AN ETHICAL CONUNDRUM OF THE UTERINE KIND

I was a little loathe to even take up this subject here. Especially since the conversation below comes off perhaps a bit crass or callous.

On reflection, though, having given the story more thought, I think that the larger context of the issue is worthy of consideration. Was this woman violated intentionally (being the biggest question) or even unintentionally?

We have to (well, I have to) start with a working premise that patients have a basic right to be treated with dignity and respect by their healthcare-providers. Granted we all work on the assumption of some level of decency between any two peoples' interaction, but in a larger arena of dependency such as that which often exists between patient and provider, higher stakes are involved--so we take the trust more seriously.

The field gets tricky when we begin to explore and question just what is involved with the give and take of a patient's basic right. In this instance, the woman in question is suing for mental and emotional distress brought on by learning that her doctor 'branded' her uterus with the UofK insignia during a hysterectomy procedure. My initial reaction was disgust and revulsion that anyone would do such a thing...my knee jerk "no harm, no foul " second reaction didn't really ease my dis-ease with the incident.

Reading further, though, I learned some additional facts and data that really have the makings of a down and dirty Ethical Conundrum...

conundrum

n : a difficult problem [syn: riddle, enigma, brain-teaser]

On with the conversation and we'll do a little follow up on the flip side...

The Breaking Story

Followup With Graphic Photo (you've been warned)

The Conversation: (news story referenced in this conversation )

c: "Doctor Defends Branding Woman's Uterus"

bow: eeewwww

bow: why would he do such a thing?

...[irrelevant text about bottle washing removed]...

c: Did I mention that the 'brand' in question was the Uof Kentucky initials?

c: Cause he's a booster..

bow: no you didn't

bow: who the hell is ever going to see it anyway

c: His defense is that it's a routine part of a hysterectomy...

bow: uh huh

c: Noone [will see it],[Bow]...it was a hysterectomy

c: ie ...all gone bye bye

bow: it was involuntary.

c: I admit, that the thought crossed my mind too...

bow: he's probably gong to lose his license as he should for that sort of thing

c: the "what the hell? it's medical waste, Babe"

bow: heh

bow: well, I didn't think that all hysterectomies were total

c: ...but I guess that I join the ranks of those who prefer that their doctors NOT use my body parts (however transitory ) as a graffitti play pad.

bow: she could be a UT grad and be very pissed

c: LOL

c: So, would her lawsuit fall under the GW categorization of a frivolous medical lawsuit like he spoke of in the SOTU?

bow: As a Harvard grad, he knows the importance of being true to your school

bow: I just got myself all riled up on that one. It reminded me that he IS a harvard grad! sheesh

c: Whatever, blah blah I hate GW blah blah. oohhh...Doc goes on to say that using the Uof K insignia to mark the midline was "...Honorable since it made reference to the college of medicine where I received my medical degree"

bow: ya ya, what a dink

c: OMG...I dunno, [Bow]...this operation took place a YEAR ago...she and her husband were recently 'watching the video tape' of the operation...

c: How's THAT for a slow TV day...

bow: ROFL

c: errr...TV Prime Time night...

bow: gee honey, let's watch the video of my hysterectomy.

c: and what the hell are you doing with a video tape of the op? to checkup on the doc? and more to the point, WHAT possesses someone a year later to pop it in? Why not right away if at all?

c: I'mnot entirely convinced that this guy should be strung up...

c: I mean, sure on it's face it kind of creeps me out...

c: but then, what about all the weird little work rituals that *I* have that my clients DONT need to know about? That really has nothing to do with the end work product..

bow: no, not really, but branding my body parts, regardless of their continued usefulness, borders on the Mengele scale

c: am referring in this instance to the ones that Do Not involve throwing darts at their logo or sticking pins in their stock ticker

bow: heh

c: okay, but...what I'm getting from the reading is that ALL or MOST surgeons have to make some sort of a mark that distinguishes the midline and points out which side is which...

