That's DOCTOR to you

Here's a pet peeve of mine. Calling doctors by their first names. Now if I were a peer, that is a doctor myself, I wouldn't have a problem with it. When techs and nurses take it upon themselves to call the doctor--in my world those are surgeons and anaesthesiologists--by his or her first name, I take offense. I think that no matter how familiar you think you are with those doctors that you may work with week after week, you are not familiar enough to disrespect them by calling, "Hey, Jim!" or "What's new Michelle?" Even if you are best of friends outside of the OR, or you happen to be dating outside of the OR, inside the OR the proper title is still DOCTOR. The ONLY exception to the rule (maybe it's only my rule?) is if you have been personally invited by the doctor to refer to him or her by their first name. There is one doc here in town that told everybody he met when he first came to town to call him by his first name. Everybody has and will most likely continue to do so. I too call him by his first name but you know what, I don't really respect him. If I did, he would still be Doctor even though he's asked to be called by his first name. The doctors closest to me that have invited me to call them by their first names have given up asking me to do so because I just can't do it. It isn't respectful.

Just catching up a bit and reading Sterile Eye's entry "Breaking the Ice" made me think of the way I interact, or don't, with patients whose surgery I assist on. I wish I was better with patients. I'm fine if I find myself forced into a face-to-face with them but typically I avoid any interaction before they roll into the O.R. Deep down (or maybe not so deep) I am a sociophobe. I seldom go to pre-op and meet the patient. Once in a great while if I am talking to the surgeon or anaesthesia before the case, and they happen to be in pre-op, I may inadvertently meet the patient. Thank goodness for consents which inform said patients that surgeons may utilize assistants during surgery.
Once the patient rolls into the operating room I am fine with interaction, I often introduce myself there, if the circulating nurse doesn't do it for me, and I stand by the patient during induction, holding a hand or touching their arm. If a patient is having some anxiety, I can see it in their faces even if they don't verbalize it and I try to give some reassurance either in words or a smile and a squeeze. I think knowing that our conscious interaction has a time limit makes me more comfortable.
There was an incident some time ago that had me promising to myself that I would never again get familiar with patients or their families pre-operatively.
Our case was delayed while we waited for the surgeon, I was still scrubbing at the time, and my good friend was the circulator on the case. We both spent time waiting in the pre-op area and, while I never spoke to the patient or the family, they knew that I was involved with the surgery in some aspect. There was a lot of eye-contact made and some smiles exchanged and when their loved one was finally rolled down the hall to the O.R., I helped push the bed. This was a very emotional case for me. The surgery was to be a palliative one to try and give the patient and family just a little more time together before the inevitable. I held the patients shoulders during the epidural. From a local tribe and allowed to carry a talisman into the operating room, the patient chanted in Native tongue while the epidural was placed. I helped to lay the patient down and stood there holding an arm during the anaethesia induction. I said my own chant in my head for the patient before I let go to go scrub in.
Unfortunately there was nothing that could be done for this patient and it still brings tears to my eyes whenever I think about it. We simply opened and then we closed. For several days afterwards, it seemed that I would see the patients family in the hallways of the hospital and they would recognize me. My stomach would do one of those chemical flip flops when we made eye contact because I suck at condolences and somehow I felt so helpless to help them, as if it had ever been on my power to do so, and because I was afraid they would want to speak to me, and because I didn't want them to see me cry.

photo credit

O.R. Chatter

During a case last week, our anesthesiologist was recounting an experience he had on a recent red-eye flight. The flight attendant walked through asking if there was anyone in the medical field on board. He hesitated because he thought it odd that she didn't ask specifically for a doctor. Curiosity got the better of him though, so he motioned to her. She came over and asked him how he was related to the medical field. When he told her that he did anesthesia she asked if he would follow her. So he got up and followed her through the airplane until they came upon a man sitting in his seat reading a book. Perplexed, our anesthetist asked how he could help.
The man in the seat asked, "What is it that you do in medicine?"
"I'm an anesthesiologist", he replied.
"Oh good! I'm a surgeon, would you adjust the light?"

