From Joseph R Furman, MD on Discrimination 911
Although I appreciate the nobility of attempting to eliminate microaggression from our workplace, I think we would all be better served by coming to grips with reality. We live in a nation of three hundred and thirty million people of diverse backgrounds and ideologies. Whereas we certainly have the right and duty to prevent assaults on our safety, we probably will never be able to prevent all assaults on our dignity.
I am of the Jewish faith. Our anesthesia group provides pediatric anesthesia coverage at a major local teaching institution. On two occasions, while working there, I experienced what would seem to me to qualify as microaggresion. In one case, for no apparent reason, the attending surgeon and the residents had a lively discussion about a Jewish person and his large bank account. After a few laughs, the topic of conversation moved on to something else. In another instance, while setting up for an emergency case, I overheard the surgical tech, who happens to be black, express admiration for Louis Farrakhan. When the circulating nurse, who is white, disagreed because of Farrakhan's Hitleresque anti-semitism, the surgical tech doubled down on his views.
In both cases, I said nothing and I did nothing. I took care of my patients, and I was able to do further cases at that hospital without having to find a safe space. The lessons for all of us should be the following: 1) we are all going to encounter ignorant people at some point in our professional lives; 2) not all ignorant people belong to ethnic majorites; and 3) some ignorant people have impressive titles after their name, such as M.D.
We should look out for each other, and we should be considerate of other people's sensibilities. However, to make it our mission to implement universal speech control is hardly worth our time and our effort.
From Mark Rockoff MD, Alan Jay Schwartz MD MSEd, and Justin Lockman MD MSEd
The Remembering the Classics Blue Baby PAAD provides our colleagues/readers k2 lessons-one about palliative surgery for patients with congenital heart defects and another about social injustice eventually acknowledged. Today’s NY Times reports another lesson about social injustice eventually acknowledged-the story of Henrietta Lacks not receiving informed consent resulting in her being exploited. Finally, she and her family are being acknowledged. Rebecca Skloot’s book “The Immortal Life of Henrietta Lacks” is essential reading from our point of view. This story of the ravages of medical exploitation and the need for informed consent and personal permission can never be repeated too many times!
“We shall overcome because the arc of the moral universe is long but it bends toward justice.” –Dr. Martin Luther King Jr.
Picture of the Family of Henrietta Lacks from NYTimes https://www.nytimes.com/2023/08/01/science/henrietta-lacks-cells-lawsuit-settlement.html
From Greg Hammer MD on methadone
Thank you for the insightful PAAD regarding methadone. We at Lucille Packard Children’s Hospital have had varying enthusiasm for the drug. I had an NIH grant to study methadone in a double-blinded RCT in cardiac surgery patients 10 years ago. Our PK data were combined with that of Bob Ward’s group in Utah and others to shed further light on its pharmacology, adding to Chuck Berde’s much earlier work (Paediatr Anaesth 2014 Jun;24(6):591-601).
The subjects in our study, all 5 years of age or under, received methadone vs. morphine administered via blinded Nurse Controlled Analgesia after cardiac surgery. Both drugs provided acceptable analgesia. One observation was that the nausea/vomiting experienced in the methadone group, though not statistically more common than in the morphine group, was more intractable and, perhaps as expected, of greater duration. For several years our cardiac group used methadone routinely in patients for whom early extubation was planned. My sense is that the protracted nausea issue caused it to fall by the wayside. At least that was the case in my practice.
I still believe that there is a role for methadone. Tony Anderson at LPCH, whose work with Stephanie Pan you referenced in your recent PAAD, is an advocate. I would be interested to hear about the experience of others re: persistent nausea - this does not always show up in publications, wherein only the incidence per se is documented.