Don't Say the Q Word: Doctors' Superstitions

I was asking some very run-of-the-mill, routine preop questions for what would be considered a fairly small surgical procedure. The patient closed her eyes. The corners of her mouth began to turn downward. She started to cry. I put my hand on her arm.

"I'm going to be right by your side the whole time," I said. "I won't leave you."

"I don't want to die," she said through her sobs, her voice sick with anxiety.

Whenever a patient says that my wariness increases a bit. It's doctor-superstition, I suppose, but it's been said that when patients have a feeling they're going to die, it's because...they're going to die. But I was hoping this was just her extreme nervousness talking rather than an actual sense of impending doom.

"I'll be there to protect you," I said, looking into her eyes with every ounce of my confidence. "I'll protect you," I repeated.

The woman nodded. A tear slid down her cheek. "Promise you won't leave?" she asked.

"Absolutely. I promise. I'll be with you until you wake up, and afterward too."

The actual surgery went fine, but she had medical issues that made her management a little tricky. I visited her later that night to see how she was doing. She was watching House. She was in much brighter spirits and had a warm smile for me as we spoke.

"I want to hug you. Is that ok?"

"Of course," I said, leaning over to hug her back. She thanked me.

But it was I who was thankful. I was thankful that she didn't in fact code and die on the table. I never tell people, "You're going to be fine," or "Everything's going to be all right," because the truth is the most routine procedure can turn deadly without warning. I guard my words with almost superstitious care. I tell people, "I'll be by your side," or, "I'll do everything in my power to keep you safe."

But that morning, for this woman, I had said, "I'll protect you." I had violated my own ritual observance of meticulous attention to language. What if I hadn't been able to protect her? What if some problem or other among all her medical issues had taken a turn toward disaster, and what if I hadn't been able to keep her safe? I never take those possibilities for granted.

Doctors pride themselves on being rational creatures. We act based on empirical evidence. We scoff at non-Cartesian thinking. And yet...

There's so much stress and chaos in the hospital, and lack of control in medicine, that sometimes little rituals and superstitions can be very comforting. I know one surgeon who never books his cases in a particular O.R. that he considers the Room of Doom. Some folks arrange their instruments a particular way without fail. I knew another doc who had a lucky brassiere that she would make sure she wore on her calls so they would be qui - er, not too busy. That's another thing - never admit that a call is quiet, or say the word quiet at all, ever! Then the cases will start pouring in and the beeper will be beeping non-stop! As for me, my superstitions are language-oriented. I try to avoid phrases like "Everything's going to be fine," or "You're gonna do great," and it makes me uncomfortable when the nurses say things like that. I'd rather say things I know will be true no matter what - like, I'll be right by your side, and I'll do everything I can to keep you safe.

In addition to little superstitions, we have little irrational beliefs. Take, for example, the quiet call versus the painfully busy call. There are those among us who would swear there's such a thing as a Black Cloud - the doc who's always horrendously busy on call - and a White Cloud - the doc that's consistently favored with tranquility and sleep while on call. There's another belief, practically urban legend, which I alluded to above - that patients who feel they're about to die are, in fact, about to die. Or that if someone has a bad, bad disease, and he or she is a really, really nice person, the prognosis is probably dismal.

Then there's the one about patients with red hair. There's an idea floating around that patients with red hair are more prone to complications. I personally haven't observed that or seen any evidence to support even a single anecdote. That said, there's actually been a study* done and presented to the American Society of Anesthesiologists that shows that red-haired patients need more anesthesia to get anesthetized or to experience relief of pain than non-redheads - but the study sample was minuscule, so who knows? There may indeed be a relationship between genes for pigmentation and genes for drug receptors but I certainly haven't read that it's proven.

Many docs, whether they'll admit or not, have these little customs and rituals, some of which have no basis in rational thinking at all. But I think this is humanizing, this "lapse" of our hard, scientific practices. It forces us to acknowledge that no matter how hard we try, in this world of ours that exalts total self-reliance, we're never going to be totally in control, and though we try to anchor ourselves with these consoling things, in the end we're going to have to accept some degree of uncertainty and lack of absolute power as we go about our work.

*Liem, E.B., Chun-Ming, L., Suleman, M.I., Doufas, A.G. and Sessler, D.I. Increased Anesthetic Requirement in Subjects with Naturally Red Hair, American Society of Anesthesiologists Meeting Abstracts, 2002.