Off the Subject

After being threatened and coerced into filling out the US Census form, why is it that the US Postal Service still can't figure out who lives here?

1 Sick Day a Year

My Favorite Trauma Surgeon gave up regular trauma call about one year ago. Since then I haven't been involved in assisting on many traumas which in part explains why I haven't had any regular postings for the same time frame. Well, with two sons fast approaching college, my FTS has come back on board the trauma panel if only to fill in on occasion, generally once a month. Last month we had no surgicals. This month his call day was Monday the 13th. I was stoked and so looking forward to it. As luck would have it, without going into too much detail, I was totally incapacitated with painful symptoms and unable to cover call with him. What did I miss? Only three, yes three, exploratory laparotomies resulting in one liver resection, one kidney repair, and one bowel resection.

Doo-doo-doo doo. Doo-doo-doo-doo. "You're traveling through another dimension --"

I've always hoped that my particular involvement in the health care profession was recession proof. Not so, it seems. Unit clerks are getting laid off, scrubs and nurses are being called off and instead of reporting to work, they are being put on call (much, much cheaper to pay call pay that an hourly salary-the hospital plays the odds that the crew won't be called back in at time and a half pay), or just told not to come in to work. I haven't worked on a call night since I can't remember when, and, my cell phone hasn't rung for two days now. It all feels so odd and Twilight Zone-ish.

Not for the Queasy

In one of the local hospitals high school kids from various programs frequent the operating room (they never had cool stuff like that when I was in high school!). During turn-over the other day, one such student was hanging around while the crew was cleaning the room between cases. As one of the orderlies was picking up bits of bone and tissue off of the floor he looked over at the student, opened his palm full of tissue and said, "Hmm, almost enough for a sandwich."

Space Camp (first drafted Nov 2009)

Wednesday was supposed to be a light day. I had enjoyed sleeping in for the first two days of the week, but Wednesday was a 7:30 start which means I have to get up at 0530. I am not a morning person. No matter, a light day of two ortho cases. One, a hallux valgus correction, which is a fancy way of saying bunionectomy, though to be fair there is a little more to it,( my foot and ankle doc would probably argue that there is a LOT more to it!) and the other, an achilles repair with FHL transfer (flexor hallus longus-the tendon that flexes your big toe) . Both cases are kinda fun and not too time consuming so I'm looking at getting done by 11:30. Yes, it was my day with the ortho foot and ankle weenie. Don't worry, I have called him a lot worse to his face, and he to mine. In a lot of ways he is my "work husband" and we are sort of the comedy team of the OR but that is another post entirely.
At 1800, sorry 6 pm, I have a dinner to go to. A general/vascular surgeon that I have recently begun assisting has invited me to dinner along with his office staff. They are invited for getting his Medicare paperwork through for him (finally!) and I, for assisting him with multiple no-pay Medicare/indigent cases.
As predicted we finish with our ortho cases and I am off the hook by 11:30. Although he still has a simple hardware, ie. screw removal and a foot puss......pus ......how do you spell that?..... washout at a different surgery center, he has an eager PA student with him that day so off I go.
Now I can: Print off some op notes, go to the credit union, fuel up my truck, spend some time with my horses, shoot off some claims and some emails, and next thing I know, it's time to get ready.
Dinner was amazing. The food was great, the company was spectacular. The only way it could have been better is if I hadn't been on call and could have enjoyed a glass of wine. Or two.
So, home by 8:30, in my jammies, comfortably stuffed and watching my dvr shows in the leather recliner with a blanket and a cat on my lap. Life is good, life is comfortable. Until my cell rings at 10 pm with a familiar ring tone. It's my FTS. Oh wait, he used to be my F avorite T rauma S urgeon, " til he GAVE UP TRAUMA CALL!! No matter, he is still my favorite all time surgeon. He has a small bowel perforation due to go to the O.R. in about half an hour. He gives me the option to say 'no' because he knows that I have a case the following morning. I tell him 'yes'.
OR times at night, or almost anytime really, are not exact. It is after 1130 pm before we even get in the room. Fixing the small bowel perforation for this patient is the easy part. The hard part is meticulous and tedious take down, or lysis of adhesions, before one can even examine the bowel to find the perforation. Not all patients have these adhesions, which are typically the result of previous surgeries, but tonight our patient does. If you ever hear a surgeon dictate one of the procedures as "Extensive lysis of adhesions." you can bet that is just what happened. Doesn't mean they get paid any more for it, but I think it makes them feel just a tiny bit better to dictate it with emphasis! Somewhere in the middle of miles and miles of adhesions, I start to zone out a little. Mind you, the surgeon is doing all of the "fun' stuff, blunt dissection with his fingers , sharp dissection with a pair of metz, while my only job at this time is lifting two kocher (clamps) that are attached to my side of the patients abdominal fascia, straight up in the air in order to provide the surgeon better exposure. As I stand bored and daydreaming, I almost startle as I see a spider run across the drapes. In my mind my first thoughts are how odd it is to have a spider in the OR. Then it dawns on me. We're in the OR! Break in the sterile field! I must point it out! And just as I'm about to open my mouth and spill my guts, replacing them with my foot, I realize that what I actually saw was nothing more than a bead of dark blood "running" through the suction tubing on it's way across the patient towards the suction canister at the head of the bed.
When it is all said and done, the leak is identified, the damaged bowel is removed, everything is put back together, the abdomen is irrigated copiously to decrease contamination and the patient is sewn back up. By time we hit the PACU it is 2:20 the following morning.
I make it out of the hospital by 2:45. I'm home by 3:15 and in bed somewhere this side of 4 am.... wide awake, and starving, and wondering if I am going to dream of spiders.