Monday musing 2/20/23- unrealistic expectations

I know I have written recently about patients’ unrealistic expectations of pain after surgery. We cannot make the pain go away. At the very least there will be incision pain.

I will not revisit that.

Today let’s talk about the unrealistic expectations of a surgeon. In the middle of the night. When no one but anesthesia is at the hospital. I get called, not paged, called. Okay.

I can deal.

There is an urgent case.

This was 0415. I told the surgeon we could get the case started by 0500.

45 minutes.

That is a gift when the circulator and the scrub are at their house in their pajamas.

The surgeon pushed back on me. Asking why, since a body part was in danger, we couldn’t start in 30 minutes.

Deep breath.

That is because we, who are not at the hospital, have 30 minutes to get to the hospital. We still have to schedule the case, pick the case, prepare the room (which is the hardest setup to do in an empty room with no secondary video tower monitor, no positioning aids, no irrigation pump.

Did I tell the surgeon I would have put the patient’s information in with my fifth hand after I’d been running for things from the other room? Yep. To get the patient’s information into the video box they have to be in the room in the computer and I had just done that. Unrealistic expectations around the computer will be another post.

This was after I told the surgeon that the patient was too far down the bed. This impacts stirrups use. They assured me it was fine.

Spoiler alert, it was not fine. They spent the first 20 minutes of the case lamenting that it was hard to do things. Because the patient was too far down on the bed.

Next I asked if there was anything specific that they wanted for laparoscopic cautery. They said hot scissors. Cool, I already had that in the room. I had gotten a ligasure machine because I knew this was going to be the next request that they turned down.

Spoiler alert, they wanted a ligasure. Gritting my teeth, I asked my tech if that had been asked for previously. The tech said no, no mention of ligasure.

Ligasure is NOT hot scissors. That they didn’t even use.

They wanted laparoscopic irrigation next. Fine. I had already gotten it from another room. I put the suction machine together, turned on the suction, and said aloud, “Suction is on but no irrigation yet.” I said it twice as I was leaving the room to get the warmed irrigation fluids that are not gotten before time of use.

And they proceeded to test the irrigation. Twice.

I reminded them that there was no irrigation yet. They reacted defensively when the irrigation button was pushed that it was an accident. Once, I’ll give them, but twice?

I hung up the irrigation bag. And announced that there was fluid.

They asked me to call to the floor and get their assisting surgeon. I did. That surgeon arrives within 10 minutes and stands there, hands washed, waiting for a towel, asking if we had their gown and gloves.

Um, no. I’ve been too busy adding irrigation and getting the supplies that were not requested and also were not in the room as this WAS NOT THE CALL ROOM.

You know, the one that is completely set up for a laparoscopic case and the equipment and the supplies are in the room? Yeah, that one.

On and on the requests came. I was heartily sick of the case by now.

Day shift started to arrive. But no relief for the call team.

I could have taken 10 extra minutes to get the room prepared prior to getting the patient. But the surgeon made it seem like a super emergent case and the patient would die.

Patient was on the table at 0502, just over my 45-minute estimate.


Don’t worry, I anticipate being yelled at for this.


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