Friday, 11 August 2017

Surreal

Those of you who are regulars here or follow me on Twitter know my feelings on pseudoscience (otherwise known as "bullshit").  Depending on the day, my opinion wavers somewhere between "Pseudoscience is potentially dangerous nonsense" and "What the fuck are you idiots thinking".  Fortunately I've had very few interactions with pseudoscientific nonsense in my professional career, though several years ago I did have one woman ask me about Dr. Oz and an "olive oil flush" for gallstones.  Since I've been ranting and raving about various bullshit modalities like chiropractic, homeopathy, and acupuncture, I've often wondered how long it would be until my next encounter.

Wonder no more.

I was asked to see Barbara (not her real name™) late one evening for what sounded like typical acute cholecystitis - several days of right upper quadrant abdominal pain, fever, nausea, and vomiting.  Before going in to examine her I looked at her abdominal ultrasound, which showed multiple large stones in her gall bladder along with thickening of her gall bladder wall and inflammation surrounding the gall bladder itself.  Checking her bloodwork, her liver function tests were all normal (so no sign of a biliary tract obstruction - good), and her white blood cell count was mildly elevated as would be expected.  It seemed like a slam dunk, and it was.

Mostly.

When I entered Barbara's room, she had a friend with her, which is certainly not unusual.  I examined her carefully, and the only abnormality was fairly severe tenderness in her right upper abdomen, typical of someone with a gall bladder infection.  I explained the treatment protocol, which would be giving her IV antibiotics overnight followed by a laparoscopic surgery the following morning to remove her infected gall bladder.  I went through my prepared speech which I've given hundreds of times, including the risks, benefits, and alternatives.  And as usual I ended with my normal conclusion: "Do you have any questions?"

It was one of the few times I've regretted it.

Barbara whipped out a little notepad with myriad hand-written notes, and I was immediately bombarded with approximately 1,058 questions, everything from the mundane ("How long will I be out of work?") to the somewhat-strange-but-still-almost-normal ("What anaesthetic agent will I be given?") to the completely bizarre ("What are your instruments made of?").

Then she hit me with one that was so far out in left field it may as well have come from a different country:

"Can I keep my gall bladder?"

Um.  Uhhh.

I had to explain to her that I was obligated to give the gall bladder to the pathologist, who would cut it into thin slices and make sure she didn't have something wacky like gall bladder cancer, so, um, no, you can't keep your disgusting infected gall bladder.  I offered her the option to keep one of her stones instead, which she readily accepted.

And then her friend started asking questions.  Approximately 792 more.

Sigh.

After what seemed like two hours (but was probably closer to 8 minutes), I finally made my way out of her room, where her nurse caught my eye.  She rolled her eyes and smirked in a plainly obvious "Oh, she got you too?" look.  I merely smiled back weakly, feeling lucky to have escaped.

The following morning I went to see Barbara, and she still looked uncomfortable.  Regardless, she told me she was ready for surgery, which was scheduled for later that afternoon.  I went back to my office to see patients for a few hours, returning to the hospital about 30 minutes before her operation was due to begin.  I figured she would be in the pre-op area, which she was.  What I didn't figure was who would be with her.

The only way I could properly describe Barbara's visitor would be to say that she looked like she stepped directly out of 1967 into a time machine, landing in my hospital in 2017.  She could have easily passed as someone who went to a costume party dressed as a hippie and then forgot to remove the costume, so she simply continued living as a hippie.  She had one hand on Barbara's right shoulder and another on her back, and it looked like she was giving her some kind of weird massage.

"Oh, hi Dr. Bastard," Barbara smiled.  "This is Rena (not her real name™), my reiki master."

Your . . . your what?

I had no idea how to reply, and the anaesthesiologist could sense the palpable awkwardness growing by the second.  He gave me a knowing look, rolled his eyes, and clearly trying to break the tension said, "Yeah, I missed my last two reiki appointments."

Heh, good one.

"I KNOW, ISN'T IT AMAZING?" Rena replied with a broad smile, obviously missing the obvious sarcasm, which was obviously obvious.  Barbara smiled too, missing the fact that now both the anaesthesiologist and I were staring at each other, our mouths agape.

It's difficult to render me speechless.

In case you aren't aware of what reiki is, it's bullshit.  It's pure, unadulterated bullshit.  Here, I'll give you the rundown: take prayer, add running your hands over someone to transfer energy to them, and you have bullshit.  I mean reiki.  No, I was right the first time.  Bullshit.

I had never seen reiki actually practiced in real life, so I watched agog as Rena ran her hands over Barbara's right shoulder, muttering encouraging words (I guess) and supposedly transferring some universal life force into her.  This was happening as her very modern IV antibiotic was running through a very modern plastic tube into her very physical vein.

