The Doctor's View: Magic in the ER

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This article, written by Dr. Scott Haig, an Assistant Clinical Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons, is the first in an occasional series of essays written by doctors.

Like any little boy in a city emergency room with a ragged cut on his forehead, the three-year-old was screaming, bleeding, sweating and kicking hard; it was just that he was even louder and stronger than most. Fortunately, I had two really excellent pediatric ER nurses and a medical student to help, and the talk with the nervous, well-dressed parents had gone well; they didn't ask to stay in the room while we worked, retreating instead to seats in the hall near the big door to the trauma room.

All four of us struggled to "papoose" the boy — strapping him down to a casket-shaped plywood board with big thick Velcro flaps — so firmly that he would be safely immobilized while I injected, cleansed, trimmed and sutured. Without the wiggling this was not too hard. With him still awake it was an acceptable struggle, far less dangerous than a general anesthetic for a medically unknown toddler with a full stomach.

This kid was tough though. As far as he knew this was a fight for his life, and he writhed accordingly. He wasn't giving up, wasn't weakening. I did secretly root for him just a little when the nurses started their stuff about lollipops and birdies, but they had long since abandoned their singsong attempts at soothing.

My equally secret repentence came soon and hard; you just don't get used to screams like this. Your face is right on top of his, point blank to the searing column of sound. He is so sweaty he slips around inside the papoose straps — and they don't hold his head that well anyway — so I have all six hands on his face and head. Then he tries to bite and the older nurse looks up at me with eyes that speak explicitly: 'You need to go talk to the parents about general anesthesia in the OR'.

No clue why, but as all of this was going on, I thought of my mother, who is an anesthesiologist. She was always interested in the fringe areas of her field — mind-body stuff like hypnosis. I had read a few hypnosis paperbacks as a teenager, got nowhere hypnotizing the girls next-door. In med school I read her journals and went to a couple of courses with her. It was interesting. But I was a surgeon.

So that night, in a pretty loud voice, I asked the older nurse, "Now give me the magic towel". She had no clue either, but she knew I needed an aperture drape, which is a sterile cloth sheet with a hole big enough to work through in its center. As she was unfolding it, I loudly and slowly explained to her that 'this is the magic towel that makes boys with cuts fall asleep and not feel anything at all'. I think she got it, though the other two certainly didn't. And why should they have? Even I didn't think it would work-it just seemed like something my mom might try and it didn't take any time or cost anything or seem to pose any danger. And the kid kept on screaming, harder and louder.

But then once the cloth touched his face, he turned off like a light. In fact, he turned off so fast and so completely that I got a little scared. But I could feel him breathing and his color was good, so I kept working. The younger nurse, however, started to pick up the drape-she was really scared. I tried to stop her without talking, without breaking the spell. In a mask all you can do is a kind of growl with your eyes.

As it turned out, it was probably too severe. I didn't pay attention at this point but I knew she left the field. When I heard the page operator overhead along with the footsteps and the carts rolling I knew that she had called a code. The emergeny resuscitation code team was there in less than a minute. It was a little embarrassing explaining to the residents on the code team. The chief asked to peak under the drape, and after doing so, promptly left. As I finished sewing, the kid didn't budge, didn't make a sound.

'I'm taking off the magic towel now and he will wake up' I told myself and the kid in a slow, loud and slightly nervous voice. Then magic again; as if suspended in mid-scream, he turned right back on. Yowling, mouth wide-open, writhing again for dear life, but now with my nice, neat row of 6-0 nylons underneath a nice clean dressing, very securely taped to his little forehead.

This is a true story.

Modern medicine has given us a lot of great new things with which to help our patients. Placebo, though, just might be one of the things it's taking away. Not many docs with enough credibility, not many patients with enough faith. Toss in the lawsuit threat with our increasingly medically-savvy patient base, and the fact that few U.S. docs report using placebo at all anymore is not suprising.

Response to placebo, nevertheless, is positive — it really works — in over 50% of patients tested in pain studies. It doesn't mean that there's nothing wrong with you — it means your mind is stronger than your pain. It is a fact that the multi-billion dollar alternative remedy industry would like you to forget. No cost, no side-effects, works half the time — more than anything, Placebo raises a lot of interesting questions.