So Check This Out…

We are getting ready to do blepheroplastys (eyelid surgery) on this one lady and she starts to cause a problem in pre-op. You see, the surgeon ordered some basic medications for her to receive before surgery…an antibiotic to help prevent an infection and a medication to lower her blood pressure to help prevent bleeding during surgery and bruising and swelling afterwards. Well, she pulls out the “I’m a doctor” card…telling us she doesn’t want any chemicals in her body. Now, the surgeon isnt doing the surgery without her taking these meds…so while they hash it out…I try to learn a little more about our patient.
I search the database of physicians at my hospital…not in there; I search other hospitals in town…can’t find her. I google her and there she is…some type of all natural remedy homeopathic aesthetician…so not a real doctor. But here is the great part…she has a clinic that promotes all natural healing with herbs and vitamins and potions and such…also featuring NON-SURGICAL FACELIFTS!!!
Here she is…having a surgical procedure…so she can go back to her clinic and sell people on her non-surgical line of products that can make them look young like her…
So just be careful when people pull out the “I’m a doctor” card…or even the “I’m a nurse” card…or the “I’m a” anything card…
I mean, I respected this lady a lot more when she was just my patient; but when she went all “I’m a doctor…”, trying to get everyone’s respect…she ended up losing it…

Things You May Not Know…

What a lot of people may not realize about the OR is that, depending on
the circumstances, the majority of the conversation that goes on in the OR
has nothing to do with the surgery happening or even the patient
themselves. Of course this depends on things like how critical
the patient and/or the surgery is, if the surgeon is teaching a new
surgeon how to do the procedure, or if there is something really
interesting about the procedure. This may surprise a lot of people, but
it is a good thing. If a surgeon and the rest of the surgical team have to
give 100% of their attention to the procedure…that usually means things aren’t going very well.
Ninety percent of surgeries going on
are routine…the surgeon and the staff have probably done that procedure a
couple of hundred times…and you want them to perform it almost out of
habit. If the surgeon has to focus and concentrate on what the next step
is…that usually mean they are not very comfortable or familiar with the
procedure…and that’s bad. If the surgeon and the staff are talking about
the ballgame last night, or the movie they just saw or their plans for the
weekend, that means the surgery is going right according to plan…with no
surprises…and that’s exactly what you want. There are occasionally times
during a procedure when things start to not go so well. When that
happens…you can sense a change in the room. The light hearted
conversation ceases, all conversation is focused at the task at hand and
the music gets turned down…but when the crisis passes…it all resumes.
Music is usually played during surgery…sometimes quite loud. You find it
generally relaxes the surgeon…and in turn the rest of the team. I once
knew a surgeon who was having “anger management issues” and his therapist
prescribed soft music playing in the background while he operates. The
music in the OR can range from smooth jazz to hard rock to gangster rap to
Spanish guitar to reggae…thank goodness for Pandora.
Unfortunately, and this is one of my pet peeves, this non-clinical
conversation sometimes starts before the patient is asleep. I am a firm
believer that all conversation should be focused on the patient whenever
they are awake…but it doesn’t always happen. The saving grace to this is
that the patient is usually given medications before they leave pre-op that
makes them forget. This brings me to the next thing that you may not
know…you are awake when you come to the OR…you are awake and talking
and moving yourself around when you come into the OR. Almost daily I hear
patients say “The last time I came to surgery I didn’t remember any of
this,”…well you know what…you won’t remember this either…and the next
time you go to surgery…you will say the same thing. Sometimes patients
will get scared when we are rolling out of pre-op and start saying “I’m not
asleep yet!”…no kidding…you’re not supposed to be asleep yet. First,
we need you awake because we are going to need you to move yourself over
from the stretcher to the OR table; second, we can’t have you asleep until
you are attached to all of our monitors, and our emergency medications are
right at hand. It would be totally unsafe to be fully asleep before we got
into the OR.
Now let me say this…there are exceptions to everything I write…none of
this is 100% true 100% of the time…it is just a generalization of the way
things are 90% of the time…people will always find exceptions…because
there are…sometimes things are a little more conservative and less
dramatic…and sometimes the opposite…but what I’m writing is the way it
is…for the most part…