c: so....since EVERY uterus being hysterectomized is going to be 'branded' /cut/marked...

bow: that puts new light on it. I guess it doesn't matter what sort of mark it is

c: should we get really bent out of shape that he uses the Uof K mark every time?

bow: that goes back to my UT alumnus comment

c: sure, but what self respecting UofT grad is going under the knife of a Uof K doc if they feel that strongly about it? Hmmn?

bow: maybe there should be a section on the surgery release forms for desired moniker

c: I have a feeling that after this incident there will be...:(

bow: White Supremicist chicks can get a Hackenkreuz, Hippie chicks a Peace sign...

c: Thereby boosting the price of the procedures through the roof...

bow: ya, cuz now the docs have to be graphic designers, too

End Conversation

I'm still muddling through the brain work on this one. I'm sure that it was quite shocking for the woman to see her uterus on TV with a great big UofK burnt into it. But then, What wouldn't be shocking given the context of popping in a tape to witness your insides in glorious technicolor? What type of mark would not make you reel given that it is seared into your own flesh? And I think that it bears mentioning that the uterus for women is a pretty intimate and focalized part of, well, their 'woman-ness'.

However, I am also largely inclined to think that the doctor meant no harm or even that he thought anything wrong with his action at the time. After all, the lady went home with a video tape of the procedure...and, most telling--he was going to have to laser/burn/brand SOMEthing there during the procedure. This is a markedly different case, imho, than the doctor who carved his initials into his patient's abdomen. That was a permanent scarification into living tissue by a mentally disturbed man. This was, let's be real, a necessary action (the marking) perfomed in a ritual/habitual manner (using the UofK) on diseased tissue that was detroyed as medical waste over a year ago.

As I hint at in 'the conversation', there are certainly work habits of my own that would not pass close scrutiny should they be revealed to clients and co-workers. But they are quirks; some with a work purpose and some whose purpose is sheer sanity-saving levity.

For example, how would it go over if a certain Program Manager were to learn that whenever I attend a meeting with her I wear special undergarments? Yep. I took a sharpie to them and neatly wrote "HUMOR THE BITCH" in bold lettering. I shit you not. When updating troubled project client contact info, I have a bodycount icon that I affix to people cycled off the team. And I smoke on conference calls. And hit mute and answer emails, IM's and compile reports. Yeah--that's gonna fly, right?

But here's the deal...I don't miss a beat. That Program Manager loves to steal my work. And it garnered her a healthy bonus this year, too. Bigger than mine, I promise you. And my clients keep me around and keep coming back because I herd the cats and navigate the storms for them on their kajillion $ projects so damn well.

Could I do this without my quirks? Errmm--yeah--probably. And I'd probably jettison them post-haste myself if I thought that they would ever negatively impact, or cause hurt or harm to anyone...

...Just as I suspect that this Doctor feels terribly that he caused a patient upset, and will probably stop using his UofK. But with what shall he replace it? And though he probably will anyway at this point, should he be forced to? Or suffer the loss of his reputation and career because of what he did? I'm not so sure.

Here's a patient who had possession of the tape for a year. The procedure appears to have gone well (I haven't heard otherwise, anyway). There's been no data reported that indicates a malicious intent in the use of that mark (ie he's not on tape humming the fight song and announcing his intention to preserve the organ in a jar for the office). She is alive and well and walking the planet. He is a UofK booster. The uterus in question is long ago gone.

So why couldn't it have played out as follows?

ring ring "Doctor. I just watched the tape of my surgery and you burnt a huge UK in my uterus. What the hell is that all about? I'm very upset!"

"Oh dear Ms. X, I'm terribly sorry to have upset you. In any hysterectomy, we have to mark the uterus to ensure that I remove it safely."

"Oh yeah? What's with the UofK, though? How does that have anything to do with it?"

"The UofK you saw is the right shape to guide me, and, well, it sounds silly I guess, but it helps remind me of the hard work I put in at school to be helping people like you with my medical skills today. It's just a tool."

