Respectful Insolence

An odd place for a telephone booth

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgWhile I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts.) These will appear at least twice a day while I’m gone (and that will probably leave some leftover for Christmas vacation, even). Enjoy, and please feel free to comment. I will be checking in from time to time when I have Internet access to see if the reaction to these old posts here on ScienceBlogs is any different from what it was when they originally appeared, and, blogging addict that I am, I’ll probably even put up fresh material once or twice.

I was sitting in my office, working on a yearly summary report for a grant. In such reports, it is customary to report on what you have done the previous year and, most importantly, to paint a glowing picture to the granting agency (in this case, the Army) of how much fantastic progress has been made on the funded project and how well-spent its money had been, so that they continue to fund the remaining years of the project. While I was typing away and cutting and pasting various figures into the document, I felt the call of nature. It’s not surprising, given that the verbiage that I was introducing into the report was not unlike one of the end products of answering said call (which is probably why such tasks seem to stimulate certain biological functions in me). I tried to ignore the need for a while, wanting to finish the section I had been working on first, but the urge became steadily more insistent. Biology can only be denied for so long before it has a way of forcing its will to be done.

I headed towards the bathroom nearest my office, thankful that the urge hadn’t hit me while I was in the operating room.

Entering the nearest stall, I prepared to do what my colon was demanding of me when, eminating from the stall next to me, I heard it. No, it wasn’t the rude noises common to such facilities, nor was it the flush of a toilet. It was this (paraphrased from memory, of course; I don’t carry tape recorders into the john with me, at least not routinely):

“Well, I realize that that regimen will really knock him for a loop. He’ll be neutropenic for quite a while, and he might even need to be admitted. On the other hand, he’s failed first-line therapy, and this is probably your best next option.”

I recognized the voice. It was one of our medical oncologists (whom I’ll call “Dr. X”). In fact, it was a senior oncologist, one of the best we have in our facility, one whose abilities and compassion I respect enormously. Apparently Dr. X had felt same call that I had. But apparently the call of nature wasn’t the only call he had felt the need to answer.

“Of course I’d be happy to accept him here, if that’s what you’d like. However, if you’d prefer to give him the chemo yourself, you could always transfer him if he got into trouble.” A pause, during which I could hear a quiet buzzing that must have been the person he was talking to coming through on his phone. “Yes, I’d say the odds of inducing a remission are probably less than 50%, but he’ll progress rapidly if you don’t do anything, and even if you don’t get a complete remission you could get a strong partial response.”

Holy crap! (An appropriate exclamation, given the situation.) Dr. X was having a long and involved conversation on a cell phone about a patient with another physician while sitting on the throne! As I sat there, I could not help but become engrossed (another seemingly appropriate word) in the conversation. He was going into great details about this patient’s course of treatment, the likelihood of success, the potential side effects, and how those side effects could be managed. I was getting a serious education in the second-line therapy for non-Hodgkin’s lymphoma right there on the commode! At first I thought to myself that this had to be some sort of HIPAA privacy violation, but on second consideration, I realized that no patient-identifiable information was being discussed at this end. (Hopefully the doctor on the other end of the conversation was in his or her office or someplace suitably private.) The conversation was perfectly legal! So engrossed was I that I temporarily forgot my purpose in entering that stall. No problem, though. My colon wouldn’t let me forget for long my original purpose.

I completed the task for which I had entered the stall.

Sweet relief, but I was now faced with a dilemma. Dr. X was still continuing his conversation next door, but my task was actually not yet quite complete. One thing remained. The problem is, I realized, that that “one thing” might cause a problem. So, there I stood, having finished wiping, and pondered the question for several seconds: Should I or shouldn’t I flush? On the one hand, flushing would very likely be heard by the person on the other end of the line, revealing that Dr. X was in the bathroom while carrying out this conversation. I didn’t want to embarrass him if I could help it. On the other hand, the end result of my visit to the commode was rather large and stinky, my having had a pretty big and greasy meal the night before. It really wasn’t fair to future users to leave it there unflushed to pollute the rest of the public restroom. Dr. X had decided to have his conversation in the sanctum sanctorum. I couldn’t be responsible. However, I could be responsible if I left the disgusting product of my colon behind, unflushed, to gross someone else out and to require them to do what I should have done in the first place. My course was clear. I knew what I had to do.

