Tuesday, August 7, 2012

Beware of the Doctor Cuticles

Herman Melville authored White Jacket, an autobiographical account of his experience aboard a nineteenth century sailing ship. Melville’s novel is a thinly disguised critique of the conditions to which sailors were then exposed. For instance, when White Jacket was published, he made sure every member of the United States Congress received a copy. As a result, legislation was passed outlawing flogging as punishment aboard all ships flying an American flag.

The story occurred aboard the ship "Neversink." Three chapters of White Jacket are devoted to medical malpractice. The key personality is "Cadwallader Cuticle, M.D., Honorary Member of the most distinguished Colleges of Surgeons ... Surgeon of the Fleet." The story focuses on the misfortunes of a sailor who took an accidental bullet in the thigh.

Dr. Cuticle, the sailor’s treatment plan was defined quickly. The leg must be amputated. Gravatai was added to the circumstance by inviting doctors from other ships berthed in the harbor. The consultation served to draw attention to Cuticle’s self-importance and smug sense of surgical expertise. None of the consulting physicians agreed, but were intimidated by Cuticle’s seniority and artificially inflated importance.

Dr. Cadwallader Cuticle was openly bored with life as a ship’s doctor. Dispensing medicines for common ailments never satisfied him and sailors proved to be very hearty folk. The good fortune of an errant bullet piercing a limb was energizing and exciting news for the frustrated medic. (Kind of makes one wonder about those who enjoy cutting on people, doesn’t it?) The consultation ended with doctors recommending the extraction of the bullet, but the senior surgeon proceeded to announce surgery the following morning.

The details of the procedure were explained in detail as the patient listened, was scalded with boiling water and oil for pre-op hygienic purposes. An assistant pointed out the patient’s suffering, his lapses into unconsciousness, and waning strength during the procedure. Cuticle kept enlarging his surgical credentials, explaining the fine points of his procedures, and boasting of qualifications to impress the young men attending.

At last, the surgery ended, the patient was taken to another place to rest and recover. The doctor continued lecturing, inflicting his self-aggrandizement on a captive audience, and establishing his place in the pantheon of self-importance. While announcing a postmortem on the severed limb for the following morning at ten o’clock, one of those attending the patient reentered the operating room announcing, "The patient is dead." To that, Cadwallader Cuticle quickly, cooly replied, "The body also, gentlemen, at precisely ten. I predicted that the operation might prove fatal; he was very much run down. ‘Good morning!’" and departed.

The moral of the story, "Surgery is a necessary procedure for keeping patients alive." When the purpose is violated, the procedure becomes a malpractice issue. As a lifelong churchman, I believe it is absolutely imperative that church leaders assess how well the church adheres to her purpose. To excel "doing church" while losing the purpose is to inflict fatalities. More later, maybe.

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