"Well. I don't know...That was very shocking to see!"

"I feel so badly that you were upset. I imagine that the tape of the surgery itself was pretty hard to watch. It probably raised a lot of questions for you. Speaking of which, may I ask why you are just now watching it? Are you feeling alright? Have you been experiencing pain?"

"Oh. No. I feel fine. I guess I just thought it was time to watch the tape. And then when I do, I am confronted with..with this!"

"I see. Ms. X. Why don't we make an appointment for us to view the tape together? That way I can narrate and explain what is happening and why. Would that be okay? Or is there something else that I could do to help reconcile this for you?"

But we don't hear that anything like this happened. No. Instead, there's a lawsuit and a huge media scandal and for all that Ms Stephanie Means claims it's about not having this happen to other women, I am guessing that her "unspecified damages" have a lot of zeroes in them. 

So what is the ultimate barometer for patient dignity? At what point has anything about this lawsuit approach been 'diginfied'?

Hey...I'm Pychoti...err..I mean Psychic!:

Late breaking news on this story includes the woman speaking out.

Highlights include;

"I am surprised that was demeaning in any way. I would apologize, but it was not intentional," Dr. Guiler said.

and...

"To him this was a piece of tissue, but to me it wasn't. This was the home of my children and was an organ that conceived children," said Stephanie.

He noted that he will continue to perform hysterectomies in this manner. Her attorney notes that 4 more women want in on the lawsuit.

She claims that he should have 'asked permission' first. (aha! per 'the conversation' here comes the extra red tape) But that would imply that he was doing something out of the norm for that procedure. Or, that each step of a procedure must be vetted and pre-approved by a surgical patient. Where does that leave emergency medicine which can be excruciatingly 'undignified' in the rush to save a life.

To step it way down on the emotion-meter, isn't this the medical equivalent of demanding, for instance, that a hair dresser would stop with each lift of the scissors and ask, "may I cut this part here? I'll be doing it like-this. If that's okay?" I mean, supposedly, one of the reasons you're sitting in his/her chair is that you have a degree of certainty that this trained professional can get the job done...I used the hair dresser example specifically to segue into this next illustrative story...

I have a friend who is pretty high-zoot in the salon scheme of things. Now, when you apply color or bleach to hair, you have to make certain that oxygen reaches all the strands or it won't develop--okay? Well, my friend's quirk is to transform the upscale businesswomen in his chair into punkrockers, bunny rabbits, elvis, and a range of other goofy-looking characters with the stiffy color gooped hair while they process...That's just how he likes to remember the aeration part of what he's doing.

Sometimes the women will complain. He lets them know, "You look silly now anyway, Dear...but this way I can look over an know that everyone's been done and that; bunny needs rinsing first, then check on Elvis and spot apply to punkrocker to get all her roots. If you've got a better system, sister, you just fill me in...or I suppose I could just wing it. You are beautiful, Girl...but you know you have to Suf-fer for that beauty.." He really does talk trash to them and gets away with it...He also what a world. I digress...

My point is not to say that having a hysterectomy is like getting your roots done--not at all. But there are some reasonable parallels here that are worth examining.

After much consideration I think that the woman suing the doctor is way out of line. I can understand her initial upset and unhappiness. However, I think she's blown it out of context. This doctor provided her (to all appearances) with appropriate medical treatment. To come after him in a lawsuit for an act that was not malicious nor harmful seems a poor choice for handling her emotional distress. 

US juries can be a voilatile bunch, though. It may just be that the woman's lawyer is counting on a swift settlement. Should the doctor or his malpractice insurance company not want to risk an easily swayed or medically unsophisticated jury, that might be a good bet on the lawyer's part.

Time will tell, and until then, I offer you the ob/gyn waiting room of the future. Swathed tattoo parlor style with flash of personal-choice insignias for all your surgical needs. Good thing too cause you'll be here for hours completing the paperwork before the final escrow-esque signing and initialling of the ream of consent forms prior to ever meeting a doctor.