A Journey

August 7th, 2024

Wow. I don’t know what else to say but wow.

Just returned from the next day follow up appointment with my ophthalmologist following my second cataract surgery. Because I’d had such a visceral reaction (or lack thereof) with the anesthesia yesterday and been so anxiety driven throughout the approximate ten-minute surgery that I’d attempted to talk on more than one occasion, I addressed my concerns with my surgeon. In all fairness, before I proceed, I’ll tell you he’s very hyperactive and prone to interrupting his patients, something that I know all too well is difficult at times to control when one is inclined in such a way, but still…..I have returned home following today’s follow up visit greatly overwhelmed, disappointed, appalled, and rattled all the way to my newly implanted eye lenses.

I’ll regress a bit and provide some background info. I had my first cataract surgery about five weeks ago and all went well. I had requested that I be put in LaLa Land and had been obliged of such a state of near existence by being given an extra dose of versed, the twilight zone drug, once I’d entered the operating room (OR). I had been, thankfully, unaware of what transpired beyond that second dose of anesthesia and the view of an initial light moving toward my eye. I was expecting a similar experience with the second eye’s surgery, but unfortunately, that was not the case.

After arriving for the second cataract surgery yesterday and being admitted to the OR Prep area, I was assisted by two nurses. The entire time (about 15-20 minutes) they were preparing, my surgeon was lingering just beyond the open curtains surrounding my cubicle, watching and waiting, surgery mask and cap already in place. It was obvious he was impatient. At the end of the prep time, as one nurse finished inserting the IV line, he, along with the anesthesiologist, moved to stand at the end of my bed as though all patience had expired. I can’t imagine being one of those nurses and having the surgeon breathe down your neck as you complete your assigned tasks. It brings to mind a vampire lying in wait. Anyway, once the IV was firmly secured, my surgeon, carrying the oxygen tube, brushed aside said nurse and moved to take a place at the head of my bed where he placed the oxygen tube on my face before beginning to push the bed out and head toward the OR.

“Any questions”, he asked while on the move.

“No, I know what to expect.”

“Well, you’ll hear me chattering in your ear,” he said.

“No! I don’t want to hear – or know - anything!” I replied, satisfied my request would be heeded much like before.

As the bed moved past the swinging doors and into the OR, I reminded my surgeon I was still far too aware of what was going on.

“She needs more,” I heard him say to the anesthesiologist as he lay a covering, or shield of sorts, to cover my face save the eye needed for surgery. “He’s giving you another dose,” he said as I felt him promptly place the speculum around my surgical eye to hold it open.

My awareness zoomed and my anxiety level only heightened as I waited to succumb to the darkness that never happened.

I would like to acknowledge that while I could feel the pressure of the speculum expand, it was not painful. I did, however, remain nearly completely cognizant of my surgeon’s continued activity. I began to see a kaleidoscope of bright colors as he hovered over me, working. I do not remember if I made complete sentences or expressed well executed words, but I do know I continued my attempt to alert my surgeon of my anxiety. I also remember being told on at least two occasions to “stop talking”.

I suppose I should be thankful he didn’t say “shut up”, but that did not appease me much as I was wheeled out of the OR a mere fifteen minutes later. Though a bit woozy, I do recall being somewhat vocal as they returned my bed to recovery. I was horrified by what I had just endured, my mind running rampant with questions as to why two doctors had seemingly not responded to my cries for help.

A short while later, in recovery, the anesthesiologist visited, standing just inside the entrance to my cubicle. He returned my stare, which I’m sure was an incredulous one and most likely, an angry one.

“That was not cool,” I remember saying.

The look he gave me was not kind. “I gave you double what you had last time,” he responded before he turned and left.

A brief minute before my departure, my surgeon appeared. “See you tomorrow,” he said and disappeared to continue performing one of ten or more cataract surgeries scheduled.

When I returned home, I could tell I’d had more versed than during the previous cataract surgery, but as I became more lucid, I was left to wonder why I had not been given something other than the non-working versed to allay my high level of anxiety. Surely an anesthesiologist has an array of drugs from which to choose that would leave the desired results in most cases - and talking during such delicate surgery would certainly indicate a need for such.

