| Welcome to The New Coffee Room. We hope you enjoy your visit. You're currently viewing our forum as a guest. This means you are limited to certain areas of the board and there are some features you can't use. If you join our community, you'll be able to access member-only sections, and use many member-only features such as customizing your profile, sending personal messages, and voting in polls. Registration is simple, fast, and completely free. Join our community! If you're already a member please log in to your account to access all of our features: |
| Excitement at work today; and yesterday... | |
|---|---|
| Tweet Topic Started: Dec 13 2011, 06:56 PM (289 Views) | |
| George K | Dec 13 2011, 06:56 PM Post #1 |
|
Finally
|
Saw some things at work in the last few days I haven't seen in a long long time. Yesterday, I was giving anesthesia for a nephroureterectomy. 61 year old lady with chronic and recurrent infections in her kidney. Despite courses of antibiotics, the kidney is nothing but a bag of pus, causing her to have recurrent bouts of sepsis. Time to take the kidney out. This is a big-ass operation. It lasted about 6 hours. About 4 hours into the case, the lady's blood pressure takes a dip. The dip turns into a drop. The drop turns into one of those "whoa!" moments. "Hey Mike, are you doing anything unusual down there? I'm having a hard time getting a blood pressure." "Um, no, nothing, really." "You've lost a fair amount of blood (about a pint) pretty quick, but I don't think that's enough to cause me to not get a BP." "Um, no, nothing unusual, really." "ARE YOU SURE???? I'm not able to get a BP and I don't feel a pulse." "Uh, let me take this retractor out..." "That's better. A lot better. Her pressure's 100/50 now. What were you doing?" "Um, I guess the retractor was pushing on her aorta a bit." "A BIT???? I had no blood pressure because your retractor was occluding the aorta!" "Is she OK?" "Yeah, fine. Keep cuttin'" Rest of the case was uneventful, and she woke up fine. =-=-=-=-=-=-=-=-= Tonight. 84 year old guy in renal failure with a bowel obstruction. He's been puking for the last 3 days, and he's totally obstructed. Probably from adhesions caused by an operation years ago. His abdomen looks like he swallowed a basketball. Massively distended. I get him off to sleep, and things are going fine. About 45 minutes into the case, I see that his heart rate is going down. It was running in the 70s, and now it's in the 50s. A minute later, it's in the 40s. Then, I see two sweeps of the EKG machine that show no heart activity - at all. "Eric, what are you doing down there?" "Nothing. I'm just freeing up his bowel. Why?" "Because I just had a serious bradycardia. It sure acted like a reaction to you pulling on the bowel." "I'm not pulling" "I'm not very happy right now, Eric, the guy's heart rate is in the 20s" (George reaches around, gets some meds to inject to get the heart rate up - realizing that he's just treating the symptom, not the problem.) "Do me a favor, Eric, get your hands out of his belly for a moment and let's see what happens" "Well, OK, but I really don't think that..." "Please, let's see. If you don't do that, I'm going to ask you to start compressing his chest in about 2 minutes." "Well, OK." Hands out...heart rate comes up to 30, then 40, then 60. "Told ya." (grumble grumble grumble - how dare you insinuate that what I was doing affected something *other* than what I was working on) "Yep, guess you were right." Rest of surgery uneventful. Took about an hour and a half, and I dropped him off in recovery at about 6 PM. I need to retire. |
|
A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
![]() |
|
| Newpianoplayer | Dec 13 2011, 07:17 PM Post #2 |
|
Senior Carp
|
A docs job can become routine, until it isn't. Thank God for docs like you , George. |
![]() |
|
| LWpianistin | Dec 13 2011, 07:22 PM Post #3 |
|
HOLY CARP!!!
|
They should know to listen to you. Silly people! |
| And how are you today? | |
![]() |
|
| brenda | Dec 13 2011, 08:47 PM Post #4 |
![]()
..............
|
Does it ever make you want to smack the surgeon, George? You know, just a quick snap to the side of the head to get them to pay attention? You're saving lives every time in these cases. Because you're on the ball, the patients get to go home and not the cemetery. Good job!!!! |
|
“Weeds are flowers, too, once you get to know them.” ~A.A. Milne | |
![]() |
|
| Mikhailoh | Dec 13 2011, 08:52 PM Post #5 |
|
If you want trouble, find yourself a redhead
|
I hate excitement. i would hate it even more in your case. |
|
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
![]() |
|
| brenda | Dec 13 2011, 09:23 PM Post #6 |
![]()
..............
