Sunday, January 27, 2013

What About the Patient?


Christmas morning at 1:30 am the phone chimes away. What the… I’m not on call.

“Please call Dr. Dred for patient Selma, perforated colon at Local ER,” read the text message.

Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.

So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, hypotension and a CT Scan that revealed free intraperitoneal air and fluid. She was intubated and on pressors, maintaining a blood pressure of around 100 systolic. Dr. Young had been paged three hours before and had not called back.

I know Dr. Young very well. He is recently out of residency, very conscientious and a very good surgeon. The only reason he would not respond is if he was in the OR at another hospital or was incapacitated for some reason. I tried to call him myself, but he did not answer.

I called the ER back.
“Did you try to call another surgeon or transfer the patient to another facility?”

The answer was that they had called. The other two surgeons who worked in their hospital had refused to come. They had called the surgeon on call at another hospital less than a mile away and he had refused to accept the patient. They had called the surgeon on call at a second nearby hospital and he had also refused. They had called the major medical center downtown and they had refused. Everyone in the city of Houston had refused to come and see the patient or accept the patient in transfer. I hung up the phone and made calls to the operating rooms at the other local hospitals, to see if Dr. Young was scrubbed in surgery. No answer at any of them.

I lay in bed for about three minutes and then called back the ER.

“I’m coming in,” I said.

The patient was just as presented. Intubated, BP 100/50 on neosynephrine infusion (not my first choice), alert, however, with a diffusely tender abdomen and CT scan which suggested perforated colon. I’d called the OR crew in before I left my home and they were arriving at that moment and setting up the room. She was ready to go to surgery within thirty minutes of my arrival. As we were wheeling her to the OR, Dr.Young appeared. It seems he had been on call for the last four days and had been up each night with similar life threatening emergencies. He had put his phone down and fell asleep and  had not heard it ring as he had left it in the bathroom. As soon as he saw the message he called and came in to the hospital. I told him that I’d take care of Selma and that he should get some rest. He thanked me and we proceeded to surgery.

Selma had suffered a perforated colon due to diverticulitis and had fecal peritonitis. She was treated with colon resection and colostomy, has recovered and now is home.

This case was a bit disturbing. The fact that the call doctor could not be reached was one issue. However, it is an unfortunate fact that doctors are actually human. I find no fault with Dr. Young. Suppose Dr. Young had been in an accident, was unavailable and it was not possible for him to even call the ER to inform them? What about the other surgeons? What doctor who calls himself a surgeon would allow a patient to die just because “I’m not on call.”

This patient was uninsured. I suspect this fact may have played a role in some of the decision making. It is almost impossible to transfer a patient who has no resources. It is possible that those surgeons at other hospitals did not believe she was stable for transfer, but if there is no alternative, is there a choice?

My greatest disappointment is with the two other surgeons who had privileges at Local hospital and refused to come to see the patient. It is one of the facts of the general surgeon’s life that sick people are inconvenient. Until our government can legislate that people only become ill between the hours of 8:30 am and 5:00 pm, and only Monday through Friday and not on holidays, there will be calls at any and all hours. Could any doctor let a patient die when it is within their power to prevent it?

The following morning, after the surgery, I talked about the case with my wife. She said she wasn’t surprised I went in to the hospital. She was surprised that so many other surgeons refused. I commented that I would have sat up all night worrying about the patient, and, rather than worry, it was best to take care of her.

Doing the right thing is always better.

Tuesday, January 8, 2013

Writing and Religion


I’m thinking about eliminating religious themes from my books and stories. Why? A very good question. Religion is a turn off to many readers. A reader may be going along, becoming interested in the plot and characters and then, bam! God pokes his head in and the reader says sayonara. It isn’t every reader, but enough to make a difference. I know it’s true because reviews say so. Sometimes the reviewer is very explicit, writing something like: “I was interested until the author started bringing God (or Christianity, or religion) into the story. Then I became angry and put it down.” At least such reviewers are honest. I believe, however, that their reviews say more about themselves than the story.

Then, there are the reviewers who find another reason to dislike the story, but implicit in their comments is a strong dislike for anything that even suggests that there is a God out there. They are offended that God has any interest in what happens in this world. Such readers may make remarks like: the characters were flat or the plot didn’t interest me, usually coupled with comments that reveal their complete disdain for all things religious, particularly Christian. Comments such as “Too many biblical references or the characters seemed too knowledgeable about God” are common.

My problem is that I find it hard to write about anything apart from God. All I need to do is look out the window and I see his presence. I tried in my most recent book to tone down the religion. “Minotaur Revisited” features the Minotaur of Greek mythology living through thousands of years of history, coming in contact with historical characters, some biblical, some real and some fictional. There is an undercurrent of religious questioning that runs along with the story. The Minotaur experiences God and gods during many of his adventures and is never sure what it all means or if he should believe in any god, be it Zeus or Yahweh. Yet, what to me are subtle references to religion strike other readers as outright proselytizing. This is never my intention. Every religious reference I make is, at least in my opinion, integral to the plot and/or character.

“Future Hope”, Book One in the ITP series, carries the protagonist, Major David Sanders, and the reader to a fictional Eden where there are sharp contrasts between that “mythical” world and the futuristic earth. One world has forgotten God, while the other can’t live a moment without seeing His presence. Major Sanders’ physical and spiritual journey eventually leads to a clash between the two worlds. God and religion are integral to the plot and elimination of either would gut the story.

“Joshua and Aaron: ITP Book Two” brings God and religion down to a more personal level. Joshua Smith is thrust into the middle of a cosmic battle between God and Satan. Once again, religion is central and trying to eliminate God and religion would decimate the story. I suppose the story line could be altered from God vs. Satan to: good vs. bad, or the Force vs. the Dark Side, or Dark vs. Light. Perhaps such alterations would widen the appeal of the ITP series, but it would also trivialize the underlying theme. God vs. Satan is a battle that has been raging since the beginnings of the Bible. Replacing such an important concept with abstract notions of good and evil would weaken the impact of these stories. God vs. Satan, biblical ideas and Jesus ask the reader to make a choice, something “Star Wars” or “Lord of the Rings” never do. After all, “Star Wars” takes place “a long time ago in a galaxy far, far away” and “Lord of the Rings” is set in Middle Earth a land filled with Elves, Wizards, Hobbits and Orcs. Even though “Future Hope” and “Joshua and Aaron” unfold one hundred fifty years from now, it is on earth where the battle is fought; an earth that is a logical extension of the world we inhabit today.

There is no question that god and religion are integral to the ITP series. But what about books I’ve written about surgery? A review of “Behind the Mask” posted on carries the heading “too much God.” The writer states that he enjoyed much of the writing and found the book to be informative, but God popping up at various points was distracting, because he was not a religious person. My problem is that I cannot look at this world, look at humanity, look at the amazing biological apparatus called Homo Sapiens and see it apart from God. We humans are truly “Fearfully and Wonderfully made.” Therefore, “Behind the Mask” and “Under the Drapes” include reference to God within the context and flow of the narrative. I don’t believe that such references are excessive or unnecessary. Rather, my use of religion and God reveals their importance in this world, as well as my life and work. The goal of these books is to bring the reader into this rarely seen world of disease and blood and life and death. I cannot accomplish this goal apart from God, because I see his hand in everything.

“Too much God?” I don’t think this is possible.