Twitter Is Now My Rolodex, and Other Things I Learned from Hope Amantine

9 Jul 2015

What happened yesterday has me thinking about Twitter.

Yesterday, before I got out of bed, at about 7:30 am, I took a look at Twitter and found a post by Dr. Alison Barrett (@DrAlisonBarrett). It read, “Anyone else worried about the ethics of this? Anyone?”

Barrett linked a post at KevinMD.com, a blogging site. Normally I don’t read stuff at KevinMD, because, to be honest, a lot of it annoys me. Too often it seems to be doctors humble-bragging about how brave and mature and compassionate they are. Since I spend a lot of my days dealing with people who have been victims of iatrogenic trauma, I don’t have a lot of patience for that genre.

But the phrasing of Barrett’s question grabbed me, because I try to be the person who listens when someone asks, “Does anyone care about this medical ethics travesty?”

So I hit the link.

It was an essay written by “Hope Amantine,” a pseudonym for someone claiming to be a surgeon in rural America. Amantine described a “teaching moment” from her own training, when a mentor, impatient with Amantine’s hesitance during a surgery because Amantine was afraid of accidentally cutting the patient’s inferior vena cava, purposefully cut a 1-inch hole in that very vessel, leaving Amantine to deal with it. A cut like that can kill you, quickly.

After I finished reading it and pulled my eyebrows off the ceiling, I retweeted Barrett’s tweet, adding, “Jesus. How is this not attempted murder in the OR?” I copied @Skepticalscalpel, my go-to guy for surgical ethics. He retweeted it, adding, “If this really happened, it’s a huge ethical issue. I’m appalled.”

“Skep” and I have a lot of followers between us. A lot of his are smart doctors. A lot of mine are smart patient advocates. The thing quickly took off. I tried directly engaging Amantine, who then had an account, @HopeAmantine, which she has since turned off. I asked her, “How is what you describe here not a crime that required reporting to authorities?” She asked what crime? I answered assault. (Lawyers later corrected me: battery. Assault is when you’re awake.)

I added that my internist-husband suggested it could be attempted manslaughter, but she could ask a prosecutor which it was.

From here, others started weighing in, all pretty much on the same side. Reason; morality: that side. Smart comments came from lawyers, including a doctor-lawyer and a prisoner rights’ lawyer, from surgeons, and from medical ethics folks. Surgeon Gwynedd Pickett (@gpsforthebrain) weighed in to say she had never seen anything like what Amantine was describing: “Floored any surgeon (even arrogant) would create” a purposeful cut in the vena cava.

Surgeon OJ Nilsen (@OJNilsen) pointed out to Amantine this kind of stuff gets practiced on animals like pigs, not humans. Amantine answered that human anatomy is different, as if that justifies what her mentor did. Disgusted, Nilsen asked in reply, “Why not stab the liver next time? Or the intestines?”

I tried getting @kevinmd to pay some attention, but I guess I’m not a big enough deal for him to bother. Meanwhile Amantine started defending herself on Twitter and in the comments thread of her article. Sample tweet by Amantine to @DebGoldenDC: “I did not MAKE the cut in the cava, I did not agree with the tactic, but I had to fix it. That is the point.” She also insisted that the patient didn’t die, as if that made the ethical and legal questions about the situation moot.

Funny all that defense of her actions on her part, because not long after, Amantine claimed it was all fiction. She posted a note to that effect at the end of the essay: “This is a fictional article. No one was harmed, then or ever, in my care or in my presence.” I wonder if this claim came because, at least on my feed, we were talking about how to figure out who the sick surgeon was and whether he might still be practicing, so that we could alert the authorities.

In any case, as internist Mike McInnis (@DrMcInnisDIT) pointed out, this disclaimer itself was unbelievable; no one was ever harmed in her presence? Impossible in surgery. Was Amantine essentially lying the first time, presenting a fake story as if it was true, or lying later in saying it was fiction?

