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December 11, 2012

BehindTheMedspeak: The anesthesia resident who got down on his knees to pray with his patient

Sigismondomalatesta700

Once upon a time, in an academic anesthesia program far, far away in both time and space where I happened to be a junior faculty member, a sparkling fresh class of incoming residents arrived on July 1 to begin their training.

It was the early 80s in Los Angeles at UCLA Medical Center.

Among the new residents was a really nice red-haired freckle-faced guy whose name I remember but will omit here. 

The intense close mentoring that happens in July in anesthesia residencies — as a rule, one faculty member is assigned to two anesthesia residents for a two week period in the same OR every day, so as to be able to deliver a consistent message and get a feel for the strengths and weaknesses of the newbies — happened, and we moved on to August, when the new residents are gradually worked into the rotation of cases and work with all the members of the teaching faculty.

In July, I tended to go to visit patients preoperatively with my new residents, pretty much just sitting quietly while they did their preop workup and then chatting with them at the nursing station about what things mattered and what didn't in terms of our job: in brief, bringing the patient to the recovery room no worse off than when they entered the OR.

Anesthesiology's a peculiar specialty in that respect: No one expects you to make the patient better — as long as you keep someone in the condition you encounter them in, you're doing your job the way it's supposed to be done.

But I digress.

Come August, the new residents go to to see their preoperative inpatients on their own just like the more experienced ones.

One day, getting organized in the anesthesia prep area along with all the other faculty and residents, someone mentioned that the cheerful red-haired resident had been fired the previous day.

That got our attention.

Long story short: After the resident had performed his pre-op history and physical, the patient, apprehensive and lonely and scared as people tend to be the night before a major surgical procedure, asked the resident if he would pray with him for a good outcome.

The resident said yes, he would, then apparently got down on his knees at the hospital bedside and proceeded to do so.

Remember, this is all hearsay AND it happened 30 or so years ago, so the fine details may not be literally correct, but the gist of the story is true: our chairman called a meeting after that day's cases were over for all residents and faculty and explained what had happened and told us he felt that the resident had behaved outside the boundaries of appropriate physician behavior and that such action could not be considered acceptable in our department.

At the time, I remember thinking a lot of things: First, how weird the whole thing was; second, how it was a shame that that particular guy was the one because he was a nice person and a good resident; finally, that I totally agreed that doing something like praying with a patient at UCLA Medical Center was inappropriate and probably merited dismissal.

Now I'm not so sure.

Anyhow, the story has a nice ending: a couple years later someone brought up the resident's name while we were sitting around talking, and someone said he'd ended up going across town to the University of Southern California School of Medicine's Department of Anesthesiology — which was having all manner of problems, with its chairman under investigation for stealing money and residents fleeing like rats off a sinking ship — which happily took him on, seeing as his negatives were a whole lot less than those of the general run of their residents at the time.

He excelled there and became chief resident in his final year.

I hope he went on to have a fine and fulfilling career and life.

What do you think?

Should we have fired him?

How about today?

You make the call.

December 11, 2012 at 12:01 PM | Permalink


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Comments

i can see why this memory haunts you a little bit joe

Posted by: sherlock | Dec 12, 2012 9:36:16 PM

Hmm, I wonder how many doctors - anesthesiologists, surgeons, whoever - might have done a little pre-op praying with the patient surreptitiously, without the genuflection. Decades ago when a friend's mother was having major surgery and I accompanied her to be with her mom beforehand, the surgeon came in the area and spoke briefly to her, and she took his hand and very softly said that she would like to say a brief prayer with him, would that be okay. He said absolutely, and closed his eyes while she spoke a couple of sentences, then patted her hand and said thank you, I'll be seeing you later in the operating room. It really, really calmed her down. The anesthesiologist kneeling might have added a touch of drama, or scandal, or fervor or something, but honestly, what's the difference?

I'm not a believer now and wasn't back then, to a strenuous degree, and if I'd heard about the anesthesiologist kneeling with the patient I probably would've felt some kind of ridiculous outrage. Not anymore...weirdly, I've become extremely tolerant of belief. Whatever gets a person through, just don't press it on me. Of course he shouldn't have been fired. Talked to, maybe. Actually the more I think about it, the more I like the idea of what he did. Maybe it was courageous.

Posted by: Flautist | Dec 12, 2012 3:24:41 AM

I also wondered, like tm if it was a separation of church and state thing. I agree with the consensus, that the firing seemed unjustly punitive. I'd use the word sanctimonious to describe the chairman, but that's certainly wrong, he was self righteously anti-pious. I assume he would have thought it OK to comfort, hold a hand, speak encouraging words, but the moral superiority of science made any display of religion inappropriate. Strangely ironic. I'm even more surprised that you agreed at the time, Joe. What was your reasoning then, and what has changed for you?

Posted by: tamra | Dec 12, 2012 2:38:02 AM

This reminds me of the Simpsons episode where Ned Flanders takes over as school principal, which results in total anarchy. The suits from the district see nothing wrong with the situation until Flanders gives a blessing over the intercom:
Superintendent Chalmers: "Thank the Lord? That sounded like a prayer. A prayer. A prayer in a public school! God has no place within these walls, just like facts have no place within organized religion!"

I wonder since UCLA Medical Center is technically a public institution, whether they had a similar policy as Chalmers. But why can a chaplain pray with a patient, but not an MD? Is this like the white lab coats, to confer the image of science? (BTW: Total # of white lab coats I saw in physics research labs over 4 years: 0. Granted, the universe cares not one whit how we're dressed. Your patients, however, might find the t-shirt and shorts off-putting.)

