When Theft Becomes Necessary

Within the essay “Education of a Knife,” Atul Gawande presents the resident’s dilemma as a “conflict between the imperative to give patients the best possible care and the need to provide novices with experience” (Gawande 2002 p. 23). Primarily, Gawande suggests that there is no way for resident surgeons to learn without the deception of patients. As he states, “learning must be stolen“ (32). Patients would be unwilling to allow a resident to treat them because of fear of mishandling. Therefore, residents must don a facade of competency and knowledge in order to deceive their patients. It is only in this way that the residents may receive hands on experience in treating cases. Through “Education of a Knife,” Atul Gawande presents his position as one that supports the need for this clandestine deception of residents in order to preserve the learning of future surgeons. Like Gawande my experiences in pharmaceuticals have also been “stolen” through the deception of patients.

Gawande views the apply named “physician’s dodge” as a necessary lie (30). That is, one cannot learn techniques of medicine without deceiving one’s patients in one way or another about one‘s skill and expertise. He states that “learning is hidden, behind drapes and anesthesia and the elisions of language,” for “who in their right mind would agree to be practiced upon?“ (30). In this, he is stating that novice doctors must perform on live patients in order to learn, yet virtually no patient would be willing to be practiced upon, given the knowledge. Therefore implying that surgical residents must keep their patients ignorant. He continues to state that there seems to be no way around this moral failure. As patients, we wish for “expertise and progress” yet residents must learn in order to achieve that expertise (28). He continues to state that “it’s all stark confirmation that you can’t train novices without compromising patient care” (30). Although disliking the deception that he must take, Gawande understands that there is no way around this. For “everyone is harmed if no one is trained for the future” (24). Gawande is therefore supporting the lesser of two evils. The unspoken but implied mishaps do occur among the novice surgeons. Nevertheless, in the end, the training of these individuals has a greater societal benefit.

Similarly, I agree with Gawande’s ambivalence over this topic because I too have experienced this ethical dilemma of having to deceive patients in order to learn. During the summer after my freshman year of college, I interned at a privately owned retail pharmacy. According to state regulations, only registered pharmacists and pharmacy technicians are allowed to physically handle drugs. As a college student, I was neither. Regardless, the pharmacy and I both assumed the deception that I was a registered pharmacy technician. While one may learn and memorize the names and functions of pills, physical handling of such drugs provides a more experimental knowledge that engrains the image, feel, and purpose of each pill upon the human mind. At the time, such a façade was necessary for my learning, though not ethical. There was no other way that I could have had this experience. If I had portrayed myself truthfully, no patient would have agreed to let me handle their prescription drugs for fear of mishandling.

Just as Gawande experienced failure during his education, I too experienced failure by mishap. One day, I accidentally switched the labels of a patient’s ibuprofen and metformin pills. Both are large white oblong pills that can be easily mistaken for each other. Ibuprofen is normally a common over the counter painkiller, taken when discomfort occurs. The clinical ibuprofen prescribed was about 150% stronger than the OTC version. Metformin, on the other hand, is a popular diabetes drug that must be taken three times a day, usually at every meal. After about two days, the patient returned complaining of constant fatigue and drowsiness from the regular ibuprofen intake. The registered pharmacist took one look, corrected the problem, and then proceeded to soothe the irritated patient’s feelings. Needless to say, I did receive a lecture for that incident but no other punishment. This both relieved and frightened me, because once again my integrity was compromised for the sake of the pharmacy’s appearance. The pharmacy could have been held accountable because of my inexperience. False self confidence makes for a gambling chance that will eventually result in a loss. Like Gawande, failure helped me realize my own iniquity. Nonetheless, the intellectual payoff is high. Just as Gawande, after seven years of his residency, always remembers his failed first central lines, my first failure in pharmaceutical sciences remains with me as a lesson that I will not soon forget .

Through necessity of learning, the morals and honesty of surgeons are compromised in order to preserve learning. Surgical residents believe, as Gawande states, in “practice, not talent” (19). Yet the chances of mistakes occurring by an individual that has only recently embarked on the learning curve are high. Nonetheless, to disclose the incompetence of these individuals to patients would result in a decrease of cases of which to practice upon. As Gawande points out, this situation is even more dangerous because “everyone is harmed if no one is trained for the future” (24).

on injury and impact

Perhaps the most traumatizing experience I have ever suffered was a sprained ankle. Seriously. Alright, perhaps “traumatizing“ is too strong an adjective to use, but it was one of the experiences in my life where I have truly felt my body’s limitations. While a junior in high school, I was a highly competitive volleyball player. Our team was one that had won scores of championships in the past: a team with a legacy. It was expected that we would have a shot at the championship that year. With that goal in sight, my summer before the season was one in which I trained to transform myself into a “lean, mean volleyball machine” True to my efforts, I soon won a spot on the starting team as a middle blocker. There was naught in the world that could deter me from my goal and dream of seeing us at the final game, coming together for a tearful embrace; the championship trophy gleaming in our midst as scores of fans cheer us on.

Yet soon I would find myself with a sprained ankle received from tripping over one of my teammates during the opening tournament. At first, I saw such an injury as being a “battle wound” and a source of pride. My peers all sent their condolences and listened with wide eyes to the tragic story. However, the novelty of this idea faded gradually as I realized how intensely painful it was to maneuver through a crowded hallway with crutches. Baths and showers became a battle of their own as little pressure was able to be put on my foot. I soon felt like a one legged pirate, hobbling my way through the hallway; my “dead foot” dragging on the floor.

At the same time, the physical discomfort was no match for the emotional cost. For an athlete, a heavily sprained ankle at the beginning of a two month season means nearly an entire season benched. I saw the loss of things I held dear at the time: my position on the team, others’ admiration of my skills, and even the muscular density that I had so faithfully built up during the off-season. Looking back, I realize that I had placed such an importance on shallow things that did nothing for my admission to college nor for any vocational path. At the time, taking away my ability to be an athlete was tantamount to breaking my spirit. Yet like a phoenix rises from the ashes, during that period of inactivity, I filled my time with intellectual pursuit and discovered a great love for the health sciences that was crucial towards spurring me to volunteer at a hospital. That volunteer experience soon became one that cemented my decision to pursue a career in pharmacy.

In the end, some good did come out of an unfortunate situation. My focus is now turned towards goals that, I believe, are a bit more socially beneficial. Though I still play volleyball, it cannot hold its previous position as an idol in my life. I would like to say that I’ve matured through this process and such aspirations for personal glory would never come again. Nonetheless, there are moments where I still long for that personal recognition. Except perhaps this time, I would like it to be admiration and gratitude from a patient that has been well served. The cheering crowds and trophy can be happy to exist in my imagination.