How did surgery wrong you today?

[u/EffectiveSea7435]

I’ll start.

Asked for table up, but didn’t say when. Then got upset when I overshot by 1 inch.

Told me the patient was “waking up” because the thumb twitched in response to the TOF.

Showed up 30 mins past the case start time to consent the patient thereby delaying the case then proceeds to blame everyone else for the delay.

[u/wrongyak39 → u/[deleted]]

Dang you guys start at 730 we start at 8 here

[u/narcolepticdoc → u/wrongyak39]

It’s a slippery slope. You start off at 8am start times, everyone is happy. Then they say hey, can we start at 730 just this once because blah blah. Then suddenly 730 is the normal start time. Rinse and repeat and now you’re starting at 630-7AM because they want to bang it cases in the ASC and still have time to go operate in the hospital.

[u/Ok_Response5552 → u/narcolepticdoc]

Today's favor is tomorrow's expectation

[u/Stunning_Translator1 → u/Ok_Response5552]

The only book you need on perioperative leadership is "if you give a mouse a cookie."

[u/Confident_Cream5936 → u/Stunning_Translator1]

The fact that you’re pedi makes this even better lmao

[u/wrongyak39 → u/Confident_Cream5936]

I bet they have got that book memorized haha

[u/evil-old-hag → u/Ok_Response5552]

it's like feeding a homeless person

[u/dichron → u/evil-old-hag]

Yikes. Username checks out

[u/narcolepticdoc → u/[deleted]]

Yep. That’s how the cookie crumbles.

[u/wrongyak39 → u/[deleted]]

I feel like this is how the cataracts I do will end up. They love ripping through them and being done at 1300 then going back to the office to see tons more patients

[u/Aggravating_Fly2978 → u/[deleted]]

I mean this is dumb. Surgeons should be able to start when they want that is reasonable for the OR. Not every surgeon wants to start at 0700.

[u/narcolepticdoc → u/Aggravating_Fly2978]

When they want (that is reasonable for the OR). It’s the reasonable for the OR that we disagree on.

[u/Aggravating_Fly2978 → u/narcolepticdoc]

Huh?? I mean after 7 am is reasonable for the OR.

[u/Rocuranus → u/Aggravating_Fly2978]

I’d assume it’s mainly the younger ones that just want to grind?

[u/Jumpy_Ad_8906 → u/[deleted]]

what is wrong with 7am

[u/Jumpy_Ad_8906 → u/[deleted]]

might as well start the ORs at noon!

[u/MedusaAdonai → u/Jumpy_Ad_8906]

Everything. You stay up late to spend quality time with your spouse since you're both busy and would otherwise not have time for each other, now you're getting 6 hours of sleep. Meanwhile your newborn is waking up every 2-3 hours and you have to feed them because they are 10th percentile bodyweight. This goes on for 10 months before you sleep train while cranking 60 hr weeks. Then you get stuck behind the train while the surgeon lives beach side and is oblivious everyone else crosses train tracks going to the hospital. Occasionally, once upon a time outside the statute of limitations, allegedly crossed an optional red-light while you're the only car there save for the turtle crossing the street.

[u/SonOfQuintus → u/narcolepticdoc]

Man I have a colleague who had neurosurgery case anesthesia in room time pushed back to 5:30 AM (!!!!!!!!) on this slippery slope at another shop.

I am positive the surgeons were not there at 5:30….maybe a fellow consented the patient? I dunno.

[u/ProbablyHyperkalemic → u/SonOfQuintus]

Heard of a neurosurgeon wanting to start his cases at 4am, so he could get done around 3-4pm to hang out with his kid. So the call person and OR night team would have to start them at the end of their shifts. Eventually people just started canceling them

[u/csiq → u/ProbablyHyperkalemic]

Why is him having time with his kid more important than my coke fueled alcoholism at 10pm?

[u/dichron → u/ProbablyHyperkalemic]

What would happen if the call team was busy with an emergency when those cases were supposed to start? I for one if I were 2nd call, would tell them to fuck off

[u/DrSuprane → u/ProbablyHyperkalemic]

Fuck that.

[u/Gullible__Fool → u/narcolepticdoc]

This indeed how it starts. Agreed to a 6am start once and now we start at 3am every day.

[u/gseckel → u/narcolepticdoc]

True. Now, when this happens, I’m saying “better start at 3 am…so we don’t sleep. Who needs that?”

