Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

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Going Home…I Think?

Hospital

Hospitals are absolutely no place to get a good night’s sleep. Even with the door to my room closed, the noise in the hallway at 4:00 AM was deafening. It seems that the patient in the room next to mine had a crisis to which the entire hospital seemed to respond. I was awakened by the shrill scream of one of the nurses, “Help me, I need help. I can’t do this alone.” She repeated this cry with some minor variations for about three minutes. It was enough to wake the dead.

I am scheduled to go home this morning. I am now waiting for the urology docs to arrive to release me. Up until today, my urine was clear but this morning it was a bloody red color. This morning, however, the catheter bag is filled with a bright red colored urine. I don’t quite know what this means, other than the simple fact that I am bleeding and the blood is finding its way into my bladder. I hope this doesn’t mean that I cannot go home until they figure out what is going on. On the bright side, the pains caused by the infusion of CO2 is much better. After the vampire came to draw some blood, I took a walk around the hallway and had absolutely no pain. These are the facts, the raw data. Now it is up to the chief resident and my urologist to determine if the bleeding is significant or not. I will project no further.

Here I Am, waiting in proximate space for the urology team to arrive. I decided to do something productive with this waiting period so I write my first coherent blog post in two days. I think that I want to comment on the bureaucracy that is in the hospital and how crazy some of the rules are. I start with the dispensing of medications. Yesterday, the day nurse came into my room at 7:00 AM with one pill I take on a daily basis. The problem is that I have a regimen of seven pills I take every morning and four that I take in the evening. I asked her why she didn’t have my full morning regimen. She told me that she would be back at 8:00 and again at 9:00 to complete the entire cycle. I asked her why this is scheduled so as to provide extra work for her and anxiety (not really but I thought it was important to mention it) for me. She just shrugged her shoulders and smiled. I would like to meet the genius who decided on this practice.

I could provide more examples but I’d rather concentrate on the effect of the modern bureaucratic design and just how that bureaucracy effects the patient/staff relationships. Bureaucratic organization reduces each task in the hospital to a specialty to be performed only by people with the proper credentials. It is the job and not the person performing the job that is important. As an example, I have now had blood drawn early in the morning by three different phlebotomists and one nurse. Is there any chance that, as a patient, I can develop any kind of relationship with the person drawing my blood? Down the line, after the blood is drawn, it is sent to a lab where a lab tech runs the blood through a machine which, in turn, spits out a set of numbers. These numbers are then sent to the medical team who, I believe, are not acquainted with either the phlebotomist drawing the blood or the lab techs running the tests on that blood.

This one example goes to the core of the bureaucratic organization that is designed to create a distance between patient and hospital staff. This scientific detachment is, I believe, creates a space in which errors are bound to occur. Doctors write general orders even when patients have specific medical issues that my be contrary to these orders. Nurses, while working with these standard orders on a daily basis, cannot be fully aware of the special needs of individual patients because they are trained to be scientifically objective rather than be an empathetic care provider. The very organization of the hospital is designed to reduce the individual patient into the same so that the interchangeable providers of care don’t have to think a lot about individuals. Hospitals, in this sense, are clearly bastions of modernity designed for efficiency and economy.

This is, of course, the very reason I anticipate going home, where my recovery from surgery will be provided on a human level.

FLASH: The urology team just left my room. I am going home. I expect to leave the hospital around 9:30 AM and be home around 11:00. YEA!

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Science and Postmodern Ethical Response

I [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or GFDL (www.gnu.org/copyleft/fdl.html)], from Wikimedia CommonsScience depersonalizes the individual; it addresses the exterior as a statistical body without regard to the individual human being.  In this sense science is impersonal, detached and objectivist.  Medical science speaks in terms of cure rates, mortality statistics and efficacy of treatment options all based on access to controlled experimental data and other statistics gathered through data collection in the field.  The goal of medicine, it appears, is to reach optimal cure rates with the fewest side effects based on a large and robust data set.

This does not mean that there are not going to be side effects of any treatment option; in fact they occur in x patients per 100 treated.  If the statistics call for a 10% possibility of any given side effect of treatment then 10 out of 100 patients treated will absolutely obtain the side effect in question.  It is a matter of numbers and a random luck of the draw that determines whether or not a side effect will occur.

The human being, the patient, is objectified into a group of patients for which treatment is offered.  The patient is a statistic, one that will comply with a normal range of expected results.  It is a matter of simply waiting to see which place on the bell curve any individual falls as treatment is administered.  No matter that a doctor will say, “We treat patients, not statistics,” they cannot escape the fact that the options offered are based on the statistical efficacy of the selected treatment.

All this means is that medicine is a-ethical.  It does not reach the standard of postmodern ethical obligations because it fails the test of humanizing the patient being treated.  In around four weeks, for example, I will undergo a robotic resection and removal of my prostate.  I will lay on a table with a robotic machine at my feet and my surgeon sitting at a control console somewhere in the operating room where he will control the robot as it performs the surgery.  In fact, the surgeon needn’t be in the room at all; he could be in Amsterdam or Melbourne and still perform the surgery if his console was linked to the robotic machine at my feet.   This places the surgeon two steps removed from the patient.  The surgeon need not look at the patient, only at the camera view of the insides of the patient, in order to perform the necessary steps of the operation.  The patient is objectified, turned into a piece of meat, and in doing so, is no more than a statistical probability.

Postmodern ethical relationships require a face-to-face responsibility (being responsible for the other even to the extent of being responsible for the responsibility of the other) which, in turn, may or may not elicit an ethical response.  The responsibility of the self is one that is given without reservations or expectations and once given, once announced, creates a state of proximity or waiting that is only interrupted by the commanding voice of the other.  While, entering the operating room, I may present myself as an ethical human being, what I am met with is a cold, sterile (in every sense of the word) environment filled with masked men and women, beeping machines and bright lights.  The room itself is uninviting and the people around me are cogs in the surgical procedure, each one with a professional task to perform; each one following a pre-determined procedure designed to depersonalize the procedure itself.

The operating room is far removed from the postmodern ethical stance.  But, it must be that way because if it were to somehow become a subjective space where ethical commands can be acted upon by individuals involved, there most certainly would be chaos; the last thing one might want in a surgical stage.

In the final analysis, it is clear that some things are best seen from an objectivist stance while other things must follow a subjectivist approach.  They are not mutually exclusive.  Each has a place and each must work within the boundaries acceptable for the practice.  So I will be objectified as I enter the surgical suite, put to sleep and violently operated on.  The ethics begin when I wake from the procedure and present myself to the nurses that will care for me during my hospital stay.  I’m fine with that!

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