Respectful Insolence

Iron surgeon?

The other day, Sid Schwab, surgeon blogger extraordinaire, brought up a question that, I’m guessing, most nonsurgeons wonder about from time to time when contemplating how it is that we surgeons do what we do.

What about bathroom breaks?

Given that most of the surgery that I do is breast surgery, my operations rarely take more than two or three hours. The only time a typical operation that I do takes longer than that is the uncommon times when I am doing a double mastectomy, and even then it’s rarely more than a four hour affair. All I have to do is to make sure to hit the bathroom right before scrubbing, and I’m fine.


However, back in the day (namely, when I was a resident), as all residents do, I tried to get involved with the more difficult cases in order to hone my skills. Naturally (and unfortunately) the more difficult cases were often the cases that taxed not just my skills, but my bladder. Indeed, when I was on the transplant service, it was not uncommon for me to scrub on a liver transplant, a case that could easily take 8-12 hours. What I learned back then is that the attending surgeons did on occasion take bathroom breaks. There was no shame. Anyone who can hold it for 12 hours, at least as far as I’m concerned, is a bit of a mutant anyway.

More problematic was the time when–well, to put it delicately–problems with the lower GI tract arose during the middle of a case. It’s a horrible thing to have happen when you’re in the middle of an operation. Really. You have no idea. It happened to me only once, but it provided a serious dilemma. What do I do? I’m captain of the ship of the O.R., so to speak. The entire team depends on me. The patient depends on me.

And that’s the key to making the correct decision.

If I’m to do my best for the patient, I can’t be trying to hold it in, so to speak. I can have no distractions that might cause me to screw up in any way during the task at hand. Patients’ lives depend upon it.

So I did what I had to do. I scrubbed out, headed to the bathroom, did my business as quickly as I could, and then scrubbed back in. What else could I do? I came back free of the distraction that holding it in was causing, and the case went much better after that.

As hard as it is to believe, surgeons are human, too. We sometimes suffer exactly the same sorts of problems that anyone else suffers. When these problems happen during the middle of an operation, our duty to the patient demands that, unless circumstances make it impossible for us to leave, we answer whatever call our bodies are making and then get back to the business of the operation as soon as possible. Sid is right: As much as surgery is about thinking about what to do to fix a problem, because it’s such a technically oriented specialty, there are time when it is indeed all about the body.

Unfortunately, even the body of s surgeon is not made of iron.

Comments

  1. #1 Warren
    July 23, 2007

    Wouldn’t an iron surgeon be harder to sterilize, and more prone to rust?

  2. #2 Chad Orzel
    July 23, 2007

    You know, my first thought on seeing the title was more along the lines of Iron Chef, namely, a tv show in which two surgeons from different hospitals would compete to see who could do a better job with a mystery surgery.

    “Today’s secret procedure is….. APPENDECTOMY!!!”

    I’m a sick person, I know.

  3. #3 Paul
    July 23, 2007

    Was there ever a time that required you to call in another surgeon because of lower GI issues, per se, but you couldn’t leave the patient on the table, under general anesthesia, for the time that you would be taking care of business?

  4. #4 Icepick
    July 23, 2007

    Chad, Iron Surgeon sounds like the coolest TV show EVER!

    (I guess you’re not the only sick person out here….)

  5. #5 Joe
    July 23, 2007

    In the movie “Semi Tough” Burt Reynolds’ character has to sit in on a long seminar; so he buys a “motorman’s friend.” It is a metal container that straps to one’s ankle and has a tube that runs up inside the pantleg …

  6. #6 Sid Schwab
    July 23, 2007

    Yep, it’s that ol’ number two, all right. Whatcha gonna do? I didn’t mention — and maybe should have — the occasion when there’s the, y’know, unmistakable odor of, well; and you wonder if someone in the room is distressed, or if there’s a hole in the bowel somewhere that needs attention…

  7. #7 Orac
    July 23, 2007

    That’s not a problem doing breast surgery, unless the surgeon is capable of more of a surgical “misadventure” than I’ve ever believed possible.

  8. #8 Calli Arcale
    July 23, 2007

    Wouldn’t help with the, um, “lower GI issues”. Of course, for those you could go space-age and wear Depends. That’s how astronauts get through their EVAs, because no matter how badly you have to go, the fact is that it simply takes too long to get in and out of that suit. From the time they start suiting up, through testing the suit, through airlock depress, through the EVA, through airlock repress, through unsuiting, it can be twelve hours quite easily before they can even *think* of visiting the space potty.

    (Of course, I’m told a lot of them try to hold it the whole time anyway, especially “number two”, since that’s not much fun to have in your pants for a few hours.)

  9. #9 GrumpyOldMan
    July 23, 2007

    I can send you some of my (disabled) son’s nappies if you want – they are adult size.

    It’s just a question of whether your dignity is more important than the practical advantage they offer.

  10. #10 Uncle Dave
    July 23, 2007

    Wait till you get a bit older.
    My guess is the three to four hour duration may seem a bit longer to you bladder as time progresses. Or is that mostly a female problem as age progresses?
    My mom says “When they told me its the golden years, I didn’t realize they meant that was because you have releive yourself constantly.”

  11. #11 Jamie
    July 23, 2007

    A lovely post. I love seeing the ‘human’ side of the machines society thinks doctors should be.

  12. #12 Chris
    July 23, 2007

    I’m a sick person, I know.

    Sick enough to volunteer to be one of the patients?