I couldn't think of anything else to say, so I quickly signed my paperwork, muttered something about changing into scrubs, and walked out.  The anaesthesiologist looked jealous.

Barbara's surgery was moderately difficult though uncomplicated.  Her gall bladder was quite inflamed, but it was no different than most any other case of acute cholecystitis I've handled through the years.  She went home the following day feeling somewhat better, but still in some pain.  My typical gall bladder patients go home the same day as surgery and are back to their usual activities within a day or two, relying on ibuprofen (if anything) for pain.  Barbara, on the other hand, emailed me several times a day over the next few days to describe the progression of her pain, nausea, appetite, temperature, and anything else she managed to quantify.  She finally started feeling better just over a week later, to her (and my inbox's) great relief.  She came for her follow-up visit two weeks after surgery, Rena tagging along.  Of course.

With that goddamned notepad.  Of course.

After conducting my exam (everything looked absolutely fine), I dutifully answered all of her remaining questions, including "When can I start juicing again?".  Barbara and Rena both profusely thanked me for my patience and warm bedside manner, and they left looking quite satisfied.  If they only knew what I had really been thinking.

Now I realise that this is only an N of 1 and anecdotes are not data, but it sure seems to me that Rena's energy transfer didn't fucking work.  Of course it's possible Barbara's surgery would have been even more difficult, and her recovery much more protracted, if she hadn't had the reiki treatment done.  Right?

Ha!  No.

38 comments:

  1. I would have had a great deal of trouble not making a comment such as "I'm concerned about the fact your recovery has gone much more slowly than most of my patients, but i am glad to see you are doing better."

    so I give you kudos for your presumed restraint.

    but then I also recall seeing a person walking normally while complaining that his knee pain was ten out of ten; so I suspect some of the delay in recovery was the product of being inherently delicate. some years back, I had a suspicious mole removed from by back for pathological analysis, and then went to donate blood for more pathological analysis, and then dug a ditch in gravel. (the result was as bad as I expected, I was confirmed to have british ancestry)

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  2. scheduled for heart surgery at Mayo next month and in the packet sent to me are a bunch of info, including Reiki. I am now baffled. pls see this link. http://dahlc.mayoclinic.org/2015/12/29/9-facts-about-reiki/ would you mind addressing why Mayo would offer this if it is bullshit?

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    Replies
    1. I chalk it up to pandering. I refuse to believe it is anything but.

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    2. thanks for responding. I have a hard enough time accepting real medicine. I'll skip the bogus stuff.

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    3. I guess at least reiki isn't so obnoxious as the "the beatings will continue until morale improves" theory of massage that some practitioners seem to have.

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  3. You should have entitled this episode "The Reik's Progress."

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  4. I have to disagree with you, Doc. If Reiki gave your patient psychological support during and after her procedure, you shouldn't criticize. I'd have a problem, however, if your patient opted out of surgery and sought Reiki as a cure instead of surgery.

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    1. With due respect, reiki is batshit insanity. First, you'd have to believe in qi. Then you'd have to believe that certain people can channel that qi unto others. Then you'd have to believe that qi can do something beneficial.

      That's just too much bullshit for my brain to process without criticism.

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    2. So you discount the placebo effect?

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    3. And may I add ...you don't have to believe in it, it's your patient who is helped by such belief.

      Reiki isn't science, it is belief. If the patient believes it's helping, it helps.

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    4. I'm aware of what the placebo effect is and its uses. But whether it "helps" or not is debatable. Can it make you feel a bit better? Sure. Can it actually make you better? No. And that is the problem.

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    5. and did it speed the patient's recovery at all? it sounds to me like a no.

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    6. That "belief" has also lead to people dyung by not seeking proper treatment and only seeking bullshit. Steve jobs for jnstance instead of going on chemo or havinf surgery went on a cleanse apparently convinced dieting would save his life and wondered why he suddenly was diagnosed as terminal.

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  5. My son's ex-girlfriend bailed out of med school and decided to become a reiki practitioner. When I was scheduled for surgery to remove a pheochromocytoma from my left adrenal, she offered to do "long distance" reiki, since "Kaiser wouldn't allow her in the actual operating room." I declined as politely as possible.

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    Replies
    1. ok now this is funny

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    2. Obviously he broke up with her the moment he realized how batshit she was.

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  6. A friend of mine who's been into woowoo for the last 20 so years, posted on FB that both her children (under 16) have become certified in Reiki. One has achieved master level. I did not comment.

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  7. I took care of a quadriplegic older man for almost 13 years. He had a reiki therapist for awhile and it never made a difference in his health, just his checkbook. He also drank a tea made out of grasshoppers.

