Burwinkel 1

Matthew Burwinkel
Professor James Pihakis
English 2089 Community Essay
12/13/13
Mercy Hospital Surgical Community
I walk in through the doors into a massive jumble of information centers, stairs, elevators,
doors, and cafeterias to finally reach the surgical center. I scrub my hands and throw on my
scrubs. I head to my office to meet with the patient one last time before we begin their knee
replacement. I cover the procedures, and confirm that they have followed the guidelines leading
up to the day of the operation. I lead the patient into the operating room to be prepped for
surgery. I meet with the anesthesiologist and make sure everything is in place. I check the list of
instruments again, and then again to make sure everything is accounted for on my tray. I meet
with the surgical assistant and nurse to finalize the plans for the surgery, and I make sure
everyone understands their position. Finally, I put on my gloves and prepare to start the
procedure. First, I check the treatment plans again to make sure Im performing the correct
surgery on the correct patient, on the correct side of the patient. After confirming that, I ask the
nurse for the scalpel and we begin. Two hours later Im about to begin suturing the patient, but
before I do, we run through the list of equipment and make sure everything is accounted for on
the tray. Every last glove, tong, scalpel, sponge and cotton ball is carefully listed to avoid leaving
anything foreign in the patient -- a surprisingly common problem among surgeons. I suture up
the patient and they have a new knee. Finally, I go onto the next part of my day which could be

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anything from another procedure, talking to the patient about what to do now that the procedure
is finished, or perhaps consulting a new patient.
Surgery is seen as far back in history as ancient Mesopotamia, but has only recently
advanced in the past 50 years. As we look back, we can see the evolution of medicine from
quackery to the modern medicine we have today, and with that, rapidly changing literacy
practices in the community. The specific community I am looking at is the surgical community
at Mercy Hospital. Mercy Hospital was founded in 1831 by Sister Catherine McAuley. Sister
Catherine, sought to bring the healing and teaching of Christ to the poor and needy, and thus
Mercy Hospital sits in a less wealthy part of town. Being a private catholic institution, the
hospital community has a variety of interesting and unique aspects and practices. For example,
no employees are allowed to smoke at all, even in their free time, and their mission statement is,
Mercy Hospital extends the healing ministry of Jesus by improving the health of our
communities with emphasis on the people who are poor and under-served. Looking into the
community, we see the vital role of texts as forms of communication, documentation, and guides
for both patients and members of the community.
Membership in the surgical community, as one might expect, is fairly rigid. There
are two main members in the community, Surgeons and Surgical Nurses. Most surgeons go
through medical school, and then another four years of addition study as a resident to become a
surgeon. Surgical Nurses first go through nursing school, but then go onto a graduate program in
nursing and training programs at a hospital surgery unit. Both surgeons and surgical nurses have
set guidelines to follow and requirements to maintain their licenses. My contact into the
community is a family friends and surgical assistant at the new Mercy Hospital West. I was only
able to observe a knee replacement, the surgery described in the introduction, and talk to the

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doctor and my contact about what its like being a member of the surgical community at Mercy
Hospital.
As stated earlier, the goal of the hospital provided by the hospital is to, extend the
healing ministry of Jesus by improving the health of our communities with emphasis on the
people who are poor and under-served, but I think it can be said that the goals of the individuals
could vary somewhat within the community. Many doctors just want to help, and while its true
the financial benefits of the medical fields cannot be ignored, doctors are not paid nearly as well
as we might think. The United States department of Labor reports that the average salary of a
general surgeon in the United States is about $230,000, but to put this in perspective, many
surgeons go through ten or more years of schooling at no small cost, they often work long hours,
60 hour work weeks, theyre on-call, and their job is by no means an easy job. Talking with
many doctors about insurance and money, you can see that the vast majority of money being put
into healthcare does not end up in the hands of doctors. A paraphrased quote of one doctor I
spoke with lends a new prospective on how doctors feel about money and medicine in the United
States, The United States is in a difficult position. We have the best medicine in the world, but
one of the worst healthcare systems of any first-world country. Development costs money, and
the competitive nature of American medicine has always driven new research, but sadly,
business, paperwork, and the need to turn a profit often steer away from the initial goal of
helping people. Every doctor I spoke with has also told me that you cant be a doctor for the
money. You have to want to help people to be successful. So, while no one is going to blatantly
tell me, Im in it for the money, I think the vast majority of medical workers legitimately care
about the work they do to help people. These goals of the community and the members of the
community thus lead to the values that the community holds. The community values human life

