Tuesday, October 24, 2006


Dr. Evil,

This letter will contain a critique of my PEG-insertion surgery which may cause you to react defensively. I urge you to restrain that impulse, because my comments are intended to improve your future treatment of patients.

I obtained a favorable impression of you when my wife and I met with you. I trusted you. The fact that you used a Macintosh, as I do, when PCs are nearly universal, made me think that perhaps you were willing to think for yourself, to buck the trend of hierarchical doctor-patient relations, in which the expert does unto the inexpert without regard to the needs of the patient, without unnecessary, time-wasting, overly-sensitive communication.

I trusted you. You said that I would be given valium to reduce anxiety, and local anesthetic to reduce the gag reflex. You may not have said that I would be too drugged to care what was done to me, but that was the impression I got.

When the surgery happened, I was put in wrist restraints (surprise!) I gather that you avoid telling patients about this in advance in order to reduce anxiety. There are other ways to keep hands away from the abdomen, and I surmise that the real reason for the restraints is to prevent people from trying to grab the probe that is inserted in their throat. But the restraints did not worry me, for I still trusted you.

I heard you give the order to administer some kind of drug. Perhaps it was the valium. It did not change my mental state at all, it only made me yet weaker and perhaps drowsy.

A process suggestion: If you do give any drugs intended to reduce anxiety (and I have no experience to indicate that you do), please 'test' the patient with conversation and mildly alarming actions to determine if they are 'stoned' yet.

I have a major speech impairment, and many of your other patients probably do too. A process suggestion: Institute a way to communicate with the patient to determine if they have urgent concerns. Prearrange some signals. I could have pulled on a cord or dropped something loud.

Yes, these suggestions increase the length of the procedure, and yes, it might induce some few patients to stall, or even get more anxious. But you're a professional, and you can handle those situations adroitly.

As I mentioned, the valium, if there was any, did not change my mental state at all. But I was calm, because I had confidence in you. There was no local anesthetic to reduce my gag reflex. You folks did not announce any, and did not apply anything to the back of my mouth.

What happened next was torture. You're familiar, from the news, with 'waterboarding' -- making someone think they are drowning. The probe was put down my throat, and I did manage to endure that. But I have a lot of saliva, and I have a weak palate that tends to close, like a flap, over my airways -- including the ones from the nose. I had recently had an episode of near-asphyxiation in which thick saliva combined with the weak palate to nearly strangle me to death. As you might imagine, that was unpleasant.

After the probe was out, the saliva pooled over my air access. Each time, I was able to cough it away. However, each time I was about to draw a breathe after the cough, cruel irony made one of your staff immediately suction me. She saw the cough as a signal that I needed suction. The suction blocked my airway, and redistributed the saliva over my airway. That's not what is supposed to happen, but it did. She was trying to help me, but she prevented me from breathing enough air. Each time I exhaled, I looked in her eyes and tried to form the word "air!" She never understood, nor showed any interest that I might be trying to say something. My guess is that she thought she was dealing with yet another overanxious patient.

It's not sufficient for you to say that you monitored my blood oxygen level and that it remained ideal. If that's sufficient, then let me hook you to a machine that oxygenates your blood, while I tie a plastic bag over your head. The sensation of asphyxiation is very real.

It's also not sufficient for you to remind me that you warned me that nobody likes having the probe down their throat. As I mentioned, I endured the probe, unpleasant as it was. The well-intended waterboarding afterwards was the real torment.

Please do not narrow this down to an issue with the suctioner. You are responsible for the entire procedure, including the lack of communication.

I repeat that some form of patient feedback during the procedure is essential.

I do not appreciate your comment the day after the procedure, where you said I have a need for control, and that at a certain point, your team had to take control of me, which I must have found unpleasant. I am not the problem. My need for control was overridden by my trust in you. I trusted you, and you tortured me.

As it now stands, I would not urge fellow patients to have a PEG. If you can assure me in writing that you have implemented my process suggestions, I may change my mind.

I understand that the PEG tube wears out after a year or so, and needs to be replaced by a similar procedure. I fear that procedure and am of half a mind to refuse it, regardless of consequences.

I know that you're not in charge of PEG design, but I have a suggestion anyway: See if you can encourage the development of a PEG that has a tube that can be replaced by an external procedure. In my mind I see the a hollow, hard plastic tube with appropriate ridges protruding from the abdomen. Onto this would be mounted the flexible PEG tube, with appropriate clamps. If such a PEG exists, offer it as an option to patients. I predict a 100-percent adoption rate. The current design is asinine, as it requires surgical replacement.

I hope that you are the surgeon of my first impression, who, rather than dismiss these comments intended to improve your future treatment of patients, will find value in them.



cc: sexy lady doctor, clinic director
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