I switched the order of the cases, and I’d do it again

One of the guiding principles of scheduling cases in the evening is fairness.

First one to call is first case scheduled.

I schedule by this.

I live by this.

I have received a lot of negative feedback from doctors about this.

I don’t care.

Last night was rough.

There was an obstetrical emergency that involved bleeding.

There was an already ruptured appendix.

There was a person whose potassium level was 6 due to kidney failure.

The first call was the OB patient.

And bleeding trumps most everything.

The second call was the already ruptured appendix.

The third call was the kidney patient.

The OB caller acted as if I had a team on standby at all times, ready to spring into action.

I don’t.

They were quite put out when I would not grant them an immediate OR and begrudgingly took the soonest time slot.

Which was an hour away.

After one of the rooms dropped.

It takes roughly an hour to get a patient ready.

It takes less time in an emergency.

You know, depending on who is the prepping nurse.

Next the appy doc called.

I gave them a time that was three hours later.

I still had 3 rooms going, and now an OB emergency.

They took the time without a whimper, or a complaint.

After I picked the OB emergency case I had to relieve as the robot scrub.

Because the tech was adamant on getting out bang on time.

No matter the fires going on in the OR core.

When another scrub was available after their case, she came and got me out.

Immediately the phone rang with ANOTHER emergency.

The PA was a little taken aback that they were the 3rd emergency in line.

I looked at the cases continuing to drop.

I looked at the likelihood of the OB case finishing by 1900 (they did).

I looked at the 2030 appy time.

And, although the kidney emergency was the third call, I made the executive decision to jump the appy and schedule the kidney for 1930.

And of course the kidney case was difficult.

What should have been a 15 minute case turned into 75 minutes.

But sometimes you have to rank the cases on how sick the patient is.

The appy patient was sick.

But he was already ruptured.

The kidney patient was not ruptured but his labs were far worse.

So I let the kidney patient go second.

And, even though the appy started 45 minutes late and I didn’t get home until 0200, I am at peace with that decision.

Because taking cases as they come in is the guideline, sometimes you have to look at the kinds of patients they are.

And plan accordingly.