By yesterday evening, Amantine’s twitter account was gone, as was her personal blog. By this morning, her post at KevinMD had also been removed by Dr. Kevin Pho, who owns and runs the site. He apologized “for publishing the story” and added that he “will obviously learn from this experience.”

But what will Pho learn? He hasn’t explained why he published it in the first place—did it not occur to him the author was describing a crime? He hasn’t explained why he let it stay up even after the “it’s just fiction” addendum when he did not “know whether the story is really true or not.”

What he seems to have learned is that if enough people get mad at you on Twitter for your “curating,” you’d better show up at the performance art gallery and deal with them.

Meanwhile, I’ve learned a few things:

First, I’m just as cranky as ever about people, especially alleged editors, mixing fiction and non-fiction as if the distinction doesn’t matter. How is it Pho leaves up the rest of Amantine’s work as if it is non-fiction, when he doesn’t even know the truth about the piece he took down? (He really does need to give up her real identity to Ivan Oransky, @ivanoransky, who is internationally respected as a leading health journalist and expert on retractions.)

Second, even when someone manages to remain anonymous and ethically daft as she or he becomes the target of sharp criticism on social media, it still gives me a queasy feeling in my gut to be a part of the criticism and to watch it all unfold. I felt as I did during the sex ed Twitter-storm craziness: kinda sick to my stomach.

I felt as I did during the Tim Hunt unfolding.

Wait! YES, WHAT HUNT SAID WAS AWFUL, DAFT, STUPID, AND HARMFUL. I am so grateful we were alerted to it by Deborah Blum (@deborahblum), Oransky, and others. I am so incredibly grateful it led to the #distractinglysexy movement, which was nothing short of awesome. (Although it did start to look like try-outs for an all-female version of The Village People.)

I just felt a little sorry for Hunt because the sex ed storm taught me how utterly shocking the experience can be when you are at the center of a social media tornado without any meteorological warning.

Third (and this also relates to the Hunt tornado), I have been struck by how incredibly good Twitter can be for calling people to a higher standard of behavior. That happened with Hunt. With regard to Amantine—which, by the way, too late finally got a hashtag of #IVCgate—I would point especially to Janet D. Stemwedel (@docfreefide) and her really smart comments yesterday, as some people expressed some sympathy for the now-disappeared Amantine, including this: “Part of being a grown-up is grappling w/your stupid shit . . . & recognizing & trying to live up to your duties to other people, like your readers.”

Right on. That shook me out of misspending more energy worrying about Amantine, whomever she or he really is. Twitter at its best crowdsources moral behavior, particularly in medicine. That’s rather wonderful.

Fourth, finally, Twitter has replaced my rolodex.

As recently as a couple of years ago, during the whole “dex and Dix” debacle (read my book if you have no idea what I’m talking about), my fellow intersex rights activist Janet Green said, laughing, “Don’t fuck with Alice’s rolodex!” What she meant was that over 20 years of activism and scholarship I had accrued a huge number of powerful and influential contacts I could call when we needed help to try to stop a medical ethical travesty.

I still have a lot of those contacts, but the majority of investigative health and science reporters I had in my rolodex are no longer working in the business. The internet has economically crushed investigative journalism. And this has been absolutely terrible for patients and subjects of medical experimentation. It means that it is so much harder now to get the word out about medical ethical travesties. And if you can’t get the word out, you can’t stop them.

The Amantine case yesterday was a little one. We don’t even know if what she described happened. If it did, we haven’t managed to bring the surgeon to justice, nor to find a way to tell the patient to whom it happened what happened. (Paging Kevin Pho’s moral conscience: it’s not too late.)

But what yesterday’s take-down of Amantine’s post taught me was that Twitter is my new rolodex—it is a place where I can quickly call on a large number of smart, thoughtful, and often-influential people. And that feels comforting and maybe a little hopeful.

Maybe I can stop completely hating the new media for killing the old media. Maybe there are ways to use it in the service of truth and activism that are actually effective, and not just a waste of time.

You can follow me @AliceDreger.