Hear no evil

BMJ 1996; 312 doi: (Published 17 February 1996) Cite this as: BMJ 1996;312:449
  1. Ian Robertson

    Take my advice: starting from tomorrow, be extra nice to your friends in theatre. No, not the gorgeous serial adulterers of the West End. I mean the ones in the sexy green pyjamas and the Lone Ranger masks. It's not just that your heart, liver, or other organs vital to meaningful life are in their control—they potentially have your very mind in their clingfilm-covered hands.

    It is now well accepted that it is possible to take in some of what you hear in surgery, even though you have no memory of it afterwards. For instance, a group of anaesthetists in Wales recently succeeded in getting a significant proportion of their anaesthetised patients to stop smoking by playing a tape to them while they were under, suggesting that they wouldn't enjoy the weed when they woke up. None of a control group gave up. No one could remember hearing any messages. Several studies report better postoperative recovery among patients given therapeutic messages through earphones during anaesthesia. Published cases describe patients psychologically traumatised by careless comments they have taken in during anaesthesia without having any conscious memory of what they heard. Scary stuff, eh?

    Imagine this scenario: you (not actually you, you realise—really Mr X—but you flows so much better in the telling than does Mr X) leave the grand round feeling mighty pleased with yourself, having successfully humiliated that little upstart surgical senior registrar who has got up your nose so regularly for the past four years. You feel particularly satisfied by having done so in front of an audience that includes most of the interview panel for the consultant's post which the arrogant sod has been slavering after all that time. A job which he now sees receding before him faster than the money from a Robert Maxwell pension fund.

    The first twinge strikes as you are about to sit down to a well earned celebratory lunch. By 3 pm you are being prepared for surgery for acute appendicitis. At 3.10 a face appears, unmasked and disfigured by a smile taut with undiluted malevolence. At 3.12, after two minutes of teeth-grinding regret and bowelwrenching anxiety, you are unconscious.

    His scalpel is deft, the wound near bloodless, the surgery faultless. This is a valedictory operation—a virtuoso performance which will stand as a monument to the Surgeon Who Would Have Made This Hospital Great. The theatre staff are a little puzzled by the way he bends over you from time to time, appearing to murmur in your ear, but they put it down to devotion to a respected and senior colleague.

    After the operation you feel fine, thank the young man heartily for his professionalism. You even manage to mutter something about “water under the bridge,” wish him well, etc. He seems very happy—rather strange for someone without a job. Quite a good chap, really. Pity about the interview….

    The hospital management did their best to cover up the incident. What really messed things up was the photograph in the local newspaper—the one of you out mowing the front lawn dressed in black tights and nurse's uniform. As I said, be nice to your friends in theatre.—IAN ROBERTSON, neuropsychologist, Cambridge

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