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I know exactly what happens during surgery. As a victim of medical sexual abuse and currently going through trauma therapy, I had to have major abdominal surgery this week. The surgery had been scheduled since May, and the thought of being unconscious after an unfortunate surgery last fall and knowing nothing about it until I awoke to find things done to me that I was unaware would be done, I was afraid the same thing might happen again.I informed the surgeon that I was an abuse victim, and he arranged everything so that I would be as comfortable as possible. Since the abuse involved two male doctors, two male nurses, and a male technician, he arranged for an all female surgical team for me.I drafted an addendum to the consent form, and I edited the form itself to make sure my needs would be met, and they were. The doctor agreed to everything. I was reasonable and knew that emergencies could change things. One of the requests was that anesthesia not be induced until after the prep work was completed. I also discussed the drugs to be used with the anesthesiologist, and she agreed to use no drugs that produce amnesia. No Versed or Propofol.Thus, I was awake for all the preparation work, including placing all the leads and pads, catheterization, skin prep, and positioning, everything up to placing the sterile drapes This relieved any apprehension that I had, and I was ready to be put out without any fears.When I moved onto the OR table, blankets were removed, and my gown was pushed up to my neck to do a full abdominal prep. Before the skin prep, leads were placed, and the electro cautery plate was attached to my hip, and the leg stockings were placed. Then I was catheterized, my legs covered, and the safety strap placed over my thighs. The skin prep solution, which was very cold, was then applied to my body. Each step was explained by the person before doing it and while it was being completed, so there were no surprises.Finally, when it came time to do the sterile draping, I said okay, and anesthesia was induced. I was out like a light for the two-hour surgery. I was comfortable and found all the prep to be routine and nothing to be afraid of. Having a female team really made me feel at ease. And knowing what is done beforehand and being able to go through it saved me further trauma.Since I had none of the usual drugs, I woke up in the OR after the surgery, completely aware of my surroundings and to everyone saying hi to me and checking to make sure I was okay. The anesthesiologist and the PA who had also done the pre op exams were there to check with me and make sure everything went okay. The PA who assisted also checked in with me.There are some doctors who will go that extra mile to make things go well. I am very much relieved to know what really goes on during surgery instead of signing a blank form and not being given the information everyone should have before surgery. The doctor, his office staff, all the nurses and techs were wonderful. It made a potentially traumatizing experience one that gave me new faith in doctors and nurses. I know they care about me and are willing to go that extra mile. I can now face the remainder of my therapy and continue to heal.To those of you who think this is going too far, you haven’t walked in the shoes of a sexual abuse victim, especially one who has been abused by the doctors and nurses who are supposed to be helping you. A sacred trust is broken in the worst way. You have no business judging. And you do not have the compassion to treat patients as people and want to help us overcome something that has devastated us through no fault of our own. Save the recriminations and insults about asking for same gender teams and special accommodations. Nothing that was done changed the procedure in any away or inconvenienced anyone involved. Everyone was happy at the outcome, and they were glad that I made progress toward getting my life back.Update: August 19, 2019: I had a flashback last week when I had a colonoscopy. I found out right before the procedure that the tech would be male. It didn’t occur to me that there would be a male tech. I’ve had colonoscopies before, and they had always been female. I explained my history of abuse and asked for a female. I had to state directly that I didn’t want the male to be present. I did that. The charge nurse found a female to take his place. My history is in my record, so it really threw me a curve. It triggered bad memories, which I’m now dealing with and made an ED visit this week more difficult when I had to deal with a male doctor. Two steps forward and one back. Don’t let your guard down and make assumptions.Update: June 19, 2020:I had a lumbar laminectomy yesterday. I had a really positive experience with the neurosurgeon who performed the procedure. It began in January when I first met him.We discussed the surgery, and I told him of my prior sexual abuse and that I needed a female team. I wasn’t too optimistic about getting one, however, because most neurosurgery procedures require strength for lifting and positioning patients. I was also meeting the surgeon for the first time and knew nothing about him other than his reputation. He turned out to be extremely supportive, and he listened to me. When I left his office, he had promised me he would put together an all female team. Surgery was scheduled for March.The coronavirus postponed my surgery, with no date in sight. I thought my chances of keeping the female team were slim to none. When I got a call on June 8th for a June 19th surgery date It was short notice, but I took it, because I would have an all female team. I was relieved and grateful that he remembered my request and made the effort with all the madness of the pandemic. It turned out that the surgery slot came up, and a female team was scheduled for it. He had not forgotten my request and offered the spot to me instead of someone else. I hadn’t expected