Through the night, my thoughts escalated. In some strange sense, I felt violated though I know that word is a strong one to use. I suppose it was the lack of ability to control my situation and the lack of help from those that I had trusted. My follow up appointment to remove the eyepatch was scheduled for the next morning. I determined I would discuss the situation with my surgeon at that time and perhaps receive some additional insight to explain what had occurred as no one had ventured along such a path of explanation following the surgery.

Seated in the chair at my appointment the next morning, my surgeon used the prescribed eye drops in my eye, looked at both eyes with his equipment, and reviewed my steps of care – all within a minute’s time. As he concluded, I mentioned that I wanted to discuss the anxiety I had experienced during the surgery and the upset I’d felt in recalling the events of yesterday.

Before I could finish my second sentence, he interrupted (as I mentioned, he does this all too frequently) and became a tad bit defensive. While telling me I’d had as much versed as I could have without it killing me – and he didn’t know why it didn’t work – he also threw out about my vocalizations of unhappiness following the surgery.

I remember asking if the anesthesiologist could not have given me something other than versed to help the situation, but was quickly silenced and told I should “take it up with the anesthesiologist”.

I did press on the points (in broken interruptions) that it did not seem as if he allowed sufficient time for the versed to do its magic and also that no one had bothered to explain to me that there was nothing else to be done and no other drugs to be given. He immediately said he had to be focused during surgery and could not pause to reassure me, which I understood. My response was to question why he had not touched on the explanation when visiting afterwards. To his credit, he paused and apologized for that misstep, which I accepted and for which I thanked him. At that point, I was satisfied and thought the discussion (and I use that term lightly) would end. However, at that point, things took a major turn in a very ugly direction.

My surgeon continued to speak to me in a multitude of sentences, recounting over and over in a defensive way about what had occurred and accused me of wanting to discuss the situation non-stop. He said I had turned a thirty second follow up appointment into a fifteen-minute appointment (his words, not mine). Did I not realize he had just performed a wonderful surgery in six minutes and could I not be thankful? Not allowing my full response, he persisted. I should stop yelling at him. I had made him feel like dirt, and maybe I should have gone to someone I liked better because he sure wished he’d never done the surgery.

In his succession of negative and ugly remarks, after attempting to say I was not yelling (“yes, you are”) and apologize because I had not intended to make him feel that way ("but you have"), I looked away for a brief moment, unsure how and whether to continue in my endeavor to respond. His ongoing barrage of attacks seemed unnecessary, disrespectful, and completely irrational. I turned and looked at him again as he continued, now using an analogy to this moment I do not understand: “It’s like a wife calling a husband a big, fat, lousy, husband, and the husband replying with ‘but I love you dear’. I did respond with, “That’s a really poor analogy” but was promptly told “no it’s not”.

Amazed and confused, I said, “Let’s not do this. It’s not cool. I’m done and hope you’re done.” Still, unable to stop himself, he continued along the same lines of being made to feel like dirt while I yelled at him. I looked at him in disbelief; I couldn’t begin to yell at him if I wanted to because he was doing all the talking.

At that point, in the midst of his continued tirade, I stood up to gather my bag from a nearby chair. He moved to stand behind me, his hand on the doorknob in front of him. I turned and looked at him, saying again “This is so not cool. Let’s please not do this” and even attempted another apology, saying that this was not what I had intended. At that point, he threw out the wife and husband analogy again and said to stop yelling at him. I think the look I gave him after being accused of yelling yet again was one of disbelief, at which point, he looked at me with all the anger of a petulant five-year old, took one step forward and said with conviction, “Yeah, that’s right - you are.”

I suppose he finally realized he was blocking my way (and that he had other cataract patients waiting for their follow ups), so he opened the door. As he took a step out of the room, he must have seen his staff of about four nurses standing and waiting, wide-eyed and much like deer in the headlights.

“I’m done with you,” he said boastfully. “After we finish with this eye, you’ll need to find someone else to care for you.”

I said nothing, but mentally I responded with ‘You’re about fifteen minutes behind me, doc’.

