. Both conversations, the surgeon and the hospitalist, were held here in public, with strangers walking past. Manny’s wife asked to go somewhere private to talk it over, but neither the surgeon nor the hospitalist understood or cared that Lucy was asking for privacy. And it was in the corridor then that the surgeon finally mentioned the other thing. From Lucy’s notes: “He said, ‘Oh, things got kind of crazy in the O.R., and (Manny) had to be restrained.’”
Restrained means physically tied down. Here is something else you should hope never to find out about: Come back with me 30 years to Philadelphia where a surgeon drilled five screws into a patient’s femur while he lay on an operating table, fully awake, feeling everything and unable to move even a finger until finally somebody in the operating room noticed his heart beat had doubled or so.
The next day the surgeon said it must have been a dream. “People,” he said, “imagine all kinds of things under anesthesia.”
In this case, the hospital said Manny was out of his head with the narcotics. I don’t know how much difference there is between being tied down physically and chemically, but being completely helpless and at the same time in overwhelming pain scars you, which is to say becomes part of who you are. Pain is not always a transitory thing. In certain circumstances, in certain amounts, it—or its effects—never goes away. Sometimes things cannot be put back the way they were. You only wish that the nurses and doctors who are so blasé about pain, so blasé about the lives that are falling apart in front of them, could spend an hour or two in the patient’s shoes, or the family’s shoes, and then discuss pain as a hallucination, or how they are too busy to keep the family informed.
According to the hospital’s records, subsequent to the operating room, Manny was tied down again in the recovery room. Who ordered this is not clear. Keep in mind, though, that this was going on at a time that Manny was in new territory, pain beyond his own understanding. The surgeon was halfway across town, and the doctor in charge at the hospital—the hospitalist again—did not for some reason administer morphine.
We are talking now about two kinds of suffering. One is physical suffering—patients too weak or too old to fight back, reduced to begging for pain killers. But there is also the other thing, the family’s suffering. Imagine going through of the worst time of your life and not being able to find out what’s being done to the person you love, or why. Obviously, there are gentle doctors and good nurses, etc., but if you in any way think that they are the norm, you’re either brand new at this or have been very lucky.
There is nothing good about what happened to my friend Manny except he didn’t die in the hospital. Knowing his choices—his kidneys were shot, his bladder was shot, his heart was bad, his lungs barely kept him in oxygen—knowing the consequences, he disconnected all the tubes running in and out of his nose and mouth and arms. His exact words: “No more.” And he went home with enough morphine to get him through, and died.
In the last day and a half Manny was at the hospital, seven different doctors came into his room—Lucy there, at his bedside—looked him over, and only one of them was kind enough—human enough—to introduce himself and explain what he was doing. The others just looked and left.
And those little pieces of unnecessary torture may not sound so consequential to you—he was going to die pretty soon anyway, right?—but when you have been there yourself, they are criminal.