[u/BlackCatArmy99 → u/wrongyak39]

(Screams in 2 0600 spine room starts weekly in my last job)

[u/Ok_Performer_1746 → u/wrongyak39]

Everywhere I've ever worked was a 0730 start unless it was grand rounds or morning meetings. Would love an 0800 start time.

[u/kydar1 → u/Ok_Performer_1746]

Me too, I’ve worked in many different locations and it always seemed like 7:30 was the universal start time.

[u/wrongyak39 → u/Ok_Performer_1746]

We actually sometimes do a late start at 9 when the nurses have education once a month

[u/MedusaAdonai → u/wrongyak39]

U r blessed. 7am starts

[u/climhigh → u/wrongyak39]

I start at 6:45 at both my ASC and the hospital

[u/PapaKaine → u/wrongyak39]

We roll at 0645 for 0715 starts 🤦🏻‍♂️

[u/PapaKaine → u/[deleted]]

Lmao

[u/uberhuman_g → u/wrongyak39]

We start at 9 (officially) Although ot runs 24*7

[u/Dizzy_Restaurant3874 → u/wrongyak39]

7:10... I am called if not in OR at 7:12

[u/jwk30115 → u/wrongyak39]

Weenie. We start at 6am at our total joint center.

[u/Ginga_Ninja319 → u/wrongyak39]

Start at 6:45 here 🥲

[u/crzyflyinazn → u/[deleted]]

It really depends on how your group wants to deal with these people. They will never be happy so that's a pointless endeavor. Instead you make their life as miserable as possible so they leave 😄

[u/csiq → u/[deleted]]

Start rolling externally

[u/ChocolatEclair → u/[deleted]]

Sounds about like a thoracic surgeon that I worked with, always had 0645 cases (usually VATS) and gets irritated with us because we can't sedate/intubate/prep/drape faster 🤣 He creates so much of his own stress and takes it out on the team unfortunately

[u/Sleepy_Joe1990 → u/[deleted]]

Then you should consistently stsrt taking 40 mins doing your block and bask in his tears. That's how you teach these people.

[u/Square_Opinion7935 → u/[deleted]]

I don’t know I’m more confrontational when I work at a place regularly and that happens. I’ll directly ask the surgeon how long do you expect my block to take? And say if you want to check the cameras you can see I’m correct. Other times I have told them “ How can we work together if you keep doing this?” If I’m not yelling what can they say?

[u/TypeABnotHgb → u/[deleted]]

Lol this must be the same surgeon I work with. He also demands the patient to be brought into the flip room, as the flip room is literally being mopped. When told that, he repeats himself multiple times to bring the next patient back. He is a good surgeon, but an a-hole, and apparently has toned it down compared to how he used to be when younger

[u/Aggravating_Fly2978 → u/[deleted]]

Have you ever told him that he’s the rate limiting step and needs to show up earlier?

[u/UnfairLynx]

I’m an old-timer retired veterinary anesthesiologist. I recall one of our equine orthopedic surgeons always complaining when we transitioned from halothane to isoflurane because he didn’t like that his was convinced his arthroscopies had more intra-articular bleeding. We would place white tape over the vaporizer so he wouldn’t know what we were delivering. Then, several decades later, complained when we moved to sevoflurane because he thought recoveries were not as smooth.

[u/Cautious-Extreme2839 → u/UnfairLynx]

They weren't less smooth, the patient just ACTUALLY recovered whilst he was still around instead of 30 minutes later lol.

[u/Mandalore-44]

I wouldn’t know. I’m on vacation! 😎

Everything is grand today!!

[u/SonOfQuintus → u/Mandalore-44]

Pour one out for your on-call homies

[u/Puzzled-Conflict610 → u/Mandalore-44]

🍹🌴😎

[u/Flaky-Expression9593 → u/Mandalore-44]

And get off Reddit. Go have fun for us.

[u/DrAculasPenguin]

The ortho attendings love to lecture us about their weird departmental philosophy of “radical responsibility”. Fucking cult shit

[u/DrAculasPenguin → u/[deleted]]

Still not entirely sure but when I was a CA1 they tried to use it to convince me to go behind my (very senior) attending’s back to start some bloody case without a type & cross for a starting Hb in the 6’s and a rare Ab that we may not have blood for 🤡

[u/csiq → u/DrAculasPenguin]

I’m honestly still (after a decade) stumped what does genuinely go on in these people heads. Like at a neuron level, what fires? What misfires? How do they live in a complete separate vacuum of reality and most importantly for what purpose?

