The surgical shot
The recent murder of healthcare workers in the United States is a reminder of what is at stake for doctors for whom workplace violence has become a professional risk.
American accuses surgeon of back pain after spinal surgery; kills him and three others,” shouted the headline that made the rounds in the news recently. A patient with a gun had shot his doctor at a hospital in Oklahoma, one of the most developed countries in the world, destroying lives full of promise. He was reportedly unhappy with the unrelenting pain following surgery performed a few weeks earlier. He had bought a gun hours before his despicable act was unleashed and had killed the surgeon, his colleague, the receptionist and a passerby who had taken a bullet for his wife, robbing four people of the gift of life.
Many people have asked me why I came back from the United States after training there for a few years, and I think I finally have an answer. More than two-thirds of pain specialists surveyed in an education session on violence at a 2019 American Academy of Pain Medicine meeting said a patient had threatened them with bodily harm at least once a year. Almost half said they had been threatened for opioid management.
“If guns were legal in India, we would all be dead by now,” a doctor I know commented, when headlines made their way through WhatsApp circles. Indian doctors are also no strangers to violence. Over the years, the news has been full of reports of brutality against people in the fraternity, but like all scoops, it only remains a problem until something more sensational happens.
An article published in a psychiatry journal states that “The Indian Medical Association suggests that up to 75% of doctors have faced some form of workplace violence, which is similar to rates in some other countries on the continent”. This violence can include telephone threats, intimidation, verbal abuse, physical but non-injurious attacks, physical attacks causing simple or serious injuries, murder, vandalism and arson. “Healthcare professionals who are confronted with violence are known to develop psychological problems such as depression, insomnia, post-traumatic stress, fear and anxiety, leading to absenteeism,” quotes the British Journal. of General Practice in a 1994 article – nearly three decades ago. !
When I was training as a resident doctor, I once walked into the room to fill out paperwork for an elderly gentleman who had died of a complication not directly related to surgery. Her crying son aggressively grabbed me by the collar and shook me until my teeth chattered. “You killed my father! he yelled in a voice I hear echoing through his bloodshot eyes to this day. I was momentarily stunned, but soon realized where this uncontrolled hysterical outburst was coming from.
I remember not too long ago the clergy of a religious sect was brought to the emergency room of another hospital with a flat line on the ECG. The staff did everything to resuscitate him, but his heart attack was massive. His supporters smashed ERs, destroyed glass and damaged monitors, causing a colossal loss to the hospital’s overall infrastructure. We’ve all seen CCTV footage showing relatives of patients cornering and beating resident doctors in public hospitals. A statement from the popular American newspaper JAMA written 130 years ago, in 1892, still rings true today: “No physician, however conscientious or prudent, can say on what day or at what hour he cannot be the object of an undeserved attack, malicious accusation, blackmail or suit for damages.
Illness, when confronted with us or inflicted on loved ones, evokes a plethora of emotions. We have all, at some point in our lives, cursed a doctor. In the space of two consecutive days, feelings towards a doctor can change from intense affection to extreme anger. Sometimes you can hear it in their voice, sometimes in their eyes. Of course, patients and families have a right to be angry when things don’t go well. As physicians and surgeons, we understand this. We recognize that when patients are not getting better, there is anguish and distress. I also realized that good communication often alleviates most concerns, even if uncertainty can linger. Violence stems from ignorance and hatred, when instead we should strive to learn and reason, the much needed antidote to impulsive behavior.
I had patients who were not satisfied with my treatment. I had results that were less than satisfactory (to put it mildly). However, I have always strived to find a solution that makes my patients better than they were before they came to see me. If their problem is beyond my basic skills, I refer them to the right specialist, and if it’s a complication of previous surgery, I seek a second opinion. It is imperative for a physician to go above and beyond in an attempt to relieve suffering by being true to himself and his patients. Most doctors do it, and most patients can see it.
Pain is multifactorial and remains a complex problem to treat. If the main problem is not adequately addressed, the long-standing pain is hardwired into the brain. Neuroscientists are now determining networks that could modulate these circuits through transcranial magnetic stimulation and relieve pain. Soon we may be able to use this technology to change the minds of those who want to shoot us.
Egaz Moniz, a 20th-century neurologist who won the Nobel Prize in Psychosurgery in 1949, pioneered the now obsolete procedure of frontal lobotomy to cure mental illness. His belief was that the surgical removal of white matter fibers from the frontal lobe would improve a patient’s anxiety and depression. He was shot several times by a patient with schizophrenia and lived the last 15 years of his life in a wheelchair, until his death from internal bleeding in 1955.
“Love is the only way to save mankind from its ills,” wrote Leo Tolstoy, one of the most prolific writers of his time, in a letter to Mahatma Gandhi, affirming his plea for no -violence. Violence in all its forms, in all areas, must be reprimanded. This is simply not the way a civilized society can progress. As legendary composer Leonard Bernstein said when addressing the country’s most distinguished artists, writers and other public figures days after JFK’s assassination: “It must be the mission of every man of good will: to insist, relentlessly, at the risk of becoming a repetitive boredom, but to insist on the realization of a world in which the spirit will have triumphed over violence.
The author is a practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and the Sir JJ Group of Hospitals.