a date until later in the summer.In pre op, before the surgery, each member of the team came to meet me and introduce themselves. i got to talk to them—the surgeon, his assistant, nurses, and technicians. There were six of them. I was put at ease by this exchange. Surgery was a success. The surgeon said it went perfectly. He expects a full recovery, and I’m feeing good about the whole experience. Incidentally, I have Kaiser coverage.Update October 6, 2020I had the first of two surgeries to evaluate and place a sacral nerve stimulator. The second surgery will be on October 20. It was to be done under general anesthetic, but I opted for lidocaine with some fentanyl for pain control. It involved fluoroscopic placement of leads in the right spot in the sacral nerve, so it was a great deal of poking around, and an inch and a half incision to insert the permanent device. Surgery lasted for almost two hours.Again, I had a female team, including the anesthesiologist. Though there were quite few needle pricks for the lidocaine and the incision, it never rose to the lever of needing a general. The anesthesiologist did a great job with the fentanyl.I was very apprehensive, knowing the assistant surgeon would be male and that a male representative from the medical device company would also be there. I was told he would not scrub in and would be off in some corner of the OR where he couldn’t see the surgery.It was particularly important that I was awake for this one. It turned out that the medical rep observed the whole surgery, as he had to give directions to the surgeon and measure electrical muscle responses to be sure the surgeon implanted the leads in the optimal spot of the correct foramen.That was not part of the game plan, and I was very hesitant about allowing him to watch. However,since I was awake, I had control over the events. I could have said no, and surgery would have stopped with no chance of having it done in the future. With the empowerment of the local anesthetic, I made the decision to leave him there, and I was comfortable with it. I was part of the discussion as the surgery progressed and talked to the rep to find out what he was doing. I couldn’t have done this six months or a year ago. I was still too traumatized from being abused.Everything turned out well, and I felt like I had reached a new milestone in my effort to heal from my experiences. The rep was very nice and very professional as were all the others who were present. The bottom line is that I was awake. I was the one who decided to go ahead with the surgery, even knowing what I had suffered in the past. Being conscious made all the difference.I left the OR saying goodby to everyone and thanking them for being so good to me. I really am grateful for the way they conducted the surgery, what that meant to me and the implications for my future. It is the first time I have been able to deal with the presence of males in surgery other than the surgeon. No flashbacks, no descending into that deep hole of trauma into which the previous sexual abuse events had placed me. I think I will be able to go through with the next surgery. It will also be done with local anesthetic, at my request. It was a shock to have the rep there, but my rational self put a lid on my emotions to allow me to accept his presence. I’m glad I did. The surgery has been highly successful and is a life change for me. I will definitely qualify for the implantation surgery on October 20. And I learned a great deal about emerging from the dark place.Update October 20, 2020I had the second of the two surgeries to implant the permanent device. Another female team and male surgeon and assistant surgeon. The rep showed up, but had the nurse tell hi to leave until after prep and draping. He left. All he had to do was shoe me how to use the hand held devices to control the device. He never came back and did that in post op. Again, local anesthetic and fentanyl. The surgeon removed the temporary device, opened the pocket prepared during the first surgery, and implanted the permanent device. Surgery was fast and easy. Again, I was ready there minute I got to post op, although they made me stay for about an hour.Again, this was a positive experience, thanks to a great surgeon who has now operated on me four times. I would not have been able to handle a male team, but I’m making progress.

When my wife was dying of stomach cancer, I had to tell our teens (15 & 18) in two steps. Telling their older sister (27) was easier. In the end, I guess I did about as well as I could, but there was some drama.Soon after my wife started her treatment at Mass General, we met our oncology social worker, who mentioned a special MGH program called PACT: Parenting At a Challenging Time, which aims to help parents with cancer, in dealing with their children's fears. Initially, we mistakenly dismissed it, but nine months into my wife's treatment, I arranged to talk to the PACT director, a woman named Dr. Rauch.Usually, the illness my wife had was reliably fatal, but though we'd been told there was a real hope / chance of successful treatment, I figured I ought to hear what PACT had to offer, just in case (Doh). I sat with Dr. Rauch for 90 minutes, taking notes. She explained what kind of unexpected fears our kids might have, ways to break the news if the cancer should recur, ways to disclose a parent's death if necessary, how to handle survivors' guilt… Dr. Rauch was very comprehensive. I had to play a long game, throughout my wife's illness, planning ahead, just in case.I went home that evening with my handwritten notes, and surreptitiously typed them up for later. Then I heated up dinner for Betsy and the kids, from one of the steadily-arriving meals that our friends and neighbors had brought to us. I don't remember what I served; we had a lot of lasagne those two years and more, but it might also have been a nice vegetarian casserole, or Russian food…Through that fall and into the winter, the