Erasing memories in the OR

Wow. What a story from Time’s Scott Haig. The reflexive use of propofol and it’s subsequent “erasing” of an uncomfortable memory in the OR.

Comments

Anonymous
Maybe it’s ’cause I grew up in the 1970s when the phrase “better living through chemistry” had happy associations — but if a similar time comes for me I want that anesthesiologist!
She still got the bad news, she just got it in a final form from somebody who was trained to help her know what to do.
Anonymous
That poor woman’s news was horrible regardless how it was broken to her. Was the news any less memorable/horrible if broken to her in a sterile office or hospital room?
I think it is indicative of doctor’s general inability to really help people that they presume to psychologically manage the bad things against which they are powerless.
Mitch Keamy
The news IS less horrible being received in a supportive atmosphere with family there; as an anesthesiologist, I can tell you that an OR is a cold, hard place to try to process this sort of stuff. As to the gnashing of teeth in the article over the manipulation of memory, I am much more concerned with the manipulation of “memory” that takes place on network TV news and media programming designed to craft public opinion. As clever a drug as propofol is, Time Inc and the rest of the media business are ten times more so; I can’t craft memory; only erase five minutes or so, at the price of transient unconsciousness.
Doctors help plenty of people, anonymous #2; but we can’t do everything for everyone, and we mostly don’t seek to “manage” psychology; unless you consider compassion a management tool…
Sid Schwab
It’s interesting to consider what would have happened had the pathologist gotten the word and waited to give the news over the phone. If so, the surgeon undoubtedly would have been met with the question “what did he say,” in which case he’d have had to give that bad news in only a marginally better settting — ie there in the OR or in the recovery area — or lied by saying “they can’t tell yet and we’ll have to wait…” I think the ethics of what happened would be muddier if the information was erased and never given (which would, of course, be impossible.) As it is, it may have been essentially a reflex on the anesthesiologist’s part, but it led to the proper outcome — namely the giving of the information in an optimal setting.
Anonymous
Excuse me, Dr. Keamy, but that anesthesiologist committed an illegal assault and battery on the patient. She did not consent to any sedatives, thus the unconsented introduction into her body of those drugs was A CRIME. The anesthesiologist should have gone to jail.
Further, as long as you’re not concerned about the pharmacological manipulation of memory, I suppose it’s not a problem.
As for your banal paranoia about the manipulation of the “TV media”–well Katie Couric never came out of the TV to inject me with anything.
“Doctors help plenty of people, anonymous #2″ Do they? It’s well known that aggregate spending on healthcare has little effect on macro-health indicators once diet and exercise are factored in.
If doctors stopped thinking they do so much good, perhaps they’d feel less entitled to essentially commit an illegal assault and battery on individuals.
T. Bruce McNeely
Anon 4:21
She did in fact agree to “some sedation” if it was deemed necessary. I think this consent covers what the anesthesiologist did.
Incidentally, this incident exemplifies why , as a pathologist, I never use the intercom for frozen sections. I usually go to the OR in person, or occasionally use the phone. This also allows much better communication with the surgeon, as well as avoids breaches of confidentiality.
Mitch Keamy
assault and battery-oh nonsense. The care of an anesthesiologist in the OR comes with a consent to sedate based on the anesthesiologist’s judgment; no anesthesiologist will care for a patient on any other terms.
Anonymous
“She was adamant about not going under, but agreed to “some sedation” if we thought it was necessary.”
I would say that the poor woman did not agree to complete, consiousness-loosing sedation– particularly for the purpose of saving the doctor from embarassment/ difficult situation.
As you no doubt know, doctors, ANY drug carries risks. The poor woman probably accepted the risk of sedation for incredible pain–not to save the doctor from embarrassment or difficulty or his perceived psychological good for the patient. Ahh . . . but in the end doctors don’t like people making decisions.
Bruce
From a surgeon’s perspective, the frozen section is performed to make certain that the biopsy is adequate and to make certain that the procedure doesn’t need to be extended. The pathology report isn’t complete until the final permanent slides have been interpreted. THAT is when the diagnosis is shared with the patient and family.
The compassionate, ethical physician gives an honest report as soon as possible with a plan and hope.
I admire the essayist’s candor and insight, and I hope we would have thought quickly enough to do the same. Even still, I suspect the team would have handled the situation compassionately even if retrograde amnesia had not been available.
scalpel
Please let us know when you present for medical treatment so that we don’t mask your pain unnecessarily.
Anonymous
As a patient who has had versed (is that the same medication you are talking about?) many times, for repeat EGDs I don’t think what he did was wrong at all. But, I also didn’t know it would erase your memory for things that happened prior to being given it. When I have had it, I remember the doc putting it in my IV so how is it that it erases 10 minutes of time before it is given?
Anonymous
As someone that’s been in the position of getting the news you have cancer and knowing what that means, knowing how that felt. Under a situation such as this one. I would want him to do that for me. It’s going to be bad enough to face, but to hear it broadcast in that cold sterile environment without your loved ones there beside you, who love you, alone, draped and defenseless. I’d want him to do that for me.
Anonymous
The way the patient was described in the story, she was getting hysterical, shreiking, when she accidentally heard the bad news, broadcast on the intercom because of a misunderstanding. Under the circumstances, not hard to understand.
Patients sometimes panic or otherwise get unruly under local anesthesia. They get claustrophobic, can’t hold still, they get sore laying down, try to sit up and go home, etc…….even when things are going well. If the anesthesiologist felt things were getting out of control, no one would blame him for giving the Propofol.
UroCanswer
This is the type of situation that is never written in textbooks or fit into a “protocol” or “algorithm”. It requires JUDGEMENT. This is the ART of medicine. In that 1 second, the anesthesiologist saw the woman’s hysterical reaction, and recognized a dangerous situation in the OR. He took prompt action that prevented her from: becoming more agitated, falling or jumping off the OR table, lashing out at people around her, knocking over instruments (including scalpel and local anesthesia needles, etc), and becoming overly distraught to the point of having to be physically restrained or tied down. Imagine hearing this news, and then having people forcibly hold you down and tie your arms down so you don’t fall or hurt anyone (including yourself). How traumatic would that be to your psyche? I applaud that anesthesiologist’s razor sharp thinking, his foresight in having the propofol ready, and his quick finger in pushing it when needed. In some systems, this sounds like the type of surgery that would easily have been assigned to a CRNA. I’m sure the surgeon was happy to have that anesthesiologist on board that day.
Anonymous
The anesthesiologist had to make a snap judgement. Anyone who has ever been in his place knows it was the right judgement. Yes, I’ve seen patients get unruly under local anesthesia in the OR.
“Oh my God”, hand to the chest, now it’s a contaminated surgical wound going to bone.
To be honest, I don’t even get the premise of the article. There is no ethical problem here. She agreed to “some sedation” if the anesthesiologist felt it was necessary.
The anesthesiologist gave her some sedation. He felt it was necessary. Anyone in that situation would agree.

Erasing memories in the OR

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