Pre-Surgery Safety Checks: Redundant or Reassuring?
ROBERT SIEGEL, host:
Here's a story from the hospital where commentator Joe Wright is continuing his medical education.
In the pre-op waiting area, patients lie on beds in hospital gowns. Nurses and doctors come and run through pages of checklists. They check name tags and ask the patients their names and birthdays. A surgeon comes by and asks more questions and, with a pen, marks the site of the surgery. The anesthesiologist comes by and asks about lung and heart function, asks about dental work. The patient answers the same questions twice, three times, maybe four times, maybe more.
As a medical student, I sometimes find myself waiting with a patient. `I answered those questions already,' patients sometimes say to me as the time for surgery comes closer. It's sometimes hard for people to tell when redundancy means reassuring safety and when it means a frightening lack of coordination. Sometimes I explain the redundancy by saying, `This is like before an airplane takes off. Everyone has checklists; everyone has to double check and triple check. This is to make sure everything is safe.'
The analogy is more literal than it might seem. As Atul Gawande's book "Complications" first taught me, surgery and anesthesiology are borrowing lessons in safety from the aviation industry. They want to make more and more operations as safe as an ordinary airplane trip. But I don't know if my analogy is reassuring since despite aviation's good safety record, most of us are at least a little afraid of flying, and surgery, too.
If you're sitting in the pre-op waiting area, it means we're about to gather around you in masks and gowns and put you to sleep and open you up and cut and sew and staple things inside of you, all with the hope of making you better off than when we started. All the checklists show that people are taking safety seriously, but they're also a reminder that safety requires concentrated coordinated effort. Surgery, at its most ordinary, especially at its most ordinary, is a triumph of human inventiveness and cooperation. But like the project of flying thousands of tons of metal through the sky, it also seems unnatural and improbable.
When I was a boy, I loved airplanes because I loved the power of a big machine that could fly, just like I loved rockets and spaceships. As I grew up, I learned more about what could go wrong, and I spent more time thinking about the possibility that it might. Now I'm moved in a different way by the lines of planes at their gates, planes taxiing in and rolling slowly out, the rows and rows of passengers strapped into their seats, sitting still, waiting to be launched into the air.
Airplanes and surgical operations embody the modern world's technology and expertise, but my premodern instincts of shock and disbelief still remain. And so as airplanes come down to land on the same busy runway every several minutes, one after the other, and as the recovery room fills up with groggy,n bandaged people slowly awakening, these routines remain extraordinary, frightening and, in their ordinary regularity, startlingly beautiful.
SIEGEL: Joe Wright is in his third year at Harvard Medical School.
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