The Patient Was…

One meaning of “cut” is a transition between scenes, usually in filmmaking, and this entry in the blog consists of a series of unconnected surgery-related experiences and misadventures that I have encountered in my career. Some of these vignettes are illuminating of human foibles, some are sad, some funny, and some unnerving. Some have been described earlier at greater length in individual patient encounters in the blog but are included here for their connection to the unique world of surgery.  

A physician is being operated on by a close friend who wants to do the procedure under general anesthesia where the patient is asleep, because the surgeon knows the patient will be giving him annoying advice if only local anesthesia is employed. The surgeon relents and starts the operation using local anesthetics only. Sure enough, the patient starts offering suggestions on the operation. The last thing the patient remembers is his surgical friend bellowing to the anesthetist, “Put that son of a bitch to sleep.” The patient awakens from anesthesia two-and-a-half-days later, with an incision already healing.

A very obese surgeon is performing a major abdominal operation. Because of his own abdominal girth, the surgeon’s sterile operating gown only covers the front and sides of his body, which are the parts in contact with the patient and the operating table. He is wearing surgical scrubs under the gown as all surgeons do. Midway through the operation, the doctor’s scrub suit belt loosens, and his trousers slide down to the floor. He is not wearing underwear. The so-called circulating nurse, who is not at the operating table but moving about in the operating room, is horrified as she passes behind the surgeon and sees his bare bottom fully exposed. She insists the operation stop and that the surgeon put new pants on; he refuses because the surgery is too involved to interrupt. She refuses to stay in the OR, he angrily dismisses her, and the operation is completed by the bare-assed doctor, minus a circulating nurse.

A young woman with heart disease is advised by a group of expert cardiologists and cardiac surgeons to undergo open heart surgery to repair or replace a damaged heart valve. She is reluctant to do so, but willing to undergo the surgery if her personal doctor agrees. Because she is still feeling well and has no signs of disability or difficulty doing her normal life activities which include caring for her two young children, her physician advises her not to have the operation. One year later, the same group of experts practically insist that she undergo surgery, and they chastise her physician for advising her otherwise. Because of the pressure put upon him, and because the experts are much more experienced than he is, her doctor persuades her to have the operation even though she still feels well and functions without difficulty. She agrees to have heart surgery, and dies on the operating table.

A middle-aged woman, sitting in the last row of seats on an international airplane flight complains of abdominal pain. In response to a call for medical assistance from the flight cabin crew three physicians respond. The patient is laid on the floor in front of the galley in the back of the plane, where the physicians meet her and one another. One doctor, a young man still in his training, excuses himself and returns to his seat since the other two physicians are older and more experienced. One of the two is an Egyptian surgeon, the other an American cardiologist. Before even examining the patient, who is lying comfortably at the moment, the surgeon announces, “We have to operate.” The cardiologist looks at him in amazement, says nothing, but proceeds to examine the woman who has no signs of distress whatever. The surgeon repeats his demand that they perform exploratory surgery on the floor of the aircraft. The cardiologist glares at him and says, calmly but firmly, “You will operate over my dead body.” The surgeon, who wanted to do something “heroic,” slinks back to his seat. The patient, apparently comfortable and in no distress, retreats to hers. The cardiologist returns to his seat, where a grateful flight purser serves him champagne.

An older man is hospitalized in advanced heart failure due to a severely damaged heart valve. He is seen by a number of expert cardiologists, each of whom independently advises urgent surgery to replace the valve. Although he is desperately ill, the patient refuses surgery because he is terrified at the prospect. Finally, after yet another cardiology consultation, the patient agrees to undergo the procedure, but only if it is done by the most famous heart surgeon in the country, who lives and works halfway across the continent. Arrangements are made, and the patient is flown in a special ambulance plane to the medical center where the legendary surgeon is Chief of the Surgical Department. Surgery is successful and the patient returns home to the care of his personal cardiologist. When reviewing the post-operative medications given to the patient, the doctor notices one crucial medicine is not listed. He tells the patient he wants to call the surgeon and find out why this vitally important drug was omitted; the patient forbids the doctor to call the surgeon because it would be embarrassing to suggest there was an oversight or error of omission. The cardiologist explains that without this medication, the patient is at serious risk of a stroke, but the patient is adamant. The doctor reluctantly adheres to the patient’s wishes. Three weeks later the patient suffers a massive, fatal stroke.

A middle-aged woman who had previously undergone successful open-heart surgery for replacement of an infected heart valve, and is on anticoagulant medication to prevent blood clots around her artificial valve, awakens one Sunday morning with a severe headache, the most severe headache she has ever had. Within a short period of time, she becomes lethargic and less responsive. Her family calls her cardiologist who suspects she has had a cerebral hemorrhage, bleeding into the brain. She is brought to the hospital by ambulance where the diagnosis is quickly confirmed. Her conditions steadily worsens and she lapses into a coma. A neurosurgeon, still in his Fellowship training, sees her and says that unless she has immediate brain surgery she will not survive. Fortunately, the Attending neurosurgeon on call is the Chief of the Neurosurgery Department, and the patient’s family is so informed and they agree to surgery; unfortunately, the surgeon cannot be reached. The doctor still in his training repeats that without immediate surgery the patient will die. A decision is made by the cardiologist and the young surgeon to proceed with the operation to be performed by the neurosurgical trainee; the family is not told of this arrangement. The surgery goes well. The patient survives. The family never learns that their loved one was saved by a doctor in training.

A retired anesthesiologist is in the operating room as a patient about to be operated on. The surgeon and operating nurses are at the operating table, and the anesthetist tells the patient he is about to be put to sleep. The patient refuses to go under and insists he must first tell a joke. The surgeon is annoyed at the delay, but the patient is adamant. He tells the joke and cracks up everybody in the OR. The surgery proceeds well but later, on awakening in the Recovery Room, the patient finds all of the operating room personnel and other staff surrounding his bed. Alarmed, he asks if there is a problem. The surgeon says, “No, we just want to hear more jokes.”

An elderly woman suffers from severe claudication, pain in the legs due to blockage of blood vessels that prevents her from walking. She requires surgery to bypass the obstructed arteries that are the cause of her distress. She fears the procedure, not because of the actual surgery but because of the necessary general anesthesia that will be administered. She knows that the drugs used can damage the brain in some cases, especially in older people, so she wants the shortest anesthesia time, which means the fastest surgery. She is told by her regular doctor that the surgeon he chose is the fastest and best surgeon for the procedure, so she agrees. She is on the operating table, having just been put to sleep by the anesthesiologist, when the surgeon, who hasn’t yet made an incision, collapses to the floor. Anesthesia is stopped, the surgeon is rushed to the Emergency Department, and the patient is returned to her room with nothing surgical having been done. She awakens quickly since anesthesia had been so brief and is amazed how quickly it went. She tells her regular doctor she is thrilled at his choice of surgeon. Then, realizing she has no incision or bandage, she extols the surgeon for his amazing prowess: incredible speed and no incisions. It takes repeated explanations to convince her that she did not have an operation. And it takes even more to convince her to do it all over again.  

My own experience as a surgical patient began when I was 13 years old. (I’m discounting ritual circumcision which, fortunately, I neither remember nor care to). I had an emergency appendectomy by a general surgeon in a small hospital. The post-operative period was painful for longer than I expected, and my scar was larger than any appendix scar I’ve ever seen. A year or so later, when I timidly asked the surgeon why my scar was so big and I still had twinges of pain in the region, he responded in his gruff voice, “I cut you wide, I cut you deep, but I cut you good!”

Bless the surgeons who help us. I always try to focus on the “good” part.