And I don’t mean the shit, as in a good thing.
Yes, this post is tragically late. I have an excuse. I had the second stage of a dental surgery (root canal #2) today; I had the first root canal emergently last week. And my mind is limping along. Dentist terror flop sweat commenced.
Back to the issue at hand.
Pre-surgery workups are terrible.
They are either not done, or incomplete.
Kind of like ordering a BMP (basic metabolic panel) and expecting liver panel results. Like for a lap chole patient. And the surgeon shrugging it off or, worse, asking for the AST and the ALT and the bilirubin on an assay that doesn’t have them.
Patients are sicker. This is a fact of the OR.
Patients are also not tuned up for surgery in the most efficient way.
Sometimes I feel like Mrs. Weasley and the Howler she sends Ron after they’ve taken the flying car in the second book. “Car gone! No note!”. This is when I am looking at the patient’s chart prior to surgery, just perusing their blood levels and lab tests that were done. And finding nothing recent and the last labs they had were 4 years ago. Or longer.
You want to do a total hip revision of implants that are at least 10 years old, who refuses blood products, and the last hemoglobin on their file is from 5 years ago?
Make it make sense.
There are standards and I would like to assure myself that we are not going to kill this patient.
Sometimes I wonder if the surgeon just wants to cut and doesn’t want to look under that rock of the 93-year-old in multi-system failure. But we can fix them!
There is a fracture, I have to fix it.
You see, every case is a mini-mystery. There is a problem that needs a surgical intervention. Please give us all the tools to help the patient and to help you not kill the patient.
Dispatches from the Evening Shift 