Saturday, June 13, 2009

weekend call

Saturday cardiac call... doing an abdominal case for the cardiac service and an abdominal case for the thoracic service... weird.

Sunday, May 10, 2009

Gall bladder

I was doing non-cardiac cases the other day... thought I might have a straight forward day for the first time in a while. Things seemed in order looking at the patient's history for a cholecystectomy (Gall bladder removal). I said hi to the patient asked a few questions and then moved along to see my other patient that morning.

The resident came up to me a few minutes later and told me there was an "issue". The history has looked unremarkable and was wondering what I had missed.

Apparently the patient wanted to take her gallbladder home with her as was getting visibly upset when the surgery resident told her that wasn't the usual procedure.

Now I'm wondering why someone would want to take a nasty old gallbladder home...yuk.

I think the gallbladder usually gets sent to pathology after these surgeries. I can only guess what they're looking for but 1)they're checking that you actually took out a gallbladder and not something else 2)possibly looking for cancer in the gallbladder... i'm not sure but that seems reasonable to me.

"I think she's gonna walk" said the surgery resident after 10 minutes of talking to the patient "I need to talk to the attending surgeon"

Apparently the patient wanted to bury the gallbladder in the backyard as some sort of spiritual closure from having it removed from her body... not too unreasonable if that's what you believe in.

The attending surgeon came down and sorted it all out.... She was not going home with her gallbladder... and she wasn't walking out.

Wednesday, February 04, 2009

Busy morning

It's a busy morning for me... I've got two cases to start... one of them is a Left Ventricular Assist Device (LVAD) in a really sick patient with bad heart failure.

She's in the intensive care unit and will be a transport to the OR. I'm there a few minutes early (as I try to do, but don't always succeed) I meet my resident in the ICU and he tells me the case is on hold.

"Why?" I ask.

Apparently there are two LVADs scheduled for that day, which is pretty rare. They do have two sets of surgical instruments, but there's a particular wrench which they use to tighten certain components of the device. They only have one of those wrenches. They don't want to start the case unless they make sure they have everything they need for the surgery. Of course the OTHER room has already started.

I'm more than a little annoyed... both cases have the potential for lasting most of the day... so a delayed start is less than optimal. Both cases had been scheduled since the day before, so you think that it would have occurred to someone to deal with the problem before it was an issue.

The charge nurse was in the process of contacting the representative from the device manufacturer to see if he could bring the extra wrench.

A few minutes later, they said we could go ahead. The two surgeons agreed that whomever was to the stage that needed the wrench first would get to use it first. Then they would quickly clean and resterilize it so the other could use it.

Not the best solution, but workable I guess.

In the meantime, the representative from the company was able to get there in time with extra tools so that there was actually no issue. Still much unnecessary stress for me though.

Saturday, January 31, 2009

are you busy?

I'm standing the preop area in the morning talking to some of the residents before cases get started for the day. One of the preop nurses comes over...

"Are you busy?" Fateful last words "Are you covering the recovery room?"

No cases have come out into recovery room yet, "I'm not covering, but you need help with something?"

"Can you come over and look at one of our perioperative techs? She's having some chest pain? We're going to hook her up to the monitors... could you look at her EKG?"

They bring her over to a recovery slot, hook her up to monitors, everything looks okay, vital signs stable.... I take one of the residents over with me... we start getting some history.

Family history of vascular disease... pain started this morning while she was moving things around in the OR... yes I've had his before... not as bad as this time... it's always gone away.... just a little short of breath... just a little sweaty....

She looks fine to me, but the story is a little suspicious for having heart disease... soon my resident and I are wheeling her over to the ER... just to be sure.

Of course she qualifies for chest pain protocol.... they want to "rule her out" (2 sets of EKGs and blood tests 8 hours apart to see if there's heart damage) and probably watch her overnight maybe a stress test in the morning...

Never a dull moment.