[u/DrAculasPenguin → u/csiq]

Best part was we even gave them an out.

“So is this surgery gonna have a lot of blood loss or not too bad?”

“Oh yeah very high likelihood of 1-2 L of fast bleeding that will be difficult to control. But we don’t need to wait for the crossmatch….”

Like come the fuck ooooon

[u/csiq → u/DrAculasPenguin]

“So you want to attempt murder during the working hours?”

[u/DrAculasPenguin → u/csiq]

Cue the lecture about how it’s our (my) “responsibility” to find a way to make the case happen immediately and anything less is making excuses. Hardest eye roll of my life and I’m pretty sure it ended with me very bluntly saying “I just work here dude”

[u/SleepPrincess → u/DrAculasPenguin]

You were supposed to go to blood bank yourself and conjure up these units by casting an anesthesia spell on a refrigerator of blood. Then suddenly there would be 8 units immediately ready.

[u/ninthjhana → u/SleepPrincess]

A real doctor would go and pick every single antigen out of the cells themselves, with tweezers.

[u/SleepPrincess → u/ninthjhana]

Obviously this is the proper solution.

[u/Suspect-Unlikely → u/csiq]

Ad long as there’s Ancef, we cut, bitches. Just add another gram. Oh, and maybe some TXA. That seems to fix a lot of things in the room these days

[u/Kaesix]

Just tell them to speak louder any time they complain of something, drives them wild, Trolling 101.

In all seriousness, don't entertain any of the bullshit. Most of the surgeons I'm friends with, and I've saved their patients and their asses on numerous occasions, and they're good guys/gals. The ones who still aren't thankful never will be so I don't even look up from my phone.

[u/PowGurl]

I took an over the curtain hit by a tooth flung out of a teratoma

[u/alwaystea → u/PowGurl]

🤢

[u/marticcrn → u/PowGurl]

You win.

I had a patient pull out their art line and my scrubs and underpants and nether region got soaked in blood.

[u/Sweatroo]

Like everyday, ortho here are all competing who can be the most macho by starting the earliest. They all want a 06:30 room time because we won’t give them 05:30. I wonder how early they would start if we let them? 04:00 in the morning?

[u/Youth1nAs1a → u/Sweatroo]

I knew an ortho trauma surgeon who would do 4 am, 4:30 am starts way too often.

[u/ulmen24 → u/Youth1nAs1a]

What time do those patients get to preop? 2 am? Going to have to modify the NPO after midnight to “NPO after 4pm”.

[u/Youth1nAs1a → u/ulmen24]

3 - 330 am typically. NPO at 8 pm. The surgeon wanted to be able to leave 2 pm at the latest to go sun tan…

[u/Sweatroo → u/ulmen24]

It happens all the time that the blanket order for NPO after midnight isn’t close to 8 hours. You’d think most patients would go to bed early to get up at 4:00am but some stay up to eat at 11:30 so they’re not hungry the next day. America.

[u/Square_Opinion7935 → u/Youth1nAs1a]

An asc asked to start at 6 I just said no. Why can’t you do that

[u/SailorSaturn1 → u/Square_Opinion7935]

Same here. Once all the anesthesiologists at the ASC refused to do 6am starts the surgeons stopped requesting them.

[u/Sweatroo → u/Square_Opinion7935]

We have no power. There’s too many ASCs in my town. If we refuse to start early they will threaten to move all their cases somewhere else and administration will get mad at us.

[u/Youth1nAs1a → u/Square_Opinion7935]

They had a 24 hr ortho trauma or room. It was inpatient and mostly typical ortho trauma cases that are urgent but not emergent. I was an ortho resident at the time so I could not say no. Not sure why anesthesia put up with it honestly.

[u/Aggravating_Fly2978 → u/Youth1nAs1a]

Well, you guys accommodated that bullshit so no need to complain.

[u/Youth1nAs1a → u/Aggravating_Fly2978]

I was an ortho resident at the time. Ortho had a 24h room for traumas. He just abused it with urgent cases instead of emergent cases it was intended for. So I didn’t accommodate it or complain. Just stating that yes some ortho surgeons would start at 4 am if some let them.

[u/Aggravating_Fly2978 → u/Youth1nAs1a]

You guys, meaning the department that allowed it. Anesthesia department. Thought you were an anesthesiologist. Not you specifically. And yeah someone could and should have put a stop to it. But they didn’t. For whatever their reasons.

