The saddest OR case

I’m not going to lie.

It’s been a rough week in the OR.

This is outside of the Covid-19, mask tumult, Black Lives Matter.

Something you never want to hear a surgeon say is “hmm, that doesn’t look good.”

Especially when he is talking about the suspicious appearance of the abdominal tissue discovered while doing a lap chole.

Especially when he says “gosh, that looks like CA.”

The patient is going to have to wait for the pathology report.

Or, while doing an upper endoscopy, looking for bleeding, and small bowel tumors let them selves be seen.

Or the peek and shriek.

What is the peek and shriek?

It is where the belly is opened emergently through a long midline incision and the surgeon gets to the bowel, quickly buzzing bleeders and cutting through the fascia to discover the bowel is completely dark purple and necrotic.

This has happened while anesthesia is still doing their thing and putting in lines to monitor the patient.

There is nothing to do but close them  up and take them to the PACU.

There is no life without the bowel.

Emergency laparotomy case with terrible labs, acidotic as hell, a very worrisome CT, and the beep that comes in the middle of a Saturday morning to summon you to it.

Other things that are not reassuring is the anesthesiologist remarking that the patient’s vital signs are trending toward a code.

Now, quickly, have to get the patient off the table and to the ICU so they don’t die on the OR table.

Taking care to get the ICU bed and the travel monitor so we can keep an eye on their vitals and react to his blood pressure and saturation readings.

Taking care to count as the surgeon is frantically closing.

Taking care to secure the foley to the leg so that the catheter is not pulled on.

Taking care to have a travel monitor available, plus a full tank of oxygen to make the trek to the ICU.

Taking care to take the seven extras EKG leads off the abdomen.

Taking care to put a gown on them.

Taking care to put a new pillow under the patient’s head, with a chux pad on top of it.

Taking care to send someone to call for the elevator and hold it until we get there.

We pass the surgeon in the hall, talking to the family, somewhere in the midwest.