clinicians’ accounting was that her treatment was going well, with a real chance of success and survival, despite this illness' terrible statistics. But then, in mid-winter, my wife needed another major GI surgery, during which her surgeon discovered extensive, hopeless metastasis, just two months after her successful gastrectomy.Her surgeon told me while he was still in his pale-blue scrubs, even as my wife was still on her way to an intensive care floor. Since I had to tell my wife first, and she was going to be in the ICU for at least a week, I was afforded time to plan how I would announce to our kids that their mother would almost certainly die, despite everything. I dug out my notes from my meeting with Dr. Rauch, and read the pages over a few times.The hard case was our middle child, the 18 year-old daughter, whose temperament is the most similar to my wife’s: shy, sensitive, subtle, and hot-headed as hell. Her older sister was pregnant with her first child, which divided her attention, but she also had her husband’s support. Our son, fifteen at the time, was reserved and a bit of a cipher, but he had his soccer teammates as a social cushion. The middle daughter really had only an overseas boyfriend to talk to, so I was most worried about her.In the end, I waited nearly ten days to tell my wife, and another ten to tell the kids. I told our son before I told his sisters, because he's the calmest, and could keep a secret for a few hours. Our eldest, the mom-to-be, I planned to tell last, because she's very talkative, and would surely divulge too early. To tell the 18-yo, I had to form a careful plan, so as to manage her temper.That Sunday in late February, I had only her with me at church, so I decided to break the news to her in the car, on the way home. I wanted privacy for her explosion, and I wanted to have her in a small space, with less scope for physical outbursts. But my choice turned out better than I expected.The snow that winter was terrible, the worst I've seen in more than fifty years. I remember the roads were mostly passable, but the snowbanks at every curb were five to six feet high (1.6m), just blank icy walls of densely packed, plowed snow. Driving every street felt like driving at the bottom of a deep, narrow gully.When I told my daughter, she reacted initially with rage, towards my wife's doctors and nurses. Her tantrum ramped up for 5 minutes, then she calmed down enough that I could speak a bit, trying to explain that it wasn't anyone's fault. Then, after catching her wind, she resumed her tirade, and ramped up again, louder and louder, with ever-more venomous threats againat the MGH staff.Through all this, I just kept driving, running a few stop signs and traffic lights, so as to keep her from bolting out of the car. Fortunately, on a cold Sunday afternoon, ignoring the laws wasn't as unsafe as it might've been. But finally, I came to an intersection where I would have to stop, and she unlocked her door, as I slowed.So, I quickly pulled over to a parking space, and sideswiped the snowbank firmly, so as to jam her door up against the wall of snow. Even opening her window gave her no way to leave the car. I turned off the engine, and waited. My daughter erupted again, but stayed in her seat, and just vented for the next ten minutes. Her plans for revenge got more detailed, more sweeping, and more florid, until finally, she just ran out of steam.I asked her, “Can I drive you home now, without you trying to jump out of the car?”“OK.”So, I drove home, stopping at the stop signs. At home, I reluctantly got her to talk to her mother, who was convalescing upstairs, in bed. In this way, we managed to limit the explosion. What a mess.My wife lived another four and a half months, in and out of the hospital. Surprisingly, the last stages of her cancer weren't very painful, at least not physically, so caring for her wasn't as traumatic for us, as what my Mississippi relatives go through with cancer deaths. Betsy spent her last ten weeks at home, with family, friends, and clergy visiting quite often.We had two family members staying with us to help, so we all took turns sitting with my wife, talking with her, watching Downton Abbey with her, fetching ice chips for her, coaxing her to eat. I had sole responsibility for managing her IVs: saline, antibiotics, sleeping meds. Until you have to scrub and glove up, you won't possibly understand how hard it is to hold an IV port in one sterile hand, and not scratch your nose with the other.One night in early July, just a few days after my wife's birthday, I relieved my kids in the bedroom, where they were sitting next to the bed, alternately texting on their phones, and watching her sleep. I sent them downstairs to eat dinner, and I sat down to read in a chair near our bed. As she slept, my wife's breathing was odd: slow and regular, but gasping and loud. She'd been breathing that way only for a few hours, during this nap, and I didn't know what to make of it.After I’d read for an hour or so, looking at her frequently, I realized that her loud breathing had stopped. I checked her pulse, and it too was gone, along with the rest of her. It was anticlimactic. She was here, and then she wasn't. I guess I was lucky to be present, and to catch the moment.I went downstairs to tell my mom, and she came up to double-check, but she agreed that my wife was dead. The kids overheard us, and my son decided to call 911, which actually wasn't gonna help, but he was doing the best he could.Unfortunately, his sister, the 18-yo, exploded again in sorrow, as I should have anticipated. So I had to spend a few hours managing her again, while the emergency staff came and went, and while we waited for the funeral home staff to arrive. If I had it to do again, I would have gotten my mom to stay close by my daughter, while I broke the news more carefully.The best thing I did for my daughter’s grief came a couple weeks later. Her best friend came to our house for a