Surgery News - November 2008 - (Page 19)

NOVEMBER 2008 • SURGERY NEWS OPINION EDITORIAL 19 Table for One idea of Misya to greata job be food critic: the person who gets the best BY LAZAR J. GREENFIELD, table in the M.D., FACS restaurant, is fawned over by the staff, and samples the best products of the chef ’s imagination. Unfortunately, years of hospital food have dulled my palate’s sensitivity to the nuances of exotic herbs and spices. But I can legitimately express an opinion from the table where you lie looking up at bright lights while you talk to an anesthesiologist. When you are the one wearing the skimpy gown, you become sensitive to the nuances of hospital care. Your initial focus on the experience of your surgeon shifts as you realize that you have much more at stake in the person who will try to maintain your blood pressure and oxygenation. The tag-team approach often leads to different faces at the table, but in my case, once I decided to go to Famous Hospital, where I knew my orthopedic surgeon, I realized I could depend on his team. In fact, the decision to go out of state was clear once my local orthopedist suggested it as a vacation trip. I’m sure he saw me as more risk than benefit, since any complication would be broadcast and witnessed as long as I was limping around. In the course of events, I found friction points in the processing rituals at Famous, comparable with those of my own institution. First was the difference between the admission interview with anesthesiology (5-minute wait, 10-minute interview) and nursing (1-hour wait, 40-minute interview). After reviewing everything from my family history to my grooming habits, the nurse became a tour guide, advising us where to eat and shop, and even providing a map. It was easy to see why a staff of 10 experienced nurses was required. Same-day surgery is slick at Famous Hospital, and a breeze for the patient thanks to pharmacology and preheated blankets. The glitches come later. The first night, I got woozy on the bedpan, and my hypotension was confirmed by the aide who promptly turned up the IV fluids. But I recalled that potassium had been added to the IV earlier, so I rang for the nurse. An aide came and said the sole nurse for the floor was handling an admission. Fortunately, I convinced him to slow down my potassium infusion. Nursing care was great during the day, but I wondered why some of the outpatient tour guides couldn’t be put to better use at night. After 3 days in the hospital and 2 in a hotel, I was ready for the trip home, but unaware that the adventure was just beginning. Little did I know that crutches are considered a weapon and must be abandoned for inspection at the airport. Ungainly hopping through the detector confirmed that my new knee was indeed made of metal, but the swelling there was not from pride. Are platelets your friends or enemies? The answer depends on whether there are no clots in the veins, or whether they forget to seal the wound. In my case, the hematoma increased my analgesic needs, but I discovered that the mind’s friend is the gut’s enemy. A few days later, I got to sample Home Hospital’s surgical service for volvulus, then the medical service for toxic pancreatitis and gastritis. The contrast between services was remarkable, and not just because I was a familiar face to the surgical residents. On surgery, the senior resident called the shots and answered questions. On medicine, the intern was in charge and my chart was the focus of attention. Rounds on medicine consisted of a competition to see which resident or attending could think of the most bizarre explanation for my laboratory findings. Had I not understood the game, I would have been alarmed. Fortunately, a seasoned internist got me paroled into his care. Long after these events, I can appreciate my experience and give credit to splendid surgical teams and physical therapists, who cajole and threaten you through teeth-grinding exercises. For a journey like this, they are indispensable guides. Joint replacement is a technical marvel and a steep hill to climb, especially if you have the added risk factor of being a physician. ■ DR. GREENFIELD is Editor in Chief of SURGERY NEWS. http://www.chloraprep.com

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Surgery News - November 2008 Contents News:�Without a Stitch The 20/20 Vision:�Med School Mix News From the College:�New President General Surgery: Diabetes Debate

Surgery News - November 2008

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