Doctor, Patient, Object, Thing: A Story About a Surgeon and a Teacher

By Diane Anderson Harvey

The surgeon bounded into my life uninvited. He was thirty-nine, talented, charming, and a self-proclaimed yuppie. I was sixty-two, a successful academic, popular with my students, and a self-proclaimed teacher. We had little in common, my surgeon and I, except a vulvectomy: a surgery that he would perform and that I would undergo.

The vulvectomy was well done, the relationship was not. This is the story of that relationship.

Professor Diane Harvey weaves an engaging story about the relationship between a charismatic, confident, competent youngsurgeon in his late thirties and a popular, award-winning senior professor of philosophy. At first, the young man is her surgeon. As the story enfolds, she becomes his teacher.

The purpose of the story is to share thesensitive surgical journey of a patientwith others, especially those who are undergoing or have undergone personal female surgeries such as hysterectomies, mastectomies, and vulvectomies, and to engage the reader in a discussion about the effect on the patient of assembly-line surgery in which the patient is treated by the surgeon as an object.

While the emphasis is on personal female surgeries, any reader, male or female, who has undergone or is facing a surgery for life-threatening conditions, will be interested in the relationship between the surgeon and the patient. Certainly, however, this book is a must-give to your mother, sister, adult daughter, wife, lover, or partner and to any friend traveling the surgical journey.

• Language: English
• Publisher: AuthorHouse
• Release date: Sep 21, 2006
• ISBN: 9781467802888

Diane Anderson Harvey

Diane Harvey holds a Ph.D. in Philosophy from Stanford University and is Emeritus Professor and Dean of Menlo College, a small private college in Northern California.  She is an award-winning teacher who has created many unique courses in Philosophy, Psychology, and the Humanities. Professor Harvey is an experienced motivational speaker, known for her talent for simplifying and personalizing the big philosophical issues and introducing them through stories.  Currently Dr. Harvey is president of Life Journey Seminars which mentors individuals in small group settings and hosts philosophical salons focusing on ethical, political, and social issues. Diane Harvey lives in Northern California with her husband. They have two adult sons.  Besides her teaching and writing, Professor Harvey enjoys skiing, scuba diving, traveling, family, and all of the family pets.

Book preview

© 2006 Diane Anderson Harvey, Ph. D.. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

First published by AuthorHouse 9/14/2006

ISBN: 1-4259-4207-5 (sc)

ISBN: 1-4259-4206-7 (dj)

Library of Congress Control Number: 2006908198

Printed in the United States of America

Bloomington, Indiana

Contents

CHINA

TEACHING

THE INTERNATIONAL PROGRAM

FORESHADOWING

THE DIAGNOSIS

MY PHYSICIAN

DOCTORS AND TERRORISTS

THE SURGEON

THE DISEASE

PROTECTION

SONS

HUMILIATION

TRUST

RECOVERY

POSITIVE ENERGY

THE UNEXPECTED

DIFFERENT REACTIONS

THE CHANGE

THE HOSPITAL

AN ODD STORY

HOME

COUMADIN

PATHOLOGY

RUNNING BACK

INFECTION

FAILURE

DISTANCE

PROFESSIONAL RESPONSIBILITIES

THE WAIT

THE IMAGE

THE INTUITION

ABANDONMENT

FOREBODING

CRISIS

DEPARTURE

THREE BOATS

JANET

RUTHIE

DON

THE PHYSICIAN-HEALER

LONELINESS

ALICE

DIANE

THE SPIRITUALIST

WILL

SADNESS

PENNY

BEN

JUMP

FLAMES

FAREWELL

PAIN

HEALING MYSELF

RECLAIMING MYSELF

MESSENGERS

MOVING FORWARD

RESOLUTION WITH THE SURGEON

COMPASSION

ENERGY

CHARM AS A PLOY

THE MANTRA

THE BIGGER FISH

ASSEMBLY-LINE SURGERY

ANGRY WOMEN

THE MESSAGE

PERSON TO PERSON

ONE AMONG BILLIONS

IT’S NOT OVER YET

Dedicated

with great respect and appreciation to

My Surgeon and My Physician

and

with immense love and gratitude to

My Family of Healers

In memory of

my beloved mom

Phyllis Talbott Anderson

and

my passionate, sparkling sister-in-law

Penelope Harvey White

ACKNOWLEDGEMENTS

This book contains the story of a surgical experience that would lead to major changes in the life of the patient. The surgery was a vulvectomy, a rare female surgery. The patient was a senior professor of philosophy, dean and vice-president of her college. The surgeon was a charismatic, confident, competent, young man in his late thirties. The story is about the challenging interaction among the surgery, the patient, and the surgeon.