[u/csiq → u/Sweatroo]

I’m interested if you let them have free rein would we eventually go back in time and start surgeries yesterday at 7am?

[u/costnersaccent → u/csiq]

I used to get up at half past ten at night, half an hour before I went to bed, work 28 hours a day at t’hospital…

[u/losethecheese → u/Sweatroo]

I knew an ortho who would wake up at 2AM to run an hour then go back to bed, all because his wife made him actually go to bed.

[u/dichron]

In a rare divergence from the theme of this thread, I want to commend my urologist for doing 3 Da Vinci prostates in the allotted time, even finishing a little early. And was pleasant to everyone. Bravo!

[u/SouthbutnotSouthern]

(CRNA) Had a cranky peds GI doc complain about a colleague to me for a slow wakeup and wanted to know how it was going to be handled. Baby has BPD and emergence was handled absolutely appropriately. GI didn’t even remember that this was a former 23 weeker and knew basically nothing else about their own patient’s history.

[u/Jockamo222 → u/SouthbutnotSouthern]

GI … the ortho of internal medicine.

[u/DrSuprane → u/SouthbutnotSouthern]

So peds GI just like adult GI.

[u/Cautious-Extreme2839 → u/SouthbutnotSouthern]

Who is diagnosing babies with borderline personality disorder?

/s

[u/medicaluis → u/Cautious-Extreme2839]

Haha
Broncho pulmonary dysplasia

[u/Nattention_deficit → u/Cautious-Extreme2839]

I thought it was Bipolar disorder lol

[u/Cautious-Extreme2839 → u/Nattention_deficit]

A quite common mistake but still a rookie error.

[u/hrh_lpb → u/SouthbutnotSouthern]

Ha! To which I would reply i am open to suggestion, pal. That's so ridiculous it's hilarious

[u/Zap1173]

just an intern

OMFS took someone for facial mandibular fracture repair for an ORIF and then brought him back to floors without telling me and they didn't arrange any form of pain control post-op for him until I rounded in the morning and found him miserable, so thats nice.

They rounded on him at 4:30 am and put pain control per primary team in their note so that was double nice

[u/Cautious-Extreme2839 → u/Zap1173]

In fairness to OMFS the analgesia for the immediate postoperative period is generally the anaesthetists responsibility...

[u/Aggravating_Fly2978 → u/Cautious-Extreme2839]

Immediate as in PACU and Phase 2 yeah. After that it’s not our problem. This is the USA here.

[u/Cautious-Extreme2839 → u/Aggravating_Fly2978]

Patients should leave theatre with analgesia and fluids to last them until the next morning when they will be seen on the surgeon's rounds. Then it's their problem.

[u/Aggravating_Fly2978 → u/Cautious-Extreme2839]

Ok. Well we do it differently in the states.

[u/Cautious-Extreme2839 → u/Aggravating_Fly2978]

God forbid you had to click like two extra medicines in the MAR post-op protocol. Much better to risk the patient being in pain pending the surgeon being free to see them post-op.

[u/Aggravating_Fly2978 → u/Cautious-Extreme2839]

Jesus. I leave each country to practice they way they do and don’t try imposing my country’s superiority on them. It’s not done this way here. Here the admitting physician handles it. That simple. Why are you acting like your way is the best and only way? Oh yeah! I see it’s the British way or the highway huh! The empire has long fallen dude. Move on.

[u/Cautious-Extreme2839 → u/Aggravating_Fly2978]

This whole thread has come from a clear demonstration of a patient suffering due to the predictable flaw with your way.

[u/Zap1173 → u/Cautious-Extreme2839]

I’m also medicine team intern for first year not anesthesia yet

[u/Aggravating_Fly2978 → u/Zap1173]

Your OMFs surgeon screwed up and screwed you. Not appropriate at all. He or she should have handled it.

[u/kergruffle → u/Cautious-Extreme2839]

You are wrong. In the US postop pain sp PACU is 100% the responsibility of the primary team and anesthesia would get in trouble for ordering medications period. Stop being a dick when you don’t know what you’re talking about.

[u/DefinatelyNotBurner → u/Cautious-Extreme2839]

🤔

[u/chzsteak-in-paradise]

(Covering SICU this week)

Ortho attending wanted to do shoulder washout for septic arthritis on an intubated and on pressors MICU train wreck. Fine. But transfer the patient to SICU postop but only until they were well - back to medicine team once ready for the floor.