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  8. Was there something about this patient that required the extra day's stay and the rapid surgery?

    My sister recently had a gall bladder attack and went to the emergency room. She was sent home a few hours later with the name of a surgeon to call to schedule surgery to remove her gall bladder. The operation wasn't until a week or two later, and was done on an outpatient basis.

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    Replies
    1. I had mine removed in 2011. Found myself in the ER on Friday, had the surgery on Monday and went home Tuesday. Fairly routine laparoscopic procedure.

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    2. A "gall bladder attack", aka biliary colic, is simply pain from gall stones. It usually resolves in an hour or so and can be treated with an outpatient laparoscopic cholecystectomy. But this woman had an infection of her gall bladder, which is treated a bit differently.

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  9. Reiki's ideology is bullshit, but it "works" by the placebo effect and the soothing effect of being touched. As far as pseudoscience and quackery go, reiki is pretty tame...it has some beneficial effect actually associated to the treatment. Other "treatments" do actual harm to patients. I would just let this one go.

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    1. Well, yes and no. I believe that Doc's issue with Reiki isn't that it helps by the placebo effect, but because people believe it can fix things that *need* modern medicine.

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    2. and that it was interfering with his practicing of modern medicine - albeit mostly in an eye-rolling sort of way in this case.

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  10. Reiki sounds similar to the "energy fields" baloney advocated by nurse theoreticians in the 1970s. One of the most pathetic applications involved one of these energy field fanatics making a harp strumming motion to a blood bag in the OR during a case.

    I never did figure out why a nursing supervisor allowed this in the OR.

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  11. Doc Bastard, May I have your take on the "cleansing" craze?
    I know may people that are doing this, and I have tried to tell them the reason we have a liver and Kidneys it to help clean our systems. I have not seen anything on the subject, but I am sure I have just missed it.

    Thank you, Desiree

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    Replies
    1. My girlfriends step mom after her surgery to remove her cancer decided to Immediatelygo on a juice cleanse. Not cause she thought it would help thankfully.

      According to my girlfriend she was just bored.

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    2. Cleansing is bullshit, plain and simple.

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    3. my anecdotal analysis of cleansing is the biggest health improvement is that the cleanse usually disallows smoking and alcohol.

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  12. I had pain off and on for over a year, and went to the er twice, before a doctor finally ordered tests. It turned out my gallbladder only had 10% function. They admitted me and I had laparoscopic surgery the following morning. I will say, it was a little harder to recover from than I thought it would be. I don't know if it's because I'm a huge wimp, or because I have fibromyalgia. My honest guess is maybe both.

    A close friend of mine has been pushing me to see someone to perform Reiki on me. I also have chronic back pain (I had a spinal fusion in 2013, and the surgery left me with permanent nerve damage in my left hip and leg, and frequent muscle spasms around the scar area on my back) so she was convinced all I needed was some stupid "procedure" that cost a stupid amount of money to feel so much better. She had seen an advertisement on tv- woman who had the exact same problems I have, and she was pain free before the woman doing Reiki even touched her. My response was a very unladylike snort, and a muttered profane word.

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    1. Gone before they even touched her...aka went away by itself probably. I hope you mentioned it to your dumbass I mean close friend.

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    2. As nicely as I could, I called bullshit on the whole thing. I said I appreciated her thinking of me, but these kinds of problems don't just go away, and aren't caused by bad energy. She tried to point out my energy is negative. I corrected her- it's not negative energy, damaged nerves would make anyone grumpy.

      She calls psychic hotlines. I can't say I take much of anything she says seriously. :)

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    3. I once met a psychic hotline operator. she said it was quite a good job once you get over the fact you are being paid to take advantage of people's delusions.

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  13. I wlll say- people in pain can be desperate. They'll do anything, no matter how silly it may sound or even truly be, for any amount of relief they can get.

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    Replies
    1. Yes but this was something she did regularly enough Rena came to her before her operation and her meeting with Doc after the fact. This had probably been goinf on for a couple years I'd think

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    2. True. It just made me wonder if that woman had other things going on health wise that would prompt her to call on the Reiki woman in the first place.

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  14. At least parents and quack healers are starting to be charged for this sort of unscientific behaviour. (see: http://www.abc.net.au/news/2017-08-17/self-healer-charged-over-death-of-6yo-boy-in-sydney-hotel/8815420). Don't get me wrong - I'm all for exploring the unknown and untested ... but in a scientific manner.

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  15. I asked my doc what sort of anaesthesia she was going to use for my surgery. I wanted pictures too, but I didn't ask.
    I thought she would be a wee bit busy to take some.

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