Loves being in on a Saturday doing an "urgent" case especially since I
heard about it Wednesday

A patient's family in the waiting room wearing "I <3 Team [surgeon's
name]" tshirts. I can't imagine them wearing "I <3 Team Anesthesia".
Not that I mind really

It's going to be a banner day when the anesthesiologist is the most
qualified person in the room to put in the Foley catheter.

Trapped in cath doing aortic procedures. Resident referred to it as
'fat camp'. You don't get to eat all day. And you have to run up and
down the stairs wearing 15 pounds of lead.

Never a good day when you get blood on your shoes

Newspaper

I was explaining the risks of anesthesia to a patient before cardiac surgery... the patient said "no problem, I'm not going any where". I said I just wanted to make sure we were on the same page. The patient said "As long as I'm not on the front page, nor on the back page (obituaries), we're in good shape"

Saw woman in recovery drinking coffee from a mug she brought in herself

Physical exam

Most daily progress notes include a physical exam portion to say how the patient looks, how the heart and lungs sound etc, this was the best exerpt today I found while looking through my patients

"HEEN: WNL, could use a shave"
(HEEN=Head,Ears, Eyes,Nose; WNL=Within Normal Limits)

Surgical Plan

The cardiac surgeon today announced the plan for today's cardiac case:

Out of the room by noon, without a balloon

(Referring to the Intra-Aortic Balloon Pump - a device inserted through the femoral artery into the descending thoracic aorta, used to augment cardiac output and help a person with poor heart function come off of the cardiopulmonary bypass pump)

The hard part about leaving early is avoiding the family members of patients you've just put to sleep

Paging system down

You don't realize how much we rely on the paging system until it goes down. We've turned into the hospital you see on TV, with "stat" pages overhead every 30 seconds.

heart trouble/car trouble

Sorry ma'am, the ambulance that your new heart was travelling in has broken down


(it's going to be a long day)

Monday Morning

You know a cardiac case is going badly when you walk in Monday morning and there's a case to take over in your room from last night - and that case has already been going for 15 hours!

Truth from patients

A patient said to me today - "There are two places you can't lie about your weight - when you're having anesthesia and when you're bungee jumping"

weekend call

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

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.

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.

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.

consent

All surgical procedures must have a consent form signed by the patient before we go back to the OR. Most of the time this is done in clinic before surgery. The doctors describe the risks of the procedure, and weigh them against the benefits. (Sometimes glossing over the risks, in my opinion, but that's a different discussion) With some surgical services this is done the morning of the procedure before they go to the OR. (Usually with the more straight-forward procedures).

To assure that we don't miss this there are brightly colored signs at the patient bedside that scream "NO CONSENT"

I walk up to the patient and there are these NO CONSENT signs everywhere, so I start flipping through the paperwork after I introduce myself. I see a signed consent form..,

I'm surprised a bit, because the surgeons are still in the OR as far as I know someone else from the team would have had to come out to take care of the it.

The Preop nurse is starting an IV, "I see someone came down and consented the patient"

"No, she filled it out herself."

???

Apparently the patient is a recovery room nurse at another medical facility, saw the paperwork and just started filling it out herself.

Not necessarily great in a medicolegal sense, but mildly amusing to me.

platelet shortage

Interesting email this week:

This is a reminder that Thanksgiving is next week. We anticipate severe platelet shortages for the first week of December. Platelet availability will be VERY tight December 1-4. Monday and Tuesday will be the worst days since there will be virtually no blood donations Thursday-Sunday. If you have elective surgeries with high anticipated platelet needs, I would recommend rescheduling for the following week.

I guess I never thought of that, but it makes sense.

Platelet availability is dependent on recent (last 4-5 day) platelet donations. The week immediately after Thanksgiving and the Christmas-New Year holidays are always characterized by platelet shortages due to low whole blood donations in the preceding week.