Dude, what the hell?

Tonight we had a spot of busy.

Within 20 minutes there were two add ons.

Surgeon A calls them in.

One critical who was in the ED, and one urgent who was in the office.

But the surgeon who called me was not going to be the surgeon of record as their call was ending in 19 minutes.

Okay, I said, send the urgent patient over and we’ll get her registered and we’ll send for the critical patient and have them ready to go within 50 minutes.

They ring off.

As I am coordinating this, the surgeon of record calls and tells me he has an appy.

Okay, I tell him, but what about these two other cases, one critical and one urgent.

He had no knowledge of the two cases that were already on the board from surgeon A.

Surgeon B says well, I will talk to the off going guy and get the information. But I want to do the appy first.

Okay. This is actually sound reasoning as it is the quickest of the three and the easiest to prep. I think the critical patient will take the longest to prep and can be done during the appy.

The line up now looks like appy, critical patient, urgent patient.

I am writing these up, posting them, calling the anesthesiologist and the CRNA, normal stuff.

I go and get the patient from the ED we have a chance of making the critical patient within the hour.

I get the appy to the pre-op drop them off.

I check in with the team in the room.

There is a resident who is assisting surgeon B. They inform me that critical case is cancelled as they are no longer critical.

Sigh of relief.

Now there is an appendix and an urgent case.

Cool.

I undo some of what I already did.

They finish the appy, I was making sure that the new nurse in the appy does not feel abandoned and I was backing them up from the core, trying not to do the entire case for them.

Appy is done.

Urgent case shows up and is done.

Dropping the urgent case in the PACU, surgeon B comes in looking sheepish.

I squint at him suspiciously.

There is a second appy.

I look at the PACU nurses, both of whom have their own patients to recover and discharge.

I know there is no reason for me not to prep them, rather than wait for the PACU nurses to recovery and discharge.

I tell the anesthesia team and go off to the ED to pick up appy #2.

I prep appy #2.

I text and call the tech with no response.

The CRNA comes in and tells me the room that we are going to be doing the appy in is still dirty.

I excuse myself from the patient and go to find the tech, who was finishing up his lunch.

The tech is dumbfounded as both surgeon B and the anesthesiologist have walked past him.

And said NOTHING.

sigh.

Nothing like being welcomed back.