He should not have been fired. Did the hospital not decorate for Christmas, or have a menorah around (this is West LA, right?)? How exactly was this act of prayer with a patient measured to be "beyond the boundaries"? Or was it just the personal policy of one chairman, who long ago, when receiving the two extra letters after his name, could never say the phrase "I'm wrong" again?

It was fortunate for him that the Trojans were in dire need of someone to be less bad (seems to be a recurring theme downtown...)

Medicine is based on science, but it is not a science. It is an intimate and important service.

Posted by: tm | Dec 12, 2012 1:15:43 AM

my reaction is no, he should not have been fired.

was there a documented rule stating prayer with patients was forbidden? if not, he should have been spoken to and given another chance, to stay or leave the hospital.

firing was brutal.

Posted by: rob | Dec 11, 2012 10:20:20 PM

I am a pretty extreme atheist and I see nothing wrong with the resident's behavior. If the prayer request was truly and completely initiated by the patient, this would seem no different than other bedside behavior that helps reassure the patient but is not medically relevant.

I too would be interested to know Medical Center's justification.

Posted by: Mike | Dec 11, 2012 9:53:21 PM

I've dealing with plenty of doctors in these past years due to sick relatives, and I have the sense that a few that I've encountered would have consented to pray with a patient who requested it--if just to make the patient feel better. It's too bad an older doctor who was well established didn't encounter that woman back then; he might have been able to grant her harmless request without losing his job. I'll bet there are many anecdotes among doctors of "what weird thing have you consented to do to help reassure an anxious patient" that would make this one seem kind of tame.

Or maybe things are a little more liberal today, which is why I don't see praying being the unthinkable act it may have been back in the early 1980s.

Thank you, Joe, for posting this.

Posted by: Ron | Dec 11, 2012 7:22:57 PM

Thank you for a well-presented and interesting narrative of a poignant event I, too, would have remembered.

Much time has passed, and one must now wonder whether the patient had or had not the time to avail the services of UCLA Medical Center's chaplain unit, many of whom's assigned clerics may have been on call, rather than on site all day.

Posted by: Vigilis | Dec 11, 2012 6:20:11 PM

When I am confronted with a situation like this

I open a bottle of some good Port

and sip it thru the night.

When I awaken

I ponder the question again

and repeat the process.

Posted by: JoePeach | Dec 11, 2012 6:12:13 PM

Are you kidding me? That kind of caring and compassionate doctor is what UCLA should be creating, not robots frightened of doing something that might be considered politically incorrect. This is not about a medical procedure, but about one person doing good for another. We're all frightened as we lie on the operating table, and if this helped the patient get through a traumatic experience, then good for the doctor. And, for those who believe in the healing powers of the mind, I'm sure the patient was far better prepared for his ordeal than one who had his request for a simple kindness rejected moments before someone opened him up. Shame on UCLA, my alma mater.

Posted by: cjc | Dec 11, 2012 4:55:40 PM

I'm with Nathan! Well said.

I'm surprised at Joe's conclusion. At the least, this case would seem to fit the commandment to "do no harm."

I was raised Christian, but after 65 years of life, I have finally given up on God – or at least the God that I see most Christians worshiping. Surprisingly, I feel much better for this.

It's not exactly that there is no God. But the things that we call God may actually be something else. I do not believe in magic, but I do believe strongly in unexplained phenomena. As Arthur C. Clarke said, any sufficiently advanced technology is indistinguishable from magic. I would substitute for the word "technology," "phenomenon."

All my life I have been – if not religious, at least very philosophical. I think there may be phenomena such as radio waves which would sound crazy 200 years ago if you told someone this box picked sounds and speech out of the air. That's a crazy proposition.

I think there are a lot of "waves" we are not aware of yet. And other things. Also, if matter and energy are the same thing, then it's possible that thought can actually work tangible results. I admit, that may be a stretch. Or what about the "midi-chlorians" mentioned in the Star Wars saga?

We do know that a good attitude is very helpful in getting people healed. So what's the harm in going along with the patient's wishes as in this case. I wouldn't call it an endorsement by the hospital of the patient's beliefs or anything like that. A harmless little activity that may actually do some good, if you ask me.

Posted by: PT | Dec 11, 2012 3:07:14 PM

Nathan, you rock!

Posted by: Virginia | Dec 11, 2012 1:23:12 PM

I'd be interested to hear the reasoning behind why anyone would think this behavior would merit dismissal.

Perhaps religious behavior is seen as superstitious and unscientific by the hard-nosed medical professionals at UCLA. But in what way does it reflect poorly on his ability to do his job? You don't have to believe in God or in the effectiveness of prayer to see it as a kind gesture.

If he had been forcing his religious views on others or offering unsolicited and unwanted prayers, that would be one thing. But to be asked to pray, to do so, and then get dismissed seems ridiculous.

Consider this quote by Bertrand Russell:

"If an opinion contrary to your own makes you angry, that is a sign that you are subconsciously aware of having no good reason for thinking as you do. If some one maintains that two and two are five, or that Iceland is on the equator, you feel pity rather than anger, unless you know so little of arithmetic or geography that his opinion shakes your own contrary conviction. The most savage controversies are those about matters as to which there is no good evidence either way. Persecution is used in theology, not in arithmetic, because in arithmetic there is knowledge, but in theology there is only opinion. So whenever you find yourself getting angry about a difference of opinion, be on your guard; you will probably find, on examination, that your belief is going beyond what the evidence warrants."

When I read that story, it makes me feel like UCLA Medical Center feel they have no good reason for their dislike of his behavior, so they fired him as a knee-jerk reaction out of anger.

Who's being unscientific now?

Posted by: Nathan | Dec 11, 2012 12:52:58 PM

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