What happens if a surgeon becomes ill in the middle of surgery?

PostLessOne said:

Suppose a private practice attending is doing a case, and he or she gets an attack of stomach cramps or diarrhea right in the middle of it. Or some other distracting, somewhat incapacitating illness. What happens? Who takes over? I know that in private practice often there's only one qualified surgeon in the room without any residents available.

Or, what does a surgeon do if he or she catches the flu? I've heard that many practices are pretty busy, so extra personal to cover for the ill ones aren't always available. I'd imagine it would be pretty difficult to do a case if one had the headache and achy joints from the flu and were constantly coughing and sneezing.

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Well, if you're holding pressure on a dime-size hole in the aorta that you perforated with the scope during a re-do lap Nissen, then that diarrhea you feel will probably be kept inside by your contracted, quivering sphincter.

In a less chaotic case, you try and tough it out until you're finished. There are tons of scenarios that could play out. It's all case-specific.

As for the flu: surgeons aren't machines and medicine is still a business. You can always cancel your cases if you're absolutely unable to operate. You also run the risk of infecting your patients and/or ancillary healthcare staff. If you just need a day to recuperate and you've only got a few cases booked, you can always ask your partner(s) if they will pick up your cases. Unless they all hate you, it's usually a pretty sure bet that they'll help you out.

Capiche?

Can't say that I've ever had an attack of "stomach cramps" or diarrhea whilst scrubbed that required me to leave. Migraines are my problem but have never left a case or cancelled a case because of them.

As noted above, it depends on what you're doing. Once my nose was running really bad and I scrubbed out while waiting for a call back on my frozen section, blew my nose and then regloved and gowned. But I'm not holding pressure on the aorta.

Basically the only time its acceptable to leave is if you yourself are in worse shape than the patient - ie, having an intraoperative heart attack or stroke and even then you better get someone in to either finish the case and/or close the wound.

BTW, in PP you often have a paid assist who can do the closing if you suddenly feel the urge to die in the middle of the case.

Similar (but not the same) - knew one doc in the ED who went into VF arrest in the ED (resuscitated successfully, nice briefly, then went back to the ******* he is), and had another colleague who got the call during the shift and said, "They're coding my daughter!"

Winged Scapula said:

BTW, in PP you often have a paid assist who can do the closing if you suddenly feel the urge to die in the middle of the case.

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Not to mention that with the very rare exception of exsanguinating hemorrhage, most patients could be kept alive just fine by the anesthesiologist for hours until a new surgeon could be lined up.

Friend had a surgeon have an MI intraop.


Nurses were screaming: " place the monitors on Dr. X, take them off the pt!"

anesthesiology resident response: " uh...no. Call for help ".

Heard of another case where a surgeon @ Vanderbilt got sick, had an IV placed for fluid. Surgeon was a known jerk, and stood at the head of the table, unscrubbed, berating his residents. Time for muscle relaxant, resident placed it in the wrong IV (by accident). This went unnoticed, even when the surgeon collapsed, which was attributed to his dehydrated state. Eventually, he was intubated, without any other rx, by the anesthesiology resident. Everything turned out OK, but what a story!

I was told at Duke that recently one of the surgeons was being hospitalized for a diverticulitis flare and had a perc drain placed. While an inpatient, he went down to the OR and operated on one of his patients who needed a colectomy for diverticulitis.

One of my attendings comes from a long line of surgeons. His grandfather had frequent angina, so he would pack some nitro inside chewing gum and place it under his upper lip before a case. If he developed any chest pain, he would just moblize one of the pills and keep operating.

I guess the bottom line is get your foley in and your IV ready and cowboy up.

All for now, go back to your ham calzone.
I am the Great Saphenous!!!

When our prior plastics attending was here and doing free flaps that lasted 12-15 hrs she would routinely scrub out at least once or twice to eat something and go to the bathroom. Sometimes breaks were timed so the the resident could still be there doing something useful (then they would get a break later), but sometimes nature would call at a point where things basically where just on hold for a few minutes. Not the end of the world and I imagine most things could be handled in a similar fashion (get to a pausing point then go have diarrhea).

