Respectful Insolence

Iron Surgeon?

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgI just returned from Las Vegas after having attended The Amazing Meeting. Believe it or not, I was even on a panel! However, my flight was scheduled to arrive very late Sunday night, and I’m still recovering. Consequently, for one more day I’ll be reposting some Classic Insolence from the month of July in years past. (After all, if you haven’t been following this blog at least a year, it’ll be new to you. And if you have I hope you enjoy it again.) This particular post first appeared in July 2007.

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 Phoenix Woman
    July 13, 2009

    Quick O/T: Here’s an interesting article on America’s science illiteracy –

    http://www.salon.com/env/feature/2009/07/13/science_illiteracy/

  2. #2 NoAstronomer
    July 13, 2009

    Funny, I thought you were going to recommend a brand of adult diapers.

  3. #3 Dave Ruddell
    July 13, 2009

    Further to what NoAstronomer wrote, this is obvious, but still funny:

    http://www.drinkalot.com/Videos/564/Oops_I_crapped_my_pants.htm

  4. #4 sspudnick
    July 13, 2009

    I am actually rather bothered by this perticular blog. I mean no disrespect whatsoever to surgeons(Im a pre-med student myself) But this is the prime example of what frustrates MANY of the surgical techs (myself include) that i worked with in the Army. I’ve had MANY cases where i get absolutely no break in between cases..setup, scrub in, wait for the surgeon, as he/she comes in with crumbs on his/her face. It seems, unless you have a close relationship with the surgeon, your needs as the tech are completely ignored. It seems like a lot of Docs forget that we Techs are ALWAYS in the OR, not some of the day, or a few days a week, thats all we do…and no…we dont get the respect thats due for that. I’ve actually seen surgeons try to scrub a case themselves do to having a really bad tech, and was asked (begged) to scrub in, after standing in the room for less than a minute, he just couldnt focus, and i dont blame him for that. Now i know you’re going to say ” Well, you’re not doing surgery, you’re only helping” and this, in some cases, may be true, but in my case, not only have i had to show some surgeons better techniques of doing certain procedures(or a certain part of a procedure) Military Techs are allowed (legally or the lack thereof) to do MUCH more than civilian techs, so we are expected to pickup where surgeons leave off if needed. Do you (as in surgeons, maybe not you in particular) not get pissed, yell and scream when we make minor mistakes, possibly because we were focusing on not calling a Code Brown? YES, yes they do, and throw shit if their assholes. I’d pay to see the day a Tech could say “Doc, one sec, i gotta shit, brb” NEVER. I %100 agree with your blog, but i believe you guys value us when you need us and disregard us as collegues in the same breath. “Whats good for the goose” comes to mind. Ok, im done venting, lol, this has been a huge issue for me for quite a while. Thanx for listening.

  5. #5 sspudnick
    July 13, 2009

    I am actually rather bothered by this perticular blog. I mean no disrespect whatsoever to surgeons(Im a pre-med student myself) But this is the prime example of what frustrates MANY of the surgical techs (myself include) that i worked with in the Army. I’ve had MANY cases where i get absolutely no break in between cases..setup, scrub in, wait for the surgeon, as he/she comes in with crumbs on his/her face. It seems, unless you have a close relationship with the surgeon, your needs as the tech are completely ignored. It seems like a lot of Docs forget that we Techs are ALWAYS in the OR, not some of the day, or a few days a week, thats all we do…and no…we dont get the respect thats due for that. I’ve actually seen surgeons try to scrub a case themselves do to having a really bad tech, and was asked (begged) to scrub in, after standing in the room for less than a minute, he just couldnt focus, and i dont blame him for that. Now i know you’re going to say ” Well, you’re not doing surgery, you’re only helping” and this, in some cases, may be true, but in my case, not only have i had to show some surgeons better techniques of doing certain procedures(or a certain part of a procedure) Military Techs are allowed (legally or the lack thereof) to do MUCH more than civilian techs, so we are expected to pickup where surgeons leave off if needed. Do you (as in surgeons, maybe not you in particular) not get pissed, yell and scream when we make minor mistakes, possibly because we were focusing on not calling a Code Brown? YES, yes they do, and throw shit if their assholes. I’d pay to see the day a Tech could say “Doc, one sec, i gotta shit, brb” NEVER. I %100 agree with your blog, but i believe you guys value us when you need us and disregard us as collegues in the same breath. “Whats good for the goose” comes to mind. Ok, im done venting, lol, this has been a huge issue for me for quite a while. Thanx for listening.

