“secrets of the operating room”

Image via Wikipedia

I couldn’t resist sharing this WSJ article with you. I think you’ll find it as eye-opening as I did. The surgeon authoring the piece is Dr. Paul A. Ruggieri. It has been adapted from Confessions of a Surgeon.”

“Secrets of the Operating Room”
     “GET THIS THING out of my operating room!” The colon stapling device exploded into pieces when I hurled it against the operating room wall. I was fed up with its failure to work as advertised by the manufacturer. The stapler had probably cost less than $100 to make. The hospital paid $300 for it (and then billed the patient, or insurance company, $1,200). Now the thing didn’t even work.
     I do not react well to imperfection inside the operating room. I cannot tolerate it in the tools I use, the staff assisting me, or myself. Defective devices–I can have them replaced. Unmotivated staff–I can have them removed from the operating room. I haven’t quite figured out yet what to do with myself.
     Surgeons are control freaks. We have to be. And when things don’t go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums. These explosions are a go-to-reaction when we’re confronted with the ghosts of prior complications.
     Several months earlier, I had performed the same operation on a 66-year-old patient, using an identical stapling device. Everything seemed to have worked perfectly until the patient developed severe complications four days after his surgery. We soon discovered the cause: the nonperformance of the stapling device.
     When the stapler hit the wall, I had been in the operating room for more than four hours, struggling to remove a diseased segment of colon from someone I’ll call Mr. Baker, a 330-pound middle-aged man. Trying to keep his fat out of my way during the operation had been a continuous battle. The pain in my upper back reminded me that I was losing the fight.
     Obese patients create more physical work for a surgeon during any type of procedure. The operations take longer, tie our upper body in knots and leave us with fatigue and frustration. Obese patients also automatically face an increased risk of complications like infection, pneumonia and blood clots during recovery.
     If the difficulties posed by Mr. Baker’s obesity weren’t enough, he had been steadily losing blood during the procedure. His tissue reacted to the slightest graze with more bleeding.
     Why does this guy have to bleed like this? As if it were his fault. Here I was blaming him, even though I was the one causing the bleeding. But in surgery, it always has to be someone else’s fault. It’s never the surgeon’s fault.
     Interestingly, after an operation, most surgeons tend to underestimate the amount of blood that was lost. Whether it’s ego or denial, they can’t help themselves.
     The reality is that blood loss can be measured. Hospitals know which surgeons are losing blood, and how much, during every operation. They have data from their operating rooms, but the public cannot get access to this information. And this information matters, too. A large amount of blood lost during an operation can be a harbinger of complications to come.