Saturday, January 17, 2009

How in the hell?

Working in surgery can lead to interesting questions.

Today's question is: How in the hell is it possible that someone can shoot themself in the leg with a bow and arrow?

Thursday, January 15, 2009

HIPAA and me

So there is this law, HIPAA, that says that we medical folk can't divulge patient's medical information without a good reason. We also can't act on it for any reason other than to treat or aid the treatment of the patient. The rules are so strict that if I saw my mother's name on the surgery schedule, I couldn't go and see her after surgery unless I also got the information from a non-hospital source. HIPAA can cause some problems for bloggers, as the best stories involve patient information. I feel that on this blog I am abiding by these rules in the following ways.

I, of course, never use patient names. I don't use my name or the name of my hospital. I don't even explicitly name the city where my hospital is located, although it probably isn't difficult to figure out. However given my other interests, as seen on my other blogs, anyone who knows me would recognize me here. I am the only scrub in my town, who works the weekend shift, with my set of interests. I have a limited set of patients, so it theoretically may be possible to figure out which patient I am talking about. I doubt anyone will actually go to the trouble to figure out which town I work in, then who I am, and therefore which hospital I work at, and then connect my patients with a blog post. It could be done, but only by someone who has access to my hospital's records, and who knows me. Still I protect myself further by lying. When I say "this weekend", I mean, "sometime in the last 19 years". I can and will change the nature of a patient's injuries, disease or treatment in ways that don't change the core of the story. If I can, I might even change the patient's gender. In other words, this isn't the patient you're looking for. Go away.

Cases that suck, and their causes.

I made passing reference to the something that made a case suck over here, but I thought that the causes of surgery sucking could be further expanded upon. Note that some of this list is subjective. It is also viewed from the scrub staff's point of view, rather than the surgeon's, patient's, anesthesia's or circulator's point of view. I suppose that ophthalmologists actually like eye surgery. Some circulators like long cases because they get to sit. Anesthesia has a completely different set of priorities from the rest of us. They seem to think that just because the patient’s blood pressure stays in the 50s it is a bad case. There are even some scrubs who might some theses cases.

First and foremost, harvests suck. Nothing sucks worse.

Second, eyes suck, but not as much as harvests. Retina and vitreous surgery sucks more than other eyes.

Third, any case with certain doctors suck, because the doctor is an asshat. Luckily, this is actually a small set of surgeons.

Any case involving more that one surgical specialty sucks. The suck factor goes up exponentially. A case with two specialties sucks 4 times as much as a similar case with 1. Three specialties sucks 27 times as much. Four specialties sucks 256 times as much. If we get to five specialties, just put a central line in me and hook it to wall suction.

Any case which departs from its script sucks. Some departures suck more than others. This includes, for example, the unscheduled opening of an endoscopic case. Note that just because we don’t know what we are doing going in doesn’t mean that there isn’t a script. For example, an exploratory laparotomy for bowel obstruction has departed from the script if we find a huge diaphragmatic hernia. It hasn’t if we find a tumor or adhesions.

Dead bowel sucks. Smells too. That’s why it sucks.

Any case scheduled to last more that 150% of what a normal version of that case would last sucks. First it's going to last twice as long as it's scheduled for, and second the surgeon knows something, and it's not good.

Any case scheduled for longer than two hours sucks. (Corollary, heart scrubs are crazy.)

Any case that requires re-draping sucks.

Any case with broken bones in more than one limb sucks.

Any case in which the circulator has to leave the room for anesthesia more than twice sucks. The circulator is there to get me things, not them.

Aneurisms suck. All of them.

Holding retractors on vaginal cases sucks.

Interesting cases suck. After 19 years, if I haven’t seen it, I probably don’t won’t to. OK there’s one exception. Years ago, when I was a baby scrub, a case down the hall has a removal of a cyst. When the surgeon cut into the area an insect stuck its head out of the wound. The patient had been in the tropics recently. I didn’t see that case, but I’ve always wanted to see another one. Otherwise interesting is out.

So there it is, an incomplete list of ways that cases can suck. I leave out that there are certain case and doctor combinations that suck and that certain staff have people that they can't get along with, which sucks. I, of course, can get along with anyone.