  6. #6 sspudnick
    July 13, 2009

    I am actually rather bothered by this perticular blog. I mean no disrespect whatsoever to surgeons(Im a pre-med student myself) But this is the prime example of what frustrates MANY of the surgical techs (myself include) that i worked with in the Army. I’ve had MANY cases where i get absolutely no break in between cases..setup, scrub in, wait for the surgeon, as he/she comes in with crumbs on his/her face. It seems, unless you have a close relationship with the surgeon, your needs as the tech are completely ignored. It seems like a lot of Docs forget that we Techs are ALWAYS in the OR, not some of the day, or a few days a week, thats all we do…and no…we dont get the respect thats due for that. I’ve actually seen surgeons try to scrub a case themselves do to having a really bad tech, and was asked (begged) to scrub in, after standing in the room for less than a minute, he just couldnt focus, and i dont blame him for that. Now i know you’re going to say ” Well, you’re not doing surgery, you’re only helping” and this, in some cases, may be true, but in my case, not only have i had to show some surgeons better techniques of doing certain procedures(or a certain part of a procedure) Military Techs are allowed (legally or the lack thereof) to do MUCH more than civilian techs, so we are expected to pickup where surgeons leave off if needed. Do you (as in surgeons, maybe not you in particular) not get pissed, yell and scream when we make minor mistakes, possibly because we were focusing on not calling a Code Brown? YES, yes they do, and throw shit if their assholes. I’d pay to see the day a Tech could say “Doc, one sec, i gotta shit, brb” NEVER. I %100 agree with your blog, but i believe you guys value us when you need us and disregard us as collegues in the same breath. “Whats good for the goose” comes to mind. Ok, im done venting, lol, this has been a huge issue for me for quite a while. Thanx for listening.

  7. #7 CybrgnX
    July 13, 2009

    The ‘stiff upper lip’ idea is a very bad idea as it leads to the shakes and lack of attention to details.
    I would rather the Doc take a break and come back alert and steady.

    In a similar vane I’ve always noticed that in movies and TV the charactors very seldom have to take pee break. So during the time of high stress when the body is really needing to ‘eliminante’ they never do. And this is reflected in the medical shows as well. Only us ‘common’ folk need to answer the call.

  8. #8 sspudnick
    July 13, 2009

    O my. I’m VERY sorry about the triple post. Didnt intend for that to happen. System kept timing out. I apologize.

  9. #9 Chris
    July 13, 2009

    It is also recommended you read the error message:
    Submission Timeout

    Were you trying to submit a comment?

    If you were, please don’t submit your comment again.

    The system often gets asked to submit more comments at one time than it prefers to handle, so instead of pushing you through to the original post, it sometimes takes your comment and then stops paying attention to you (no offense intended). Hit the back button and refresh the page to see if your post made it through — odds are good it did (but that’s assuming the blog you’re commenting on has unmoderated comments).

    It is annoying, we know. But so is this software’s complete failure to allow a blockquote or any other tag to cover more than one paragraph.

  10. #10 Parse
    July 13, 2009

    I must admit, I was mislead by the title. I secretly hoped your post dealt with you building a powered armor suit and doing surgery in it.

    Well, that, or “Today’s secret ingredient is: Appendectomy!”

  11. #11 Travis
    July 13, 2009

    Back in the 1980′s and 1990′s there was a radio program on the CBC called Double Exposure. It was political comedy program and one skit comes to mind after reading this post. They created a fake advert for a bag that could be used during filibusters when you had to stay but had to go. Now I see a real reason for this product!

  12. #12 Dianne
    July 13, 2009

    Funny, I thought you were going to recommend a brand of adult diapers.

    I always thought that surgeons used foley catheters myself, but I now see that that’s just what they say to one up the internists. They probably don’t really eat ground glass for lunch either.

  13. #13 DLC
    July 14, 2009

    Parse: I thought the same thing about Iron Surgeon/Iron Chef.
    Hmm.. I wonder if we could get patients to agree to it… Iron Surgeon… you have to do the surgery neater and quicker than the Iron surgeon. But who’s going to judge ?

  14. #14 Rich
    July 14, 2009

    Well, if the need to urinate is the problem that one is having, they can always set themselves up with the Stadium Pal beforehand…. – external male catheter (condom with a tube attachment), a tube, and a collection that straps to the calf. David Sedaris had a great book chapter devoted to this little apparatus – a reading of which was featured on This American Life.

    http://www.biorelief.com/store/stadiumpal.html

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