  13. #13 Icepick
    July 23, 2007

    Actually, I can imagine an even cooler show than Iron SurgeonIron Surgeon Chef! It would combine the Iron Surgeon idea with the Iron Chef idea. The Chariman would have to be Hannibal Lecter. A la cuisine!

  14. #14 Barry
    July 23, 2007

    “Today’s secret procedure is….. APPENDECTOMY!!!”

    “I’m a sick person, I know.”

    Posted by: Chad Orzel

    Not as sick as me! Tack on:

    ‘And today’s secret surgical instrument is…..BROCCOLI!’

  15. #15 Alan Kellogg
    July 23, 2007

    How do you handle bathroom breaks during surgery?

    Depends.

  16. #16 Jon H
    July 23, 2007

    “I’m a sick person, I know”

    Nah, ‘sick’ would be if the studio was connected to that of Iron Chef, and the surgical procedure of the former provided the ingredients for the latter.

    The only post-singularity sci-fi body modification I want is some kind of nanotech or inter-dimensional waste disposal system installed in my abdomen to make bathroom usage a non-issue.

  17. #17 Russell
    July 23, 2007

    No one has asked the obvious question: is there any evidence to the notion that surgeons are more prone to kidney stones, from standing for such long periods?

  18. #18 Torben
    July 24, 2007

    Medieval knights… What did they do? I’m sure their peers weren’t as forgiving as today’s surgeons’ are.

  19. #19 Dianne
    July 24, 2007

    Medieval knights… What did they do?

    Being a squire must have required cleaning up some very nasty messes at times.

    I always thought that surgeons used Foleys.

  20. #20 Gaby
    July 24, 2007

    Thank you for this ORAC, since I am planning a future in the operating room this is exactly the information that I NEED to know! All of this “pre med” stuff is just inconsequential. :)

  21. #21 TheProbe
    July 24, 2007

    Two words: Astronaut Diapers.

  22. #22 TheProbe
    July 24, 2007

    Dianne asks: “Medieval knights… What did they do?”

    In days of old,
    When knights were bold
    And toilets weren’t invented.
    They’d drop their load
    By side of road
    And walk away contented.

  23. #23 Joints
    July 24, 2007

    I scoff at your iron. True surgeons are made of titanium alloys that are far stronger and totally rustproof. Unfortunately, most of us are just human, and need to accept and even embrace that fact. Bailing out to take care of a problem definitely beats hurrying or losing focus. I think most of us stay a little dehydrated so as not to have to take a pee break, and, indeed, that can increase the incidence of stones.

  24. #24 Biggboy
    July 24, 2007

    Well I am not so sure about biobreaks, but a long long time ago when I was a surgical intern one of my attendings (ironically nicknamed ‘Flash’* because of his mannerisms) once stopped a procedure because he wanted a cup of tea.

    We left the patient on the table, with a grumpy anaethesiologist, decamped to the surgeons lounge and had tea and biscuits. After a refershing break we rescrubbed and got right back into it.

    *Real name withheld, even though I suspect he is long gone from this world.

  25. #25 Calli Arcale
    July 24, 2007

    Torben sez:
    Medieval knights… What did they do? I’m sure their peers weren’t as forgiving as today’s surgeons’ are.

    “And go and change your armor.” — King Arthur to Sir Robin, “Monty Python and the Holy Grail”

    Well, in the Middle Ages people weren’t quite as concerned with sanitation as we are today. They were, however, concerned (as soldiers are today) with getting attacked while doing their business. It’s a matter of life and death. My grandpa, an old soldier himself, says you should never pass up a chance to empty your bladder. (I think he got the expression from Patton, but I’m not sure. He idolizes Patton.) They relieved themselves before entering combat, or once a fresh wave of soldiers came in to relieve them (no pun intended), or after retreating into a fortress or whatever. If situations did not allow for that, and they didn’t have the time to go find a good bush to use, they wet their pants. Between pee down your legs and death, the choice is a no-brainer.

    If you were between battles, or beseiged, you could take a bit more time at it and find a good spot to do your business. If you were trying to be secretive, you might look for a spot where it won’t be smelled by the enemy, giving you away. If you were beseiged, you might go in a bucket and later hurl the contents over the wall at the enemy.

    If you’re referring to the difficulty of using the facilities while wearing armor, the armor was generally designed to permit the wearer to relieve himself, assuming you’re thinking of a full suit of plate armor. (Most suits weren’t that complete, though, as a matter of both maneuverability and expense. Many relied on a short steel and leather skirt for protection of the nether regions, and it’s easy to relieve onself in that sort of outfit.)

  26. #26 Porlock Junior
    July 25, 2007

    It was either General Patton or Eleanor Roosevelt. (When shall I have another chance to use “General Patton or Eleanor Roosevelt” in a sentence?)

    The story I hear long ago was that late in her life Mrs Roosevelt was asked how she managed to go so many places and do so many things at her age. She replied that she had received three invaluable rules from the Queen Mother.

    Never stand when you can sit down.
    Never walk when you can ride.
    And never miss a chance to go to the bathroom.

    Just what you expect from those Democrats and their potty humor. (And what about the Queen Mother? Well, she sure wasn’t a republican.)

  27. #27 Jon H
    July 25, 2007

    “I always thought that surgeons used Foleys.”

    My Dad had one of those in last fall after a prostate op (on himself, he’s not a doctor).

    One night, in a haze of pain, he took it out.

    Without deflating the bubble.

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