evil

doctors can be naughty sometimes too. i suppose boredom can be fertile ground for all sorts of mischief and what speciality tends to leave plenty of room for boredom more than anasthetics, especially when you have to sit around with a stable patient while an orthopod labours through the night fixing all sorts of bones.

the anesthetist in question was on call for the orthopedic list. the list tended to start at about four in the afternoon and go pretty much right through the night. by midnight it could be quite a challenge to maintain enthusiasm, unless of course you had something to keep your mind busy.

after a few cases the gas monkey and the bone doctor took a break to replenish fluids and caffeine levels. however, while the poor unsuspection orthopod wasn't looking the evil anesthetist decided to lace his coffee with a strong diuretic. to ensure the best comic effect he put four times the usual dose in the coffee. i suppose he thought it would be four times as funny.

quite soon into the next operation, a fairly long procedure to fix a fracture of the femur (thigh bone), the poor unsuspecting orthopod started looking uncomfortable. he seemed to be struggling to stand still and resorted to crossing his legs quite a bit. finally he just couldn't hold out anymore.

"sorry guys, but that cup of coffee seems to have really settled on my bladder. i'm going to have to unscrub and go to the toilet." with that he walked out. the theater erupted in raucous laughter. only the bone doctor wasn't in on the joke. soon he was back, looking a lot more comfortable, no doubt hiding a contented smile behind his theater mask. he scrubbed up and continued the operation. unfortunately as the bladder distended again his easygoing nature gradually was replaced with irritation and impatience about the fact that the operation seemed to be taking longer than he and his bladder thought it would. quite soon the same restlessness and leg crossing started up and once again he excused himself and ran from the theater in embarrasment.

when he returned the theater staff were trying to remain composed, but there were a few snickering sounds escaping here and there as well as a giggle or two as the process repeated itself. the bone doctor stopped dead in his tracks.

"what the hell have you done to me?" he demanded. everyone burst out into raucous laughter as he charged out one more time to empty his tormented bladder.

surgeon superhero

this is a post i wrote as a guest post for another blog a few years ago. since then that blog has been retired, so i decided to import the post back here.


yes i have an alter ego. yes, i dress in funny clothes with a cap covering my head and a mask covering my face. and yes, dressed as such i try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). i am ... a superhero. but there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people.

a common cold behind a theatre mask is no small thing. remember you can’t blow your nose. sniffing loudly only works for a while and attracts all sorts of strange stares. just leaving it is really the only option. the positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. there is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘nuf sed. somehow this never appealed to me though. so, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation.

then there is a running stomach. this may be one reason to excuse yourself, handle the situation and rescrub. however, there is the real problem of dehydration, confounded by long hours of standing and concentration. here may i suggest a drip. the gas monkey (anaesthetist) can quite easily give a quick bolus or change the vaculiter when needed. (quick note, i’m not pulling this out of my thumb. i have actually seen this). stay at home, i hear you say? somehow that just doesn’t work with us doctors. i’m not sure why, but it is very rare that a doctor will stay at home merely because he is sick. what sort of a superhero would that be.

the last problem that can be encountered is best explained by thinking back to my registrarship. i was assisting the prof with some or other laparotomy. my stomach had been giving me trouble for some time. up until just before scrubbing up with the prof i had found it necessary to quietly leave polite conversation to allow the release of colonic gas quite a number of times. but once scrubbed up, this avenue was no longer open to me. what could i do? i simply puckered up and held it all in. this worked well, but became progressively difficult. we were approaching the end of the operation, but i could pucker no more. finally i reached a point where i had no choice. i needed release. i decided to quietly let one slip as to not attract too much attention with loud noises. so, as the professor started to close the sheath, i did just that. i was just inwardly congratulating myself for the stealth with which the…um…operation had been executed when the professor stopped closing and dived back into the abdomen. in a dry voice he quietly says, “someone cut the colon.” as he started carefully moving bowel out of the way to better examine the colon. now imagine my embarrassment when i was forced to say’...

“colon? yes. cut? no”

swoon

sometimes students faint. sometimes doctors faint. but surgeons??? never...

there was a funny story that happened in our university many years ago. apparently even true.

our university, according to the head of the department of surgery, is the only university in the world where the final year registrar actually has to perform an operation as part of his final exam. (when i told this to my cuban friends, they informed me that they also operate as part of their exam, so this interesting fact is no fact at all.) among the junior registrars in the department it is considered a great honour to be asked to assist in this auspicious operation.

in this particular case, the candidate had to do a thyroidectomy. he elected to use two assistants. if you can, why not. he asked two of the medical officers in the department to assist him, something that was almost unheard of. i can imagine that many registrars felt snubbed. but in all fairness, both medical officers were pretty serious about continuing their surgical training and were both apparently capable assistants.

the great and nerve racking day finally arrived. the candidate and one assistant started the operation. the second was a bit late. apparently he became engaged in the wards and couldn't free himself until the operation was in full swing. but he finally joined, somewhat out of breath, but otherwise, it seemed, none the worse for wear.

then the professors entered. to fully appreciate the tension of the situation, imagine, over the normal stress of a thyroidectomy for a registrar, adding the presence of three professors and a senior consultant, watching his every move and being more than slightly liberal with their criticism. in the theater was the head of department, the previous head of department (semi retired), the preprevious (is that a word?) head of department (an old style surgeon who was as old as the hills and, it was rumoured that you actually had to cut off his head before he would die. i think a stake through the heart might have sufficed) and the most senior consultant in the department. the mood was grave. the only talking at all was when the registrar fielded the array of difficult questions about the procedure he was doing and constantly had to defend every decision he made as well as every stroke of his blade.

and thus the operation progressed, probably a lot slower than it would have had he been alone. around this time, so the story goes, one of the assistants became progressively more pale. finally his face was chalky gray and a cold sweat had broken out on his forehead. some versions say he then promptly passed out. others have him excusing himself from the operation and quietly collapsing in the corner of theater. whichever you believe, imagine the medical officer, with a serious ambition of one day becoming a surgeon, lying crumpled up in the corner with the entire hierarchy of the department looking down (in more ways than one) on him. some would call this a career limiting move.

anyway the operation then progressed, with only one assistant, to a satisfactory end. the professors apparently hounded the candidate somewhat less. they had the collapsed assistant to pester and therefore their attentions were divided.

post script, after this somewhat embarrassing episode, i never fainted in theater again.