While the story primarily is about the interaction between the Surgeon and the Teacher, it leads to thoughts about the Doctor-Patient relation in general. The story is true as experienced by the patient. There is no intent to criticize the skill, talent, or professionalism of the Surgeon. Neither he, nor any of the other health professionals or institutions are identified by name and in some cases their descriptions have been changed in order to protect their privacy.

The purpose of this story is to share the internal surgical experience with others, especially those who are undergoing or have undergone personal female surgeries such as hysterectomies, mastectomies, and vulvectomies, and to start a discussion about the effect on the patient of assembly-line surgery in which the patient is treated by the surgeon as an object.

Many voices have entered this conversation so far: medical professionals, friends, and family. Readers are invited to join in the discussion. My greatest love and gratitude go to those members of my family who, as usual, provided the constant protection of a family: my husband, Dave Harvey, my sons, Will and Ben Harvey, my brother, Don Anderson, my cousins, Alice Anderson Smith and Ruthie Anderson, my sister-in-law, Penny Harvey White, and my long time friend, Janet Grant. Dave, Ruthie, Don, Alice, Penny, and Janet also are to be commended for the many hours they spent reading the manuscript in its roughest stages, long before it had its own voice. They were joined in their reading by other relatives: Anne Anderson, Catherine Anderson, Trish Harvey Grihalva, Pam McCormick, Dottie McCormick and Barbara Smith.

I had the greatest good fortune in being accompanied on this journey by a wise and caring female physician, who has my undying loyalty and thanks. Among the medical professionals who read the manuscript—and may or may not have agreed with it—are Catherine Anderson RN, Donald Anderson DDS, Barbara August MFCC, Barbara Korfhage RN, Thomas Krizek MD, Pam McCormick, PhD, George Sheldon MD, and, of course, the surgeon and the physician.

I appreciate, also, the spiritual or philosophical experts who read and commented on the manuscript: Marilyn Faulkenberg, PhD, former nun, now Professor of English, Sharyn Moore, Professor of Psychology, and Arlene Sutherland, PhD, former Unitarian Minister. Dr. Faulkenberg, an accomplished author, has read the manuscript many times and in its many different forms. Our Friday morning brunch discussions about both form and substance were a great pleasure for me.

The lovers of ideas and life who added wisdom to the manuscript include Peg Ankerbrand, Ann Bowman, Deveren Bowman, Sandra Conlin, Anne Flegel, and Kelly Stahl.

Finally, to my beloved former students of philosophy who read and commented on the manuscript, I acknowledge the full circle in which the student becomes the teacher and the teacher becomes the student. The new teachers are Suzette Bazar, Dean George, Cindy Grand, Jennifer McNitt Knoth, Sharyn Moore, Bahareh Sharghi, and Vanessa Siegel.

All of the wonderful people whom I acknowledge here shared in this adventure in some way—either during the experience or from reading the manuscript—but none of them are responsible for any mistakes of thought or written word. The fact that they cared enough for me to read the manuscript does not mean that any of them agreed with my ideas. It was enough that they were there.

Diane Anderson Harvey

San Mateo, California

April 7, 2006

FOREWORD

DOCTOR, PATIENT, OBJECT, THING, by Diane Anderson Harvey, PhD, is the author’s diary of illness, a remarkable, in-depth look at the everyday, but not routine, drama of patients and surgeons, interacting as they deal with illness. Dr. Harvey brings a unique perspective to the doctor-patient relationship. Her education in philosophy imparts the philosopher’s focus on human interaction under the stress of illness. Her experience as an international education administrator imparts a practical perspective on the complexity of human interaction. Her work, both as founding chair of the Philosophy Department at Menlo College and in service as a dean, has provided broad experience in dealing with a spectrum of individuals and their problems. As a result of this background, Dr. Harvey is able to describe her own illness with detachment, objectivity, and unique insight.