I hesitated a moment, my hand over the handle, and then flushed.

The sound filled the restroom, loud and reverberating off the walls. It was an unmistakable sound, an emphatic declaration that my business there had concluded. There was no way that Dr. X’s conversation partner wouldn’t have heard, as the phone couldn’t have been more than five or six feet from the sound, separated only by a partition. The sound of rushing water seemed to go on forever. It’s fortunate that it did go on so loudly and luxuriantly.

The flush covered my escape.

I darted out of the stall, went right past the sinks, left the restroom, and headed for my lab, where I could wash my hands without the chance of Dr. X seeing me on his way out, although I think he was still otherwise indisposed.

Gentle reader, you might wonder why I behaved in the manner that I did. I ask myself the same question. Why couldn’t I have thought of another solution? For instance, I could have refrained from flushing and then simply checked back in a few minutes, after Dr. X had finished both parts of his business, the primary and secondary (I don’t know which he would consider primary and which secondary). My office wasn’t far away, nor was my laboratory. Such a solution would have worked quite well.

The answer, I think, comes down to annoyance, plus a little embarrassment at having listened in on a private conversation about a patient. Yes, I realize that the embarrassment was irrational, given that I had little choice but to hear the conversation (unless I wished to go to the public restroom one floor down, not a great idea given the urgency of my need), but the annoyance was not. It used to be that, even in a public restroom, one could expect a modicum of privacy to go about one’s business with regard to the purpose for which the stall was intended. Little in the way of conversation usually happened there (the exception being large restrooms at stadiums, where people waiting in line will frequently talk), and even there usually not in the stalls. But I think the annoyance was more generalized than that. The younger readers of this blog may not understand this, but I was annoyed at the intrusion. I was annoyed that technology has reached the point such that no place is considered off-limits for conducting business or doing work, a point driven home by this incident.

No place, that is, except the rare locale that doesn’t have a signal.

Don’t get me wrong. Cell phones are wonderful devices, something so phenomenally and incredibly useful that I no longer see how I could go through life without one. I’m a complete gadget freak in many ways. However, back when I started my residency, pagers were used only by doctors and drug dealers. A few years later, anyone could afford them. A few years after that, cell phones proliferated. I got my first cell phone in 1997, and it was a brick and too expensive to use all that often. Now cell phones are tiny, and you can get plans with huge buckets of nationwide minutes at relatively cheap prices. No wonder almost everyone has one. No wonder Dr. X uses one to take care of business while he’s taking care of business, so to speak, given how much he has to do in a day. However, thinking of being so busy that I would feel the need to occupy every minute with productive activity, including my time on the throne, would give me pause.

The great benefit of these devices is that they allow us to be connected almost anywhere, an attribute that is particularly useful in emergencies and especially useful for doctors who take care of a lot of sick patients. Unfortunately, that same interconnectedness is also their curse. For many, there is now no escape from work, no place that can be considered private, no excuse for not answering. For others, there is now no place that is safe from being subjected to the interconnectedness of others. Being subjected to a detailed conversation about a paitent while I was trying to take care of business that, until recently, had been considered private reminded me of that. Twenty years ago, no one would have conceived of having telephone conversations of great import while sitting on the can. Now, no one thinks anything of it. It’s bad enough when someone as busy as Dr. X feels so harried that he won’t even allow himself a moment’s peace, but what about less important uses. I’ve seen guys walk into the restroom, phone plastered to their ear jabbering away, walk up to the urinal, whip it out, do their business, flush, and put it back in their pants, all without even slowing down their conversation.

Are all these conversations really so important that they can’t wait a few minutes? To some extent I can understand why Dr. X, being so unrelentingly busy taking care of his patients, might consider it entirely rational to take advantage of a cell phone’s ability to let him to do two things at once even in the strangest of places, but that doesn’t mean I have to like it. Technology exists to serve, but unfortunately it’s all too easy to let it rule us. All this wonderful technology that wires us and binds us through radio waves to each other can, at times, seem a smothering electronic cocoon that destroys the precious little personal space we have left.

This post originally appeared on the old blog on May 23, 2005.