Reply to Candice/Lap Chole Basics

Candice said...I'm only in my second week of my Minor Surgeries class but I'm going to take a stab at this one.
First Question: Artery
Second Question: The ST should have already anticipated the need of the clip once the bleeding started
Third Question: (I think) that the ST should be asking if the surgeon needs a larger, more durable clip or if another clip applier should be loaded(?)There you have it (maybe). Even if I'm wrong on all three questions, I just wanted to say thanks for posting this because it was a lot of fun. I love reading your blog and learning the things that I will most likely encounter one day. Keep em' coming!

Candice- Sorry about the HUGE delay.
You are right, number one is an artery as projectile, pulsating bleeding indicates, but more specifically it is the cystic artery. With all of the edema and inflammation it is often difficult to identify any structures and while dissecting, sometimes the artery finds you.

Number two. Again you are right. The surgeon should not have had to prompt the tech into action. Whenever you see bleeding, you should be thinking of what the surgeon is going to need to stop the bleeding. Now of course in order to see the bleeding, you have to PAY ATTENTION!! This tech was dozing off at the mayo stand and not even looking at the monitors.
You often won't be able to see bleeding, as in an open abdominal case where the bleeding may be out of your sight but if you are PAYING ATTENTION you will probably hear something like, "S*#t!", or "Where is that coming from?", or "SUCTION!" or maybe even, "Are we typed and crossed?" If it is a surgeon you often work with, you will probably be familiar with the favorite method of hemostasis and have already opened those supplies. It may be a DeBakey and a clip, a clamp and a stick tie, a clamp and a free tie, and for laparoscopic cases, a horizon clip, or a multi-fire endoclip applier, or even an endo loop, all depends on preference, and the size of the bleeding vessel.

And, number three, you are on the right track. One set of green Horizon clips equals six clips. Four clips had already been applied and there is still bleeding. Stay ahead of the game, ANTICIPATE! The last thing a surgeon wants to do while a patient is trying to lose blood, is nothing, standing there waiting while the tech asks for, the circulator gets (often leaving the room) and opens more supplies. Even if two more clips do the trick, we still need at least six more clips to clip and cut the cystic artery and cystic duct proper (when we actually find them in the giant gooey mess), so what was the tech waiting for? Scrub a vascular case and don't stay one ahead with your 5-0, 6-0 or 7-0 prolene and see how far you get without being less than cheerily chastised!

Great job Candice!

What do you mean it's May 5th already!?

I have been so very very busy. It's great! Not really late nights or all nighters, but my day will start with say, 2 scheduled cases and next thing I know those two suddenly become 4 or 5. Take today for instance. I went in this morning thinking, thank goodness I only have one case today, I need some time to get things done at home and in the office. Next thing I know I get a text from one of the orthopods asking if I'm available to help him with 6, no wait, seven cases. So, my one case day which should have ended at 0930 this morning, turned into a seven case day, at four different hospitals, ending at 1900 this evening. And so it seems to have gone for the last week or two. In fact, I assisted on a grand total of 60 cases in April. That ties my old record set back in Jan of 2008. Maybe I can beat it in May, I'm certainly off to a strong start! Being so busy sure beats the alternative.

Candice, I promise to answer you soon. Since you're the only one who answered, you win!!

Blog Rally

A group of bloggers is holding a blog rally in support of Roxana Saberi (who is spending her birthday on a hunger strike in Tehran's Evin Prison) and of others who have dared to express their thoughts freely only to be imprisoned, abused, or killed.

Please consider placing a blue ribbon this week on your blog, website, and facebook / myspace / twitter page, and invite others to do the same, in honor of the journalists, bloggers, students, and writers who are imprisoned in Evin Prison (nicknamed "Evin University") and other prisons around the world for speaking and writing down their thoughts.

Please visit T's blog to read more and "wear" a blue ribbon on your blog for one week to show your support.

Lap Chole basics

Ok, all you surgical technologists in training, tell me what steps should have been taken by the ST in the following scenario.

Procedure: Lap chole.

Supplies on back table in addition to basic lap chole set-up, according to surgeons preference:
One set of green horizon clips.
Endo-catch bag.

While dissecting the neck of the gall bladder and trying to identify and isolate the cystic duct and artery, the surgeon gets into some projectile bleeding coming from the inflamed, edematous mess on screen.
First question; What structure do think this is?
The surgeon sees no movement in his peripheral vision from the body on the other end of the mayo stand, so he asks for a clip.
Second question; What should the tech have been doing?
The first clip misses, second clip also misses, third clip slows it down and diverts the flow, fourth clip does little more.
Third question: What should the next words be out of the ST's mouth?