The relationship between a giver of care and a patient is complex. Each brings to the encounter disparate backgrounds, values, education, and expectations. Physicians are legatees of a professional tradition dating to the ancient world. The Hippocratic corpus, encompassing the standards of the Greek School, is over 2500 years old. The Hippocratic oath contains the elements of commitment to patients, a covenant, paternalism, reverence for the art of medicine and for colleagues and teachers.

The physicians’ code, described in the Hippocratic oath, has been influenced and modified by many forces, including religions and etiquette. During the Enlightenment, Hume’s sympathy and Gregory’s ethics blended with Baconian science to further mold the ethics and behavior of practitioners of medicine. Thomas Percival’s discourse on medical ethics was the basis of the ethical code of medicine in the founding charter of the American Medical Association in 1847. The Human Rights movement, an outgrowth of the Nuremburg Trials in 1947, is embodied in many human rights and patients’ rights legislation. It has influenced the doctor-patient relationship, also.

The physician’s challenge is to maintain his historic, fiduciary relationship with his patient, in the changing healthcare environment.

Modern medicine has within its power the potential for harm. The physician is always weighing the balance between risk and benefit. Among the first rules of medicine is primum non nocere; i.e., first, do no harm. The surgeon is a caregiver with the education and values of a physician. The surgeon’s unique role is physical intervention into a patient’s body, with intent to cure or relieve pain; it is an awesome responsibility, not shared by other caregivers.

The public expects health care to be delivered by knowledgeable, honest, and ethical practitioners. Patients bring expectations to the medical encounter that are influenced by their ethnicity, gender, religion, age, etc., and they have information gained from access to the internet and television. In recent years, the implied covenant between patients and physicians has been impacted by corporate, legal, and technological influences. The historical concept of paternalism is unsatisfactory for both caregiver and patient. Patient-centered health care is the goal of the modern health system.

When procedures or technologies are prescribed by the physician, the implied healthcare covenant is formalized by a written signatory called informed consent. This is one of the most important legacies of the Nuremburg trials. The Nuremburg Principles (1950), derived from the trials, require that no experimentation be performed on a person without their consent. This doctrine has evolved beyond research into everyday medical practice, as a required explanation of risk benefit ratios of the procedure proposed.

The legal and ethical concept of Informed Consent is the formalized communication vehicle that provides the basis of the patient-physician covenant.

The concept of informed consent is the cornerstone of doctor-patient communication. There is a point in the physician-patient discussion, however, where the emphasis of a physician has to change from being a defensive, legalistic listing of potential adverse outcomes to one of support. Some physicians err by conducting the entire informed consent as a defensive maneuver. If complications ensue, they often assume a posture of I told you so. A candor-based, informed consent is best done in the ambulatory care environment. A patient in a hospital setting, with a gown mysteriously designed to never fit, is in a vulnerable situation, and in need of reassurance rather than a defensive, informed-consent dialogue.

On a practical level, the relationship between a surgeon and patient is frequently determined by the complexity of the intervention and the outcome. If the intervention is simple, and has a good result, there is seldom conflict. If the procedure is complex, or the disease is serious, the potential for a complicated, strained relationship between physician and patient is more likely. Although no procedure is completely complication-free, statistics are always heavily tilted toward a good result. Patients, family, and physicians in most instances can and do assume that the outcome will be positive. The relationship between a surgeon and the patient, a dominant theme of this book, is challenged when complications occur. They occur as untoward events infrequently, but are part of the imperfection of medicine. It is important to note that although medical errors do occur, a complication is not an error, but a risk of the therapy.

Patients depend on their physicians to support and preside over their recovery, which includes dealing with complications. The patient may be frustrated at the delay in recovery and question the quality of care. Because unsatisfactory outcomes are infrequent, physicians may feel vulnerable or guilty if a complication occurs and may become defensive or less communicative. Unfortunately, that is the time when the needs of the patient are the greatest.

