The Importance of Apology in Medicine

In my lifetime I have needed medical treatment on a much more frequent basis than most people. Several friends have suggested to me that if I write a second book it should be about all the times doctors have said or done something that was hurtful, thoughtless, or inconsiderate. It seems that most of my friends have had at least one or two experiences with doctors that left them feeling angry or ashamed.  It should not be surprising, after all doctors are humans. What is surprising to me is that the doctors I trusted to get things right, never apologized when they got things wrong. Instead, even the most compassionate and skilled physicians default seems to be to blame the patient when the result is not successful. “You didn’t contact me early enough,” or “I don’t believe it is anything to be concerned about,” are the most frequent excuses I have heard. The fact is that these occasions are etched more vividly in my memory than the physical injury or pain I suffered at the time. Recently I learned that the latest data shows that if a doctor admits to making a mistake, even if it caused the patient some additional harm, there is a reduction on medical malpractice suits. That makes sense to me. Healing isn’t just about medicinal science it is built upon trust and the doctor/patient relationship.

Day 18 (of 31 days of free writing)

Got fish food?

There are some anniversaries that are not on any calendar. They are buried deep in my memory. They rise up slowly like air bubbles escaping from a fish’s lips. One at a time they float to the transparent surface. First one, then two, then three float up into my conscious thoughts.

They say, “This is the time when it happened.”

I try to ignore these memories; they are rarely happy anniversaries. If they had been pleasant experiences I would never have needed to banish them to the bottom. More often than not they are anniversaries of injuries, hospitalizations and trauma.

This month marks the eighth anniversary of my hemorrhagic stroke. I don’t actually remember the specific date in August when the cerebral hemorrhage began.

A few days ago the anniversary bubbles began to float up to the surface. They said, “It has been eight years now.”

I look at each bubble and remember the healing that has taken place over those years. I take an assessment of the gains and losses and determine that a game has been played well. Recovery has won the match.

Wound Healing

 
 

Bill, the nurse, took my blood pressure and temperature. He blotted my scars with saline, slathered Lidocaine gel onto two gauze pads, and secured the pads over my wounds. I was used to the routine; I had been going to the Wound Healing Center three times a week since early February. As he worked he said, “Have you had any pain?”

“None in the neck,” I said, but the arm hurt a bit.” He nodded his head in affirmation. He made notes in my chart, then set up the required tools on a metal tray.

“The doctor’s moving fast today,” he said, “It won’t be long.” Two weeks ago the doctor did the last of four minor surgeries. Now he was going to remove the stitches.

There was a quick knock on the door. The doctor strode in with a nurse following behind. The nurse removed the gauze on the back of my neck and the doctor efficiently pealed off the steri-strips. It didn’t hurt, yet when I felt his touch on my skin, I instantly remembered how the neck had been bruised and sore for a week. I hadn’t been able to sleep comfortably or turn my head from one side to the other without it throbbing. How could I have forgotten so quickly? I wasn’t attempting to be brave when the nurse asked if I had experienced any pain; I had sincerely forgotten.

“Looks great, all healed,” he announced before moving confidently to the arm. I felt a pinch as each stitch was plucked out. Vividly I remembered how it felt as my skin was sewn together like fabric. There was no discomfort until the next day when each time I shifted the left shoulder; it felt as if my skin was being ripped. After ten days, I had almost called him to check if this amount of discomfort was to be expected.

My brain forgets pain almost instantaneously once it has ceased, nevertheless my body will help me to remember. These new scars will fade like the others on my skin. I have a scar on each of my wrists. Each is a reminder of a cut made by a doctor when he could not insert a needle into a vein. I can hardly see them myself now that they have been a part of me for about 60 years. For years when I touch the slanting one on my left wrist, I could hear the doctor nervously whistling as he used the scalpel. I can sense his anxiety and feel my mistrust.

I know that my skin will help me remember the places it was cut, the void that was created, the sensation of being sutured, and the postsurgical soreness. From the doctor’s perspective it was “all healed.” However, my body will remind me that there is more healing to be done.