Not missing a beat, I said nothing and walked past him, my disbelief at what had just transpired adding a strange sense of calmness to my step. As I moved toward the exit, from behind, I heard him add, “Now if you have any concerns or complications, be sure to call me or you could go blind in that eye.”

I barely looked over my shoulder and gave a barely audible ‘uh huh”; I found his newfound and rather late concern for my well-being a bit pretentious.

When I returned home, I immediately began to research this doctor’s reviews – something, to my profound regret, I should have done from the very get go; instead, I had relied too heavily on my optometrist’s recommendation. I found that this doctor had only a 3.5 rating out of 5 and also saw many repeated reviews of all-too-similar instances that mirrored my own experiences:

• The first eye’s lens did not allow for clear vision and I had to see another surgeon for a second surgery to correct the issue. Personal notes regarding my same outcome with the first surgery was: My surgeon’s response was that I had an Astigmatism that fell in the 1% range and I should have opted for the Astigmatism correcting lens. Please note I had not been advised I had such a severe Astigmatism prior to the first surgery; I had been told I should see pretty close to perfectly although I might require reading glasses. As a result of the lens used, only my nearsighted vision was corrected – the exact opposite of what I’d been told. When my surgeon reviewed my vision and measurements he had taken, he even indicated he had overshot with the lens he’d placed in my eye. But then again, according to him, it’s all one bit guessing game. But I could correct this with a laser surgery or another surgery to swap the lens or glasses/contacts. I really didn’t expect him to cop to an error in lens strength, but intuition formed by the way he looked at his own measurements and calculations – and his defensive demeanor – told me that in all likelihood, he’d made an error.

• Rude and disrespectful behavior.

• A lack of willingness to address a patient’s concerns or questions without resorting to anger.

• Being told that I would need to find another doctor to take care of me.

Conclusion:

Physicians and surgeons should be confidant in their own abilities, but they should never be arrogant, egotistical narcissists who disrespect their patient in any shape, fashion, or form. I truly believe that even if this doctor wholeheartedly believed I was 100% wrong in my actions, he should have approached the matter in a much more professional manner. I may have at least then been able to hold a measure of respect for him if nothing else.

While the physician detailed in my account is prone to telling the patients who question him or are unhappy to leave and find someone else because he already has a ton of patients who like him, I would be quick to respond with I have a ton of perspective doctors from which to choose who will, at the very least, respect me and my opinions. After all, I don’t give a damn as to whether my doctor likes me, but I do care if he listens to and respects me in addition to providing excellent care. Those facts alone, serve me much better in my medical care pursuits than being merely liked.

Please don’t sell yourself short in your quest to find supportive and excellent medical care, and definitely do not suppress your own need to know or understand a physician’s actions. And, furthermore, for heaven’s sake and unlike me, do not fail to do adequate research on the doctor in question. Reports of personal reviews will provide a wealth of necessary information and aid in making the right choice.

I am told that medical school weeds out the inappropriate candidates or students in the first year. It’s most unfortunate that they cannot always weed out the sons-of-bitches who are such egotistical narcissists. Those individuals, it appears, are much more apt (although still as unfortunate) to play a part in today’s government.

Commentaries/Research on Narcissistic Physicians and Surgeons:

If you deal with a rude doctor, ask yourself if it's still possible to build a working relationship with them. Nobody expects you to become friends, but the doctor should be able to effectively communicate their thoughts and findings about your health. If a doctor's behavior makes communication difficult, and you can't foresee a way to resolve it through a conversation, then it may be time to look for a different healthcare provider.

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The medical profession attracts individuals who are confident, and this is an important characteristic of most physicians that helps them to reassure patients and to engage in work that is often characterized by considerable uncertainty and high stakes. However, high levels of confidence can also have a downside. In this study, we found support for the hypothesis that physicians with high but fragile self-esteem (as measured by their degree of narcissism) would respond to an ego threat by stating greater self-perceived invulnerability to conflicts of interest, relative to their peers. These results are exploratory in nature, but raise the issue of how motivational factors might, in some cases, interfere with the soundness of physicians’ clinical judgments.

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"Surgeons, in particular, stand out because of their significantly elevated levels of narcissism and primary psychopathy."

— Bucknall, et al.