Surgery and the GI Lab together generate a huge portion of the revenue of our hospital, as they do in any well-run hospital. Those of us who work in these departments function under tremendous pressure to move quickly and efficiently. Patients are brought in, prepared for their procedures, their checklists checked. We ask the patient his or her name umpteen times. Birth date. Procedure. Mark the correct side. Sign consent forms. Document everything and then some. Etc. Etc. Patients are taken into the OR’s or procedure rooms, put to sleep, procedures accomplished and documented, then taken to recovery, recovered, brought to the floor or escorted to the door. In and out. As quickly as possible, no mistakes made, all T’s crossed, all I’s dotted. Check, double check, triple check. We have a system in place to review every chart before surgery to prevent cancellations because cancellations cost everyone a lot of money—patients, the hospital, surgeons, anesthesiologists, etc. Time is money. Money is money. Teamwork is critical.
A sense of humor helps as long as it does not interfere with productivity. Forget irony.
The other day I met a patient named Margaret. Not me. Another Margaret. Though it seemed apropos.
We were moving along at our usual clip in the GI Lab: colonoscopy, colonoscopy, EGD/colonoscopy, EGD/coloscopy. Here’s the routine: The nurse admits the patient, I interview the patient, the nurse takes the patient into the procedure room. Then we do a time out with the gastroenterologist wherein the patient states his/her name, procedure, doctor performing the procedure, and date of birth. I start the anesthesia, the gastroenterologist does his/her thing, I wake the patient up, we escort the patient to recovery. I wash my hands and interview the next patient. We do this over and over and over, sometimes twelve patients with one GI doc in a single day. Occasionally we stop long enough to visit the washroom, shove food in our mouths, grab a diet soda. We could wear roller skates because this system has incorporated the efficiency of an A&W Drive-in. Paperwork and a sick patient can slow me down. Things usually go according to plan except when they don’t.
But Margaret had her own time schedule. Because Margaret was from Ireland.
She liked the fact that we were both named Margaret. It made her more comfortable, she told me.
I love Irish people. I have visited Ireland many times. I love to listen to Irish radio, drive through the west counties, visit the Burren, the Poulnabrone dolmen, sit in Irish pubs and eat lousy cheese sandwiches washed down with excellent beer. I love the Chieftains, John Keene stories, and can even tolerate Enya, but only when I’m on the island. I’ve driven through the countryside with my mom and my mother-in-law and Jocelyn in a stick-shift on the wrong side in the rain on narrow roads lined with stone hedges, returning the car to the rental place with one side view mirror and a hubcap missing. Not bad, considering.
In the usual manner of things, I asked Margaret to tell us her date of birth.
“Well,” she said, “it was in the fall, you see, and the corn harvest was poor that year.”
Under different circumstances, I might have insisted on the date and the year, but I felt a story coming on. Margaret was throwing a monkey wrench into the well-oiled machine of our day, and I was glad of it. Life gets so predictably dry.
“It was the Depression, of course. And my mother didn’t want me, couldn’t feed another child. She couldn’t feed the ones she had. What with the drought and all.”
“So it was in September then?” I asked gently.
“Nineteen thirty-one,” Margaret told me. “The end of September.”
“Do you recall the date of that poor corn harvest?” I asked.
“It was September 20th. A terrible time to be born.” I checked her armband to verify her birth date.
We were half way through our time-out, but taking a most circuitous path.
I asked for the procedures we would be doing that day…
“Well you know it started with a pain in my stomach, and they told me it was gastritis, but I knew it wasn’t gastritis,” she said, and frowned at me then. “I knew in my heart it was something worse than that. Sometimes you know these things. And I’m terrible nervous about it.”
I told my Irish friend not to worry. “Are we looking in your stomach and up the other end today, Margaret?” I asked.
“Yes, that you are.” She agreed.
“And the doctor’s name?”
She pointed to the man standing next to her. Good enough. I started the drugs. Margaret, as it turned out, had nothing to worry about. And for that I was mighty glad.