McDonald’s Eleven

I think if the public was aware of who is actually making important medical decisions besides doctors and nurses, there would be some concerned citizens. Here, I will offer one example using a possibly absurd, yet illustrative analogy.

Think of an item that you use in your work-day, without which you would be rendered impotent; something essential in your day-in, day-out endeavor to be the best mail-carrier, chef, barista, teacher, stock-broker, machinist, or yoga instructor that you can be. For a surgeon, that instrument is his or her hands. Of course, everyone uses their hands at work. Even a radio talk-show host – most dependent upon his voice for success – needs to push buttons, adjust the microphone, and have a keyboard at the ready. However, due to the precision with which a surgeon must manipulate the delicate and vital organs of the body, I think it is safe to say that, in the case of our profession, hands are of particular importance.

As you are most likely aware, ever since the universal acceptance of the germ theory of disease in the early part of the twentieth century, surgeons no longer go plunging into the depths of the human viscera bare knuckled. We wear gloves to protect patients from our germs, and ourselves from theirs. As you may also suppose, all gloves are not equal, and each surgeon must be very particular when choosing the right one. For example, an orthopaedic trauma surgeon, whose hands must grasp the jagged and sharp edges of fractured bone while cutting, twisting, and clamping steel plates and screws onto the skeleton, will typically choose multiple layers of a thick, puncture resistant material. Hand surgeons like me, on the other hand, often want a single layer of thin and very form fitting material so as to retain the tactile sensation in the fingertips required when working with small, delicate soft-tissues such as nerves, arteries, and tendons.

Each individual surgeon develops a preference based upon experience and the determination of which type of glove allows for the safest and most effective performance of the operation. After dozens, then hundreds, then thousands of procedures, one’s glove becomes an extension of the hand itself. The specific qualities of the material, the snug or loose fit (depending upon personal preference), and the way the rubber grasps the instruments and bowels, ever so fragile, inform one’s choice. That is, until some anonymous committee in the accounting office of the hospital’s corporate headquarters decides that a glove is a glove and switches to the cheapest one available.

Or maybe the crappy new gloves are manufactured by a company owned by the CEO’s brother-in-law. Whether due to nepotism or frugality, we the surgeons will never know why the change was made; for, like so many crucial decisions, we were not involved in the process – our opinions and insights considered irrelevant. But as I learned in my second round of anger management, ours is not to ask why, but rather to suck it up while counting to ten.

There was a time when I would have shared my outrage with the hospital administrators. I felt that I owed it to my patients to vociferously and, with the tenacity of a honey badger, rebel against arbitrary and nonsensical changes in policy, equipment, and personnel that might negatively impact patient outcomes and/or safety. Boy, have I learned to keep my mouth shut. An in-person visit to the administrative offices, a strongly worded letter, or an urgent phone call – though well intended – is, in my experience, met with platitudes, defensiveness, and eventually censure, and therefore futile and ultimately self-destructive.

Thus, I propose an alternative method of expressing my dissatisfaction with the capricious alteration of this most crucial piece of surgical equipment- one so intimately associated with our identity as surgeons. I would like to recruit several of my fellow operators – maybe a urologist, a proctologist, and at least one additional orthopod to do some of the heavier lifting – for a midnight caper intended to send an unequivocal message to the administration; a victimless crime really, but perhaps necessary nonetheless. Late at night, and under cover of darkness, my McDonald’s Eleven will sneak into the administration offices, remove the rather sizable, mahogany desks adorning these spacious sanctuaries – replete with personal computers, photographs, important documents, and other essential items required by the occupant – and replace them with ones like we used in elementary school. Because really, a desk is a desk.


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