We only have one neurosurgeon right now so there are times when he is on for weeks at a time (until the next locum gives him a few days off). I have seen him cancel a big spine case after being up doing crani's the night before. He tells the patient he is sorry for the inconvenience, but that if he were the patient he wouldn't want him operating under those circumstances. I have yet to see a patient have a real problem with it. Then again we are the county hospital so it's not like they have a ton of options.

dpmd said:

When our prior plastics attending was here and doing free flaps that lasted 12-15 hrs she would routinely scrub out at least once or twice to eat something and go to the bathroom. Sometimes breaks were timed so the the resident could still be there doing something useful (then they would get a break later), but sometimes nature would call at a point where things basically where just on hold for a few minutes. Not the end of the world and I imagine most things could be handled in a similar fashion (get to a pausing point then go have diarrhea).

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It was like that at Duke with the transplants. I recall one evening seeing one of the attendings getting an armload of carb stuff in the cafeteria; she still had the imprints of the gloves on her arms. She was loading up for the residents and fellows in the OR, and going back - and she couldn't be happier.

GreatSaphenous said:

One of my attendings comes from a long line of surgeons. His grandfather had frequent angina, so he would pack some nitro inside chewing gum and place it under his upper lip before a case. If he developed any chest pain, he would just moblize one of the pills and keep operating.

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This is representative of the type of machismo surgical culture which weirdly generates part of my excitement about the prospect of becoming a surgeon.

i once did a difficult b/l neck dissection from 9am to 5pm. during the middle o the case attending scrubbed out to grab a peanut butter sandwich, then chief resident scrubbed out to pee. no one asked me(the intern) to take a break or ask for a scrub relief....

njbmd said:

Someone has to "ask" you if you want to take a break? You were gagged during this case or your mouth and hands don't work at the same time?

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He's an intern. Many interns I know wouldn't dare ask if they could take a break for fear of reprisals.

I agree. Would have been good if someone had told the intern to break at a certain point (takes a while to get over the **** eating student attitude where you don't want to look weak)

yeah you are right, it was my second month of internship and i was afraid to ask for a break.

For curiosity's sake, what would be the proper way for an intern to ask for a break if the attending or resident scrubs out on a long case? Would you wait for everyone to take their breaks and then ask to take your break? On a separate note, would it be unacceptable for an intern to simply break scrub and declare, "I'll be right back"?

Depends on the situation. For something urgent and you aren't doing something at the time, a simple "excuse me, I'll be right back" would suffice (I would probable say I'm sorry too, but that is because I am lame). If you are doing something, you have to ask someone to take over first of course. If it is just that you need a break, I guess you could just ask but I haven't done it before (always been told to go, sometimes given a choice of when).

I have had to ask someone to take over so I wouldn't pass out, and I am always super embarrassed. Once I asked to go because there was a convenient time for it and it was soon going to be evident I had started my period (sorry boys). If I were in charge I would understand if something like that is going on (or just really needing to pee or take a dump), but if you just want a snack and some rest time (and I haven't had that yet) I am probably going to think less of you for asking. I will avoid long cases when possible, but if I do them I like how our prior plastic surgeon did it(explained ahead of time how many breaks she wanted us to take and emphasized that we would both be eating at least once).

I'll be the girl who says it. Yep once I had cramps so bad I thought I had a perfed appy. It was very unusual for me. Had to take a bowel perf to the OR during this episode. Adrenaline must work as a pain killer in some way, because during the case my pain was muted, but present. Plus the 30 of toradol that my cute anesthesia friend gave me prior to the case prolly kicked in, too.

Granted, I don't think it's the scenario the OP was shooting for, but since we're sittin' around the campfire telling stories...

Ah, you are all weak. I've operated on numerous cases lasting anywhere from 8 to 14 hours before...with my longest one ever being 19 hours. No breaks! (Of course I was also very aware of the fact that taking a break would be considered a sign of weakness.)

I've been in many, many, many long (10+ hr) cases where breaks were expected and scheduled. The attending smiles, like they're devilishly clever, and says "we're all going into renal failure... time for a break!" and then goes to do lines of coke in the recovery room or something.

And a good number of pregnant residents/attendings take pee breaks when they're near to term... like qh pee breaks.