Saturday, July 25, 2009
All quiet on the OR front
Everybody likes to work with the Mellow Surgeon, the Thoughtful Surgeon, and especially the Funny Surgeon. But in every hospital, there is the Angry Surgeon, the one that makes working in the OR that day a long and thankless task. The day begins with its usual buzz of activities--the anesthesiologist drawing up his meds, the scrub nurse counting the instruments. But under this calm, there is a quiet sense of foreboding. The circulating nurse is just a bit more careful to make sure everything on the surgeon's case card is in the room. The anesthesiologist arrives just a bit earlier to make sure everything is ready to go on time, interviewing the patient, starting the IV. And then the wait.
Usually the Angry Surgeon is also the Tardy Surgeon. Though he'll blow his top if anybody delays his case, he thinks nothing of arriving thirty minutes late for his scheduled case. Once he arrives, everybody jumps to attention. He inquires loudly why his cases are always late starting, as if he is innocent of the situation. The OR team quickly moves the patient into the operating room. The patient is quickly induced, the nurse gowns up the impatient surgeon, and the case begins. With other surgeons, the OR can be a happy and fun place to work. Jokes fly across the room. Gossip is exchanged. Current events about sports or politics are discussed. But with the Angry Surgeon, the room is deathly quiet. People talk only when necessary. The iPod is kept off.
And soon enough, as surely as the sun rises in the east, something displeases the Angry Surgeon. The scrub nurse, who keeps track of hundreds of pieces of equipment, is unable to find a particular instrument. The case cannot proceed without that vital tool, yells the Angry Surgeon. He demands to talk to the OR supervisor, who is called into the room. He tries to defuse the situation, looking vainly into the instrument tray for the missing piece. The only other tray for this kind of case is dirty and unavailable. The surgeon demands that an incident report be made out and ready for him to sign by the end of the case. Even without that crucial instrument, the Angry Surgeon improvises and moves on. Now his fuse has been lit. The cautery is not working properly. The OR lights are not to his liking. In the old days, surgeons used to throw instruments in this situation, but luckily generational changes and stricter OR conduct rules have made that nasty habit a thing of the past, mostly. As the case proceeds, the scrub nurse seems unfamiliar with this particular case. The Angry Surgeon gets impatient. The nurse says she is new to this procedure. Of course the OR supervisor gets called in again. The Angry Surgeon wants to know who scheduled a scrub nurse not familiar with this case to work with him. He wants to talk to the Nursing Supervisor and the Hospital Administrator at the end of the case. And he wants a second incident report written up and ready for him to sign. The case continues as planned, despite the missing vital instrument and the rookie nurse.
Cases never go smoothly for the Angry Surgeon. At the end of the case, a needle is missing. As people scramble to find the missing needle, a call is made to take an X-ray of the patient to make sure the needle is not inside the patient. The Angry Surgeon is livid that this is delaying the finish of his case. He insists the needle couldn't possibly be inside the patient. He decries the mindless hospital policy of taking X-rays even if he KNOWS the foreign body is not within the patient. Fortunately, the needle is soon found and no X-ray is needed. The case finishes, the patient is extubated and wheeled to the PACU. The Angry Surgeon perfunctorily thanks everybody in the OR and leaves. Everybody relaxes and the iPod gets turned back on. Time to prepare for the next case.