The Day of Surgery: The Gas

Let’s see here, I read, “53-year-old female, hypertension, DMII, CAD”
Has some sort of cancer, requiring abdominal surgery
I notice there’s no pre-op labs, no medical clearance, no EKG
No antibiotics ordered, no blood held, and no FFP

I play off my anger and thumb through her chart
“Just need a few labs before we can start”
I dispense with pleasantries, she seems fairly smart
It’s clear her, and her mother, both have a big heart

Her teeth aren’t artificial, diseased, or loose
A pack-a-day smoker, lungs have seen some abuse
Thyromental distance short, cervicomental angle obtuse
BMI greater than 30. She opens up wide. She’s a Mallampati two

An audible sigh escapes when I realize I’m with Dr. Wampus
He’s strange as his name, always brings up religion, his attitude’s pompous
His skill is top notch, least he warrants his confidence
I’m professional, make sure the patient feels nothing, remembers nothing, remains unconscious

Labs look okay, so I’m the first to the room
Prepare all my meds, the OR will be flooded soon
Residents usually check SCD’s, but I never assume
Then retreat to corner didactics where they’re pimped to their doom

I eavesdrop on the academic discussion, while pushing Propofol
Students in awe while the attending makes residents feel small
It’s a symphony of condescension, set to Yo-Yo Ma, live at Carnegie Hall
Chief resident takes the brunt, I watch how hard the mighty fall

The patient’s asleep and vitals are stable
Patient prepped, surgeon calls out, “Anesthesia, raise the table”
We have the time out, nurses check the patient’s label
“Please run her slightly hypotensive.” I’ll do it if able

“I need her paralyzed, you understand that, don’t you?” his voice is acidic
She is paralyzed; what’s he think I’m doing, Sudoku?! He’s so troglodytic
He “reminds” me, again, before allowing time to re-dose paralytic
Residents grunt and roll their eyes. Everyone’s a critic

I’m paying attention, it’s not just take off and landing
This surgeon, all surgeons, can be so demanding
Everything they do is “the hardest,” Whipple’s to banding
Think my job's easier because I sit while they’re standing

The case is over, patient awakes safely. Wampus leaves to dictate it
Coughing, retching, and dehiscence can all be related
I push one last med to make sure she doesn’t get nauseated
Took care of her as best we could, least better than fate did

We move the patient, attach oxygen, and roll to the PACU
I lean over her head, “Be careful out there, nurses are about to attack you”
Everyone has jobs they have to get back to
I stand with the nurses, a couple students, the last few.

I chart at the bedside, hand off to the nurse
Residents, students, in small groups, they disperse
I check the patient’s pain, it has not gotten worse
She cries and is grateful for curing her curse

She’ll head to her room in what seems like no time
Ill grab a quick bite and get back to the grind
Charge nurse then sends me to Pre-op Bed 9
That’s where I’m sure to find the next patient in line

Dr. Joshua J. Goldman is a graduate of Integrated Plastic and Reconstructive Surgery (PRS) at the University of Nevada, Las Vegas School of Medicine and is currently an Integrated Craniomaxillofacial and Microsurgery Fellow at Beaumont Hospital, Royal Oak. His professional interests include healthcare advocacy, device innovation, digital marketing, ethics, medical education, and physician wellness. You can follow him on Instagram at @GoldStandardPlasticSurgery. He is a 2018–19 Doximity Author.

Illustration by April Brust

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