Saturday, September 8, 2012

Grind

The call comes in at 9pm or so.  The patient sounds sick as all hell.  The Surgeon listens to the random assortment of numbers and vitals the nurse provides and clicks off his cell.  He finishes reading a boring Berenstain Bear story to his daughter (horrible children's lit, btw---- unfunny, droning, almost anachronistic are the travails of those generic asshole bears) and tucks her into bed.  He looks at the clock and runs some mental numbers.  By the time he arrives at Hospital, close to ten.  See the patient, talk to family, dictate notes, write all the orders and it's getting close to 11.  Then the wait for the call team to arrive, the inevitable dicking around of anesthesia.  The family questions.  The delay in transport getting patient from ICU to OR and now we're talking well after midnight.  Before he even cuts. 

The lady is in extremis.  Family is pacing in the hallway.  The Surgeon places hands on belly and the diagnosis is clear.  She is on pressors already and her lower legs seem mottled.  Fluids are running wide open.  The urine in the foley bag looks like bourbon.  After the usual back and forth with family--- surgery or no surgery, high risk, but what else can you do, she may make it /she may not, the only hope is to operate, but it could be futile and thus an operation would cause her unnecessary pain and suffering, etc etc---the decision is made to proceed to OR.  The abdomen is exposed, prepped, ready for scalpel five after one.  The arithmetic is just a little off.


It's a dead cecum with necrosis of a length of terminal ileum as well.  He works quickly; mobilize, resect, wash out.  She's too unstable for anastomosis.  The stomas are brought out.  He closes the wound and rushes to speak with the family.  Not so bad, all things considered.  Could have been worse.  She hung in there.  We will have to see.  There are hugs and the earnest shaking of hands.

He gets outside and his car won't open.  The key fob is dead.  Battery?  Who the hell knows.  It takes the Surgeon twenty minutes by the light of a streetlamp to figure out how to get the emergency key out of the fob.  Then he has to read the goddam owners manual of the vehicle to figure out the magic trick of making the fob turn on the car when the battery has died.  This is an opportunity to manifest patience and forebearance.  Another 45 minutes lost.  He gets home and lies staring at ceiling for a half hour.  It is close to four in the morning.   He drifts off.  The alarm shrieks, a cattle prod in his amygdala.  He wakes.  It can't possibly be time.   

He has four cases, starting at 7:30.  Shower and coffee are like sucking moisture out of a cactus in the desert.  The Surgeon trudges though the darkened hospital parking lot to the locker room.  He gazes at his hollowed out visage staring back at him in the mirror.  The day stretches out interminably.  Good natured, well rested colleagues pass by as he stands looking in the mirror.  Time to light the fires again.  Time to start.  He splashes cold water over his face.  The OR is paging him.

The first case is a tough colostomy reversal.  Stapler issues necessitate a hand sewn mid-rectal anastomosis.  He breezes through a breast biopsy and a routine gallbladder.  Another gallbladder is tougher, acutely inflamed, common bile duct stones on cholangiogram.  It's 2pm when he takes off gown and gloves.  There are 17 patients waiting for him in the office upstairs.  The thought of it makes him gasp and want to cry.  He writes orders, speaks with family and changes into regular clothes.  As he slips in the side door he can see the office teeming with patients.  Some have to stand because there are no more chairs.  The women always complain about the lack of reading materials in the waiting area.  The Surgeon has been meaning to mix in a few Ladies Home Journals or Cosmos or whatever the hell it is old ladies read these days.  His office manager scowls at him as he heads back to his desk.  He sits.  He hasn't been able to just sit in 36 hours.  His head is buzzing with fatigue.  He clutches his forehead, elbows splayed on the table.  Listen to them, he thinks.  Listen to them all.  One at a time.  Take a deep breath and look them all in the eye and listen to them.  Take your time.  Don't rush.  Don't be impatient.  It will end.   You have done this before, he thinks.  This is not heroism.  This is called doing your job.  The office workers start filling rooms with patients.  The names on the computer screen in front of him ring familiar.  There are new ones too.  He will listen to them all.  He stands and grabs a chart.

That night he gets home around eight.  His little boy is crawling across the floor and when Daddy appears he smiles broad and innocent and starts power crawling toward him.  The Surgeon drops to the carpet and plays with his boy.  They wrestle and play and laugh.  He holds him tight.   He is happy.....  

8 comments:

Anonymous said...

sounds like my life, but just written better.

Graybill said...

Re your predictable comment about anesthesia's dicking around, up yours.

Buckeye Surgeon said...

Thank you for the close read Graybill

Trader Bob said...

You're a little Rusty Doc, but it's good to read you are back.

LANS

Frank Drackman said...

CRY? CRY?
THERE'S NO CRYING IN FOOTBALL!!!!
umm well except when Cam Newton turned pro...

Frank

Anonymous said...

It's too bad you can't acknowledge the same God you curse and malign in your posts is the same one who has given you that beautiful healing child at the end of a tortuous day.

Anonymous said...

Just another couple of thoughts....The same hands you shook in earnest gratitude after their loved ones surgery was over were the same ones praying for you while you worked. Do you think you did it all yourself?

Also, the "dicking around" anesthesiologist probably was facing the same arduous schedule later the same day and had to gut it out just as you did. Your success depends on everyone in the OR.

Oh....another thought....the OR staff (usually mostly women) also had to complete a full work day after being called in, go home and feed their family, help with homework, pack lunches, and finish laundry. They don't have the option of getting on the floor and just being happy. Their families, just as your patients, rely on them for existence.

Thirty-six hours on your feet? You're not the only one. Take heart and have some humility.

Buckeye Surgeon said...

Anon-
I am sorry this post aroused such anger and contempt in you. That was not the intention.

Of note, the anesthesiologist came into the room for ten minutes, watched the CRNA intubate and induce and then went back to the call room for a few z's.