sleepover, and in the course of her stay, I learned that the girl had been getting along poorly with her mom for a year. So, I invited her to stay with us for awhile, and with her mom's permission, she ended up staying with us for five weeks, until school started. This was a great blessing for my daughter, and gave her friend some space to reflect on how to improve her approach to her mom. So both girls came out ahead.In the end, it took my daughter about fifteen months to come out of her grief, and to show some interest in what was next in her life. Her brother and sister had a more even course, and both have recovered well, too.My eldest named her daughter after my wife and me, both. The child is three years old now, and is basically a clone of her mother; it's as if my eldest cut off her own little finger, stuck it in dirt, and it grew. My wife never got to see the baby.Today, my two younger ones are 18 and 21, and both live at home while they attend college. My daughter's best friend straightened up, still lives with her mom, and is nearly done with college.When I started writing this, my middle daughter was sitting at the dining room table, studying for a biochemistry test, and my son was cooking some bacon and eggs, to eat before the Patriots’ football game started. I myself will never know how Downton Abbey turned out. We have all six (?) seasons on DVD, somewhere here in the house, but I watched the first four sets with my wife, and I can't watch the show again.Update, Sept. 25: For readers who find themselves in this difficult situation, please do look at the PACT publications list, which is available here: Publications for Parents1734 words.More about my wife and her illness: A Night Without StarsAll my longer posts are here.

It will help to know what kind of practice/specialization you have in mind, because this will influence the patients’ perception and form their expectations of you.I personally love honesty - but of course not everyone can truly process that effectively, so please know your patient’s readiness before you break any news to them.One such instance was when I found a new ob/gyn doctor, and they all but confirmed my “diagnosis” without asking me some very important questions, so the result was comical to say the least.Doctor started the conversation with, “I see that it’s a fetus, based on its size, I’d say about 16 weeks along”. Then she glanced as a very young me sitting in somewhat of a stupor - and the question is, what to say?This is when she started asking other questions about my marital status (married), whether I am living with my spouse (yes), whether these news were expected (very much yes), and whether I was happy about it (again, yes) - this is when I came out of that stupor and started crying happy tears, and the doctor and the nurse let out a collective sigh of relief.Well, results vary, that’s all I can personally say.The other point is about the practice itself.Of course, wishing you all the success in your learning and your practice, and hope is that you will become one of those great minds who will change the human history - but if your practice grows beyond the capacity of one’s mind to keep the patients’ details in mind, please be honest about it.There are doctors who pretend that they personally know each client, and it’s just not possible based on 100s of charts in their offices - it’s impossible, they know it, patients know it, but doctors still try to pretend otherwise.It’s a business, I get it.So, this is why the best medical help I got so far was from an emergency services clinic (much closer to my house than the regular doctor’s office and has better operating hours) - where each patient is treated as a blank slate and questions start from the “beginning of time”, because things happen and patients forget to add new medications that they’re taking, or patients decide that they’ve said something already a couple of years back and there’s no need to repeat the same claim each and every time they visit the doctor.This, as you can imagine, can be rather damaging - to the diagnosis, the treatment, and to the patient themselves.Doctors are human, patients are human, and one-on-one talks with the doctor are just not realistic - if patient expects doctor remembering in vivid detail what was 100% interactions for them, while for the doctor it was not even 1/100th of their day.The other thing that recently was concerning to me, as a patient, was a procedure. It required a lot of steps to qualify for - to be covered by the insurance, we’re talking about 4 months of time, and it was supposed to be scheduled for December of this year.Long story short, in all the visits to the doctor’s office - for checkups and to establish support for the procedure through tests and evaluations - not once had I met the doctor. Not once. If you were to line up all the staff, all I knew about him is that he was a male, and that’s about it - so I won’t even be able to pick him out of that lineup.Again, healthcare is business, and time is money.Yet, it’s patients’ lives at stake - and many of us want to live, shockingly enough - so while the payments clear and reimbursements from healthcare insurance entities come in, it’s best to at least speak with the patient, even for a moment, to make sure the patient knows what the end goal is and whether the procedure (if it takes time to schedule) is on track.An update to the doctor is that I abandoned that procedure - partially because of the way the office was run, and partially because I am lacking care post-op - and I will never recommend that doctor to anyone else.To be clear, that procedure can be life-saving to some people and patients always seek out recommendations before committing to a specialist, so there is a market and there is some relatively easy money to be made there for the right person, but showing a client that they are valued only to the extent their payments are timely is certainly not the way to build a practice.