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above all else, and therefore values eliminating things that would prevent the most effective
treatment possible. This intrinsic goal brings about the idea of patient-doctor confidentiality, trust
in scientific honesty, and accountability. Medical Ethics can be represented in hospital and legal
rules, but also in texts made by the community by members.
One of the first examples of such a text can be found in the Hippocratic Oath which
displays many of the aforementioned values of the community. The Hippocratic Oath was
written by the early Greeks and serves as a guide to ethics that many physicians and medical
professionals take. The Oath holds the basic ideals that a physicians focus should always be in
the interest of the patient, humanity, and presents the idea of patient-doctor privilege or
confidentiality we know today. These basic guidelines developed into the modern Declaration of
Geneva, the most basic ethical code that the field of medicine uses, but are essentially the same.
Its apparent that there are two main forms of texts within the community, texts meant for
the patient and general public as an audience, and texts to be used by members of the medical
community. As one might expect, the language and technical jargon/terminology is quite
complicated in the surgical community. Most people are not going to know what arthroscopic
means. So, to simplify communication between patients and to get the information they need,
doctors, surgeons, and the hospital in general provides forms that are easy to fill out and step-bystep instructions for what the patient needs to do or know. Online media and pamphlets often
provide basic instructions and guides. When you first register for surgery, a whole list of specific
guidelines on what to do before youre admitted for surgery, what to do leading up to the surgery,
what to the day of the surgery, and then what to do after the surgery is given to the patient based
on what they need. There are also texts and forms explaining the inherent risks of surgery and

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what to expect so patients understand fully what is going on with their body. This is just one
example of the surgical communitys use of texts in its operation.
The second form of texts is texts more used by the community with the audience being
other members of the community. For example, the medical community as a whole uses text to
keep information on all patients. Starting from your birth, every procedure, shot, and medication
youve ever taken is carefully recorded, so that members of the medical community can
communicate with each other about individual patients. Your medical history is basically the cliff
notes of your life medically and allows doctors and surgeons to know what pertinent information
other doctors have already found about you, and thus decide what treatment is best. Obviously,
doctors use text to document patient care, but the use of texts as a form of communication and
documentation especially comes to light when the texts are fail to be implemented properly.
Before any surgery, surgeons carefully document the type of surgery being performed, what side
of the body the surgery is being performed on, and they keep a detailed list of all surgical
instruments to be used during the surgery. This is important as an alarming number of surgeries
are performed on the wrong side of the body, leaving the patient with surgical material left inside
of them or even on the wrong patient entirely. This is partially due to the proper documentation
not being filled out and lots of small clerical and operational errors building up to large mistakes
(Sette et al. 2013.). Currently documentation and studies of such incidences have caused changes
in surgical practices, such as strict and careful documentation of all instruments used in a
surgical procedure down to every little cotton ball, sponge, and stitching. This leads to another
use of texts in the community.
The Mercy Surgical community and the scientific community in general use texts as a
mean of communication among others in the field globally to convey new knowledge. Peer-

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reviewed journals document scientific advances in the field and allow discourse in the
community about different idea, techniques, and studies. For example, a group presented new
strabismus surgical techniques that improves eye muscle strength at the annual American
Association for Pediatric Ophthalmology and Strabismus conference (Ludwig et al. 2013.)
Almost all new knowledge from research in the field comes from published paper and articles
presented at different conferences like this one. This method of communicating information
relies on trust that the studies and observations are factual, but it is self-checking as the studies,
once published, are review by other in the field. Information that is misrepresented or
manipulated data wastes money and resources and undermines the goals of the community. The
study that showed a link between Autism and vaccinations, for example, contained manipulated
data and has since been rejected by the community. This shows the value of integrity and the
importance of being honest in the community whether you make a breakthrough discover or not.
So, from my short stent at the hospital and some research on the hospitals website, I
found out a great deal about the explicit goals of the hospital, but also what some of the
individual values of the members of the community. While its also true that many texts are for
legal protection and financing, its also evident that most of the paperwork doctors do is careful
documentation of knowledge, so that members of the community can communicate with others
in the community about what they have found or have done. Many texts are intermediates that
allow the community to communicate with people not in the community, such as patients, who
might not understand the technical terms of the discourse community. Finally, there are clerical
texts to help the hospital in its general operation and achieving its goals. The goals of the hospital
community and members therefore revolve around helping people, thus leading to the values of
holding protecting human life above all else.

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Bibliography
Burwinkel, Matthew. Personal Interview.
Ludwig, Irene H., Robert A. Clark, and David R. Stager. "New strabismus surgical
techniques." Journal of AAPOS 17.1 (2013), 79-88.
Preparing for Surgery Mercy Hospital.
http://e-mercy.com/surgery-instructions-for-patients.aspx

Sette P, M Dorizzi, and M Azzini. "Preoperative Practices Overhauled After Surgical Checklist
Failure." OR Manager 29.8 (2013): 26-28. CINAHL Plus with Full Text. Web. 13 Dec. 2013.