|
So you like boring stuff? When you tell someone you like them, should they be insulted?
|
|
“Weeds are flowers, too, once you get to know them.” ~A.A. Milne | |
![]() |
|
| Mikhailoh | Dec 13 2011, 09:27 PM Post #7 |
|
If you want trouble, find yourself a redhead
|
Who's your friend?
|
|
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
![]() |
|
| Rainman | Dec 13 2011, 11:29 PM Post #8 |
![]()
Fulla-Carp
|
I've had 9 appointments with Dr.'s since September. Along with Dr. George's stories, coupled with my wife's daily stories (trauma nurse), I must admit the entire medical "community" scares the hell out of me. I am a number, in a system. Questions are asked, the doc (or nurse, or NP, or whomever) do not seem to be listening with care, as much as they are intent on entering what I say into the wall-mounted computer. And then the next appointment up the chain is made, usually 4 weeks later. Question to Dr. George: If it was not you (someone with years of experience, someone with the confidence to step in even if stepping on egos), where would those patients you described, be? Is it a new world, medically speaking? "Uh, blood pressure dropped, he died on the table (anesthesiologist thinking: 'it's my first year here, I'm a relative noobie/rookie, it would be inappropriate to say too much to the surgeon, I can't intervene, he must know what he/she is doing...'). It happens, sorry (please do NOT contact an attorney, but if you do, the hospital is covered, we have intricate entered data that protects us, that is the essence of the system...). When did the AMA throw in the towell in terms of standing up for health care and the rights of doctors to BE physicians? |
![]() |
|
| George K | Dec 14 2011, 04:14 AM Post #9 |
|
Finally
|
99% boredom 1% terror That's my job. |
|
A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
![]() |
|
| George K | Dec 14 2011, 04:16 AM Post #10 |
|
Finally
|
To Rainman - the good thing about the medical community, especially in the OR is that there's more of a sense of equality. The surgeon is not the guy "in charge" - not by a longshot. It's really a team effort, and no anesthesiologist coming out of a residency today would be intimidated to say something when such a sudden change occurs like I described. |
|
A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
![]() |
|
| Luke's Dad | Dec 14 2011, 04:50 AM Post #11 |
![]()
Emperor Pengin
|
Don't you freakin' dare even think about it. The way I see it, I've got another 30 years before my life is full enough that I'm OK with it if my Doctors screw up. Until that time, I want only the best possible. That means you're on tap until 2042. Then you can retire. |
| The problem with having an open mind is that people keep trying to put things in it. | |
![]() |
|
| bachophile | Dec 14 2011, 07:23 AM Post #12 |
|
HOLY CARP!!!
|
|
| "I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen | |
![]() |
|
| Mikhailoh | Dec 14 2011, 07:24 AM Post #13 |
|
If you want trouble, find yourself a redhead
|
|
|
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
![]() |
|
| kluurs | Dec 14 2011, 07:32 AM Post #14 |
![]()
Fulla-Carp
|
Without too many details of the where, I know a very well respected surgeon who started to strangle a resident in the operating room - during a surgery - because the resident had failed to follow directions. He's a wonderful surgeon and very pleasant guy - just be sure and pay attention or you may find your own oxygen being cut off. I like him. |
![]() |
|
| The 89th Key | Dec 14 2011, 08:09 AM Post #15 |
|
QFT
|
![]() |
|
| Kincaid | Dec 14 2011, 08:39 AM Post #16 |
|
HOLY CARP!!!
|
Hey that's what I have. |
| Kincaid - disgusted Republican Partisan since 2006. | |
![]() |
|
| brenda | Dec 14 2011, 06:48 PM Post #17 |
![]()
..............
|
Oh, bach, you would never need such a slap. Never. You are a treat to have around here, BTW.
|
|
“Weeds are flowers, too, once you get to know them.” ~A.A. Milne | |
![]() |
|
| « Previous Topic · The New Coffee Room · Next Topic » |










4:47 PM Jul 10