The current, insurance-driven, short hospitalization abruptly curtails the surgeon and patient working through the postoperative healing process. These early discharges to home usually work well but when complications ensue, such as the pulmonary embolus in this story, both patient and surgeon feel defeated.

Moreover, every surgical procedure initiates a complex metabolic and psychological response; the level of seriousness is quantitative and proportional to the magnitude of the illness and operation. The normal depression or sadness, which occurs after virtually every surgical procedure, is usually transitory. It is similar to post-partum depression. Postoperative depression worsens if recovery is prolonged and complications ensue. Occasionally, a surgeon’s capacity to manage severe depressive reaction is unequal to the task.

The author notes that as her needs increased, the capacity of the surgeon to meet those needs was exceeded. A threshold was reached beyond which the surgeon was unable to provide the support needed; he seemed to be distancing from involvement in the case. This situation is described in the book by the author’s observation that the surgeon abandoned being a caregiver and lapsed into a problem-solving mode. The surgeon, however, continued to be accessible to the patient; he did not, as sometimes happens, become unavailable and deserves credit for continuing to deal with the situation. In spite of this level of commitment, the patient perceived that he was unable to meet her needs. Issues of this nature are complicated by patients’ different expectations and needs.

The greatest fear of patients with complications is fear of being abandoned by their physician.

The author seeks better alternatives in the relationship between a surgeon and a patient than is described in her book. She argues for a more personal relationship between surgeon and patient in which the surgeon lessens his or her own emotional stress by being more involved in the concerns of the patient.

The core message of this book is the philosophical secret [of the author]: transcending oneself by focusing on the needs of others."

There are only a few books in which a patient describes and analyzes experiences in health care. DOCTOR, PATIENT, OBJECT, THING provides an unusual personal experience in illness. The analysis is unique because the patient is the author, armed with the tools of ethics and philosophy. That perspective provides the capacity to explain the illness and complications. It provides an in-depth analysis of a doctor- patient relationship under strain.

Profound changes are occurring in medical education. Two-thirds of obstetrician-gynecologists in training are women, and almost half of medical students today are women. For some patients, perhaps, the expanded option of gender choice will address some of the concerns identified in this book. Increased emphasis on communication skills and sensitivity in the education of physicians are enhanced elements of the evolving undergraduate curriculum. The graduate curriculum as required by The Accreditation Council for Graduate Medical Education (ACGME) now requires that education in all specialties include the Six Competencies. They are patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning, and systems-based practice. At the same time, as evolution toward a patient-centered health system occurs, patient and physician expectations, and understanding of available therapy, needs to be improved.

This book should be read by physicians, patients, and medical students. It defines the physician-patient relationship and its profound responsibilities. That relationship continues to evolve as patients, doctors, and therapeutic options interact in a rapidly changing healthcare environment. It is an environment in which social and scientific advances are occurring at the same time.

George F. Sheldon, MD, FACS, FRCS Ed(Hon), FRCS Eng(Hon)

Professor of Surgery and Social Medicine

Chair Emeritus of Surgery, The University of North Carolina at Chapel Hill

President, American College of Surgeons,1999

THE UNEXPECTED CHALLENGE

CHINA

The surgeon bounded into my life uninvited. He was thirty-nine, talented, Chinese, and a self-proclaimed yuppie on the fast track. I was sixty-two, Vice-President of International Relations at a small college, Professor of Philosophy, popular with my students, and a self-proclaimed teacher. We had little in common, the surgeon and I, except a vulvectomy: a surgery that he would perform and that I would undergo.

Whether it was due to a difference in age and life-experience, in focus on things versus people, in world-view, in our respective roles in the story, or in educational background and training, this doctor-patient relationship did not meet either of our expectations. The vulvectomy was well done; the relationship was not.

This is the story of that relationship. The story begins in China:

My mind was a long way from the most personal parts of my body in the spring of 1998. I had just concluded a four-month teaching assignment in Guangzhou, China and was living for a month in Beijing where I was teaching a course in International Business Ethics at Peking University. I had come to China to find her ancient wisdom; instead, my experiences led me to her people.

I was living in the university dormitory room for foreign visitors. It resembled the hotel rooms of B movies in the forties or fifties; gold was the pervasive color. The light came from two yellow