Look forward to your answers!

To text or not to text

Last Saturday I was in call with one of my Ortho Docs. Things had been pretty quiet, and my horses were nervously eyeing the last lonely flake of hay on the flatbed, wondering if there was going to be anything for supper that evening. I found a decent deal on hay but had to travel 60 miles one way to pick it up. I was going to pay for an over priced bale or two at the local feed store to get me by for a couple of days until I wasn't on call, but then I realized that I was on call every day until the following Saturday so I was gonna just have to take my chances. I sent the following text to my surgeon; "On my way to "Timbuktu" to get a load of hay. I should be available again by 1900, and also tomorrow morning" I received a text back confirming ok, thanks, and I was on my way.
Sunday morning at 8:00 he sent me a text asking me to help him on 6 cases starting at 0930. The anesthesiologist for the day was one that I had worked with quite extensively when I used to scrub for the Gyn-Onc surgeon. Into the second case he asked me how much hay I got. I told him, and didn't think anything of it. After about the third conversation about hay, I asked him how he knew I had gone to get hay. Oh I just had a feeling, he says. I said nuh-uh. Then he admitted, a text message was read to the room yesterday that you were on your way to get hay. ! Yikes ! Not that it was a private message, nor would I ever send anything embarrassing or compromising over a text, but I send texts thinking that if the surgeon is scrubbed in, they won't feel compelled to answer the interruption as they would a page or ringing phone, and will check the message after the case. So, now I know.

Transition

I have decided not to delete the blog. I truly thank everyone for their support! I have been house hunting for three years now and finally bagged one. I have been moving, well, in between cases anyway. I finally just put my head down and took the weekend off, no call, and I am starting to make progress. I had to turn down a stab to the abdomen this morning at 0800. That kinda hurt. Oh well, there are enough "sum doods" to go around, I'm sure I'll have another opportunity. Meanwhile I will be without internet for two? weeks they tell me it might be sooner but I doubt it. I look forward to resuming some semblance of a blog when I return. Thank you all, and see you soon!

I woke up this morning ready to delete this blog.
I am hesitant to post in depth about cases in the OR because of patient confidentiality. I feel that for those of you who do anticipate posts from me, that I let you down when I cannot post more often (see reason number one). I like my anonymity but no matter how many ways I hide my internet (ISP) address, tracking services keep finding ways to uncover it so bloggers can see just what city and state you are visiting their blogs from. There is really nothing in my blog that I would be ashamed of coworkers reading. I am not an unkind person and I don't have time for toxic, caustic, negative people. I had enough of that as a child and now as an adult, I simply walk away from those types and no longer allow them to affect me. To blog about those types of people who are offensive or would take offense to a post about them, is too energy consuming. I love what I do so I would never want to taint my posts with their fodder. I am simply a very private person and don't like a lot of attention. I know, I know, ...so what are you doing on the Internet!? Exactly my question.
I truly have found my calling in surgery. It is still a total high each and every time I am asked to assist. It is my desire, it is my passion, it is my commitment, it is my dedication, it is my dream, it is my life. Surgery awoke in me a compassion that I had never had for humans. I see many layers of humanity in the OR and while some reinforce my pessimism for the human race, others have melted it away. Having always felt that I was on my own with no one to depend on but myself, I now find great pleasure in helping others. All of the lessons from my early life coming to fruition it seems.
My intention for this blog was to relay this passion. I wanted to include the human factor but how to do so without compromising patient confidentiality? And so I think the blog evolved as more about myself and the interaction with my surgeons. How boring for the reader! Perhaps it is blogger midlife crisis as I have seen others go through, I am not sure. I feel as though I need to make a decision about to blog or not to blog. When I turned on the computer this morning I began surfing some of my favorites and the ever likable and dependable Ramona had the link up to SurgeXperiences 218. I felt a pang of nostalgia (?) as if I had already deleted my existence in the blogosphere. Even though I have missed contributing to many recent editions, how would I be able to submit a post in the future without a blog? Have I found a niche that I enjoy and are comfortable with? Do I really want to leave my cyber friends behind? Perhaps becoming a commenting lurker would be enough for me. I guess I'll sleep on it.