After an exceptional day in the operating room, I realize this list is definitely due, and perhaps will be added to over time. It focuses on my dislikes at the hospital.
- Standing on power cords. This robs me of my sense of stability and balance. It’s remarkably uncomfortable.
- Trying to put a forced-air warming blanket on a patient after the surgeons have draped. Although this causes me no direct pain, it is amazingly annoying and inconvenient, especially compared to how easy it is to put on the warming blanket before draping.
- Pushy surgeons. Surgeons are pushy for a number of reasons, but they usually fall under the categories of 1) Shortsightedness, 2) Rudeness, and 3) Bullheadedness. I will further explore these in proceeding bullet points.
- 1) Shortsightedness. Often surgeons are pushy because they want to get the case started. They believe that the extra ten minutes it took me to get an EKG before bringing the patient in the room because their patient was not adequately prepared is somehow MY delay and this gives them the right to be pushy. They do not realize that I am trying to HELP them take care of the patient, that it is THEIR fault the patient was not adequately prepared (Why is it so hard for a medical doctor to realize that a patient with coronary artery disease needs an EKG before surgery???), and that if something bad happens because a patient was not adequately prepared, it is MY fault legally because I succumbed to their pushiness.
- 2) Rudeness. This happens far less often than it used to, but I’m still amazed at how a surgeon will stroll in and INTERRUPT my interview with a patient without even acknowledging me. I am a physician, and this shows absolutely no respect. I have a policy now of either saying, “Excuse me, you just interrupted me,” or just leaving, telling the surgeon on my way out, “I guess I’ll come back when you’re finished.” This will usually bring an apology.
- 3) Bullheadedness. Please do not tell me that I need to transfuse blood or start an arterial line when any anesthesiologist would balk at exposing a patient to unnecesary risk. If you understood the valid medical reasons for doing things that anesthesiologists do, and if you presented such a reason in a nonconfrontational way, then sure, we can talk about it and consider it. But when you are bullheaded about wanting me to do something stupid, and I choose to be neither bullheaded nor passive-aggressive back to you, then that is not time to persist in your bullheadedness.
- Loud noise. Today we had jackhammers in an adjacent floor for the better part of the day. The subway workers manage to work at night and the weekends…why can’t hospital construction workers?
- Loud noise. Nurses with loud voices deserve their own bullet point.
- Loud noise. Surgeons with loud iPods get another bullet point of their own.
- Lack of awareness. There are critical times in surgery. I do my best to focus with the surgeons at these times. From my end, induction of and emergence from general anesthesia are critical times. This is not the time to laugh and joke and turn up your iPod. I will ask you to turn it down. And I notice the surgeons who stand quietly and attentively at the bedside while I induce and intubate a patient. Often, those are the surgeons I would choose to send my family to.
- Making a mockery of safety. During the surgical “time-out”, I stop what I’m doing and actively listen, often voicing agreement afterward. Surgeons who do the time-out with the attentiveness of a 6-year-old in church scare me. They seem to think that operating on the wrong side of the body is a thing that happens to Other Surgeons.
- Nurses who do not listen during report. I may have just spent eight hours ensuring that a patient lives through anesthesia and surgery. I may have even made a little extra effort to make them wake up without pain and nausea. Sometimes I take steps to prevent untoward cardiac and pulmonary complications. If I feel like it, I manage the patient’s fluid balance and blood counts. I listen constantly to the beating of their heart, I watch the contours of their arterial pulsatility, I monitor the electrical activity of the heart. I pad pressure points. I secure arms so they don’t fall. I paralyze patients and reverse the paralysis. I make sure necks stay neutral. I tape eyes closed–sometimes with lubricant inside–to make sure their are no corneal abrasions. I suction out the stomach to prevent nausea and aspiration. I measure urine output. I keep my patient warm. I comfort and assure patients immediately before surgery. I answer questions. I introduce myself to family members. If after doing all these things I want to take two minutes to tell you about OUR patient, please take the time to listen closely. After all, I might tell you something important.
- The Emergency Department. This is the most chaotic, most terrible place in the hospital. I cannot imagine my hospital’s ED ever being called secure, controlled, stable, or peaceful. There are sick bays. There are stretchers lining the halls. There are large families crowded around loved ones. There are people there for marginal complaints. One’s attention is constantly pulled from one thing to another. Here, one will encounter that ghastly combination of ADHD physicians, type A aggressive nurses, puking patients, blunt security guards, and a constant, rumbling cacophany.
- Lack of professionalism. Just because you are a surgeon doesn’t mean you need to curse in every sentence. Just because you are a surgeon doesn’t mean you need to talk about your sexual conquests in the operating room. Just because you are a surgeon doesn’t mean you need to talk about how your patient is too fat, too hairy, too ugly, or too annoying. I will stand up for my patient.
- Scrubs that do not fit well. Just because more than 50% of Americans are overweight does not mean that scrubs should be designed in “square” proportions. (Small = small waist and short legs, XL = huge waist and long legs.) I cannot stand bunching up my wasteband and a crotch seam that comes down to my knees; nor can I stand legs that are too short.
Wow. This post is far longer than I intended it to be. The feelings just kept coming! And the picture, if you’re wondering, relates to the last bullet-point. I thought it was worth a smile!