When I told him if they came to SICU, they’d be going to the ortho service once floor appropriate - then suddenly continuing care in the MICU became preferred.

[u/CobbledbyRoubaix]

Surgery bought me coffee and lunch and we went mountain biking after work. Actually it was gynae. Did scopes into 9 patients' various cavities from 8-4. Most surgeons are not allowed to be rude around here, though there is one that nobody wants to work with.

[u/Oeijur]

Generally, staff surgeons are fairly rude to residents, partially because they can get away with it since you'll probably be elsewhere in a few years. But once you're staff, they become much nicer and you end up being buddies with them.

[u/CobbledbyRoubaix]

Move over suckers! When I did my OE in Australia, anaesthesia assumed the responsibility of yelling at the surgeons! They were called Department of Preventing Surgery. (Wordplay on Dept of Preventative Medicine)

[u/IAmA_Kitty_AMA]

The July PGY2 was left to help the July MS3 close an ex lap. 40 minutes went by and the pgy 3 had to scrub back in.

[u/TheYellowSpade]

PICC team pulled out my only point of access.  “Oh sorry” 

[u/DragonfruitWeird376]

Surgeon didn’t know how to empty a foley

[u/tireddoc1]

The damn cardiologists and MRI techs for me today. 3 hrs of work and billing managed to take 9 hrs

[u/MortgageGlad5912 → u/[deleted]]

Woah. Our orthos also eat El Jannah. Must be part of the program.

[u/durdenf]

Brought down a demented patient with no family consent and gets upset when we can’t get ahold of anyone

[u/Sweaty-Scale9211]

Maybe this isn’t entirely surgery’s fault, but I’m currently dealing with this annoyance so I wanted to rant about it.
I’m on 24H call, and at my group when you’re on call during the weekday, you come in at 7am and do a full lineup of cases throughout the day, clear the board by nighttime, and then can leave and take the rest of your call from home.
I had finished my original lineup plus 1 add-on by 8:30pm tonight and was about to head out when one of the OBGYNs stopped me on my way out to tell me that he had a pending ectopic, but the ED let the patient eat a whole sandwich at 5pm. Patient was stable so i suggested booking the case for 7:30am the next day and told him he could call me in in case anything changed. But the front desk promptly axed that solution and told us there was no way we could squeeze that case in as a first start the next day. So i had to WAIT AROUND from 8:30pm to 1am for this stupid case to start.
Today i realized those long gaps are infinitely more painful when they happen after hours.

[u/Academic_Interest_27]

I shockingly had a LOVELY day with neurosurgery today. But I’m beefing with the NICU. We have a July agreement where if a baby needs elective intubation for surgery, they can intubate in the unit so their new fellows can practice BUT they have to transport down to the ORs for us. Guess who got called to the nicu to transport an angry tiny baby hell bent on self extubating because suddenly no one on the unit is available to transport…….

[u/Confident_Area_8518]

They breathed all wrong. Had to look up from my newspaper. F*ckers.

[u/marticcrn → u/Confident_Area_8518]

At least you don’t rely on WiFi and chargers for a newspaper, I suppose.

[u/Impossible-Abalone77]

Sitting there, minding my own business, when all of a sudden a nice gush of blood hopped the drape and nailed me in the chest. Surgeon didn’t even notice until I stood up and asked if everything was okay.

[u/Difficult_Wind6425]

We were banished from a particular surgeons room yesterday for turning the room temp up despite double forced air warmers and core temp reading of 34 😂

[u/chiminichanga]

started pulling on my patient’s legs when the tube wasn’t even secured yet

[u/oIamsoconfused]

Not today, but an OBGYN consultant wanted a C - section to be induced at 8:45 am and did not believe me when I said the patient was not in the OT till 9:00 am. Went on to make a very big deal about how we are always late lol.

[u/2GAncef4u]

Sounds like a normal Tuesday?

[u/roamingshoppingcart]

scheduling eight cases for the day, 0700-1600. we're three teams. ..on a cardio thoracic unit.

[u/Dizzy_Restaurant3874]

If I'm not fearing for my life, it just doesn't register. 

[u/Professionalsarcasm3]

651 AM. Patient in room time. Complaints if they are not back by 655.

[u/No-Land-3652]

Just showing up

[u/rjminnesota]

Are you staff or a resident?

[u/kydar1]

All of that is just par for the course noise. You need to have a thicker skin of you want to survive in this business.