Saturday, May 23, 2009

Rule #9

Assuming that I'm a blogger, it stands to reason that you, don't turn around, I'm writing to you, yes, yes you...are a bloggee. Linguistics aside, some bloggees might remember The Rules. Recently I discovered Rule #9: "It is strongly advised that hemoglobin be maintained within the blood vessels."

The case was a 70 year old patient undergoing a lung lobectomy with the VATS technique. This is minimaly invasive surgery with the major benefits being less post operative pain and quicker recovery. Things did not go well from the start. The anatomy was less than optimal and the surgeon had difficulty visualizing the relevent structures. When the stapler was applied to the blood vessels supplying the lobe to be resected, all hell broke loose. The pulmonary artery was lacerated. The pulmonary artery though not the aorta, is not a vessel to be lightly dismissed. If it weren't so deadly, I'd describe the scene as breathtaking. The velocity at which one's entire blood volume pours into the chest cavity literally takes one breath away.

No doctor, no matter how talented is immune from complications. What is unforgivable is unprofessional behavior. The surgeon screamed at the top of his lungs at the nurse who did not provide the rib spreader fast enough. I understand who stressful such a situation is. No one likes killing a patient, but that is no excuse for venting one's frustration on an innocent team member, especially one who is desperately needed to continue functioning. I have previously stressed how important it is to keep a cool head in an emergency. Even I, with my experience, was frozen in place during the surgeon's cathartic rage. (The surgeon may have felt very good about himself afterwards, but the rest of us felt like crap.) Despite the delay, the rescucitation went relatively well and the patient made it alive, albeit post pulmonectomy, to the ICU.

I personally have no desire to ever work with that surgeon again.

In the Chapters of the Fathers (פירקי אבות), chapter 4 verse 1 it is written:

איזהו גיבור, הכובש את יצרו שנאמר טוב ארך אפיים מגיבור ומשל ברוחו מלכד עיר

In translation:
Who is strong? He who subdues his passions. For it is said: "He who is slow to anger is better than a hero, and he who has control over his will is better than he who conquers a city."

We still have much to learn from our forefathers (and mothers).


Baila said...

I hope the patient didn't hear or remember that scene. And do surgeons ever apologize after the fact?

QuietusLeo said...

The patient was anesthetized so it is unlikely, though not impossible that he remembered anything.
Regarding apologies: comme ci, comme ca. (pardon my french).

ricardo said...

We, anesthetist doctors, should have the choice of whom we work together with...although a team..we usually find some kinds of surgeons...!!!
I found you blog (suddenly I think I am getting addicted to read it!!!???) when I was browsing the internet , looking for some information or even "tips" on stage B exams...I will have to face it next year as the Medical Council tolt me so, since I am graduated and got my title u can point me some good places to find exams , books, any information about stage B will be nice!

Lioness said...

Haven't even read the post yet but need to point out you're a genius, am still laughing over "It is strongly advised that hemoglobin be maintained within the blood vessels." - and the fact that haemoglobine actually has its own little category! I do love your blog, will read on now.

Ok - amen.

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