Y!IFMBA - Surgery Style

Q-Optics, surgical ergonomics - redefined
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I love the attendings who are on the tail end of their career and just say the darndest things.
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I imagine him doing that without thinking on guys, but realizing that with a woman the situation is a wee bit different.

My attending was telling me a story about the first transplant she scrubbed as a fellow and her staff asking her if she had underwear on. He then proceeded to tell her that he didn't. She had no idea what to say and didn't know if he was hitting on her or what. Then during the case when the blood soaked into and ruined her pricey underwear, she understood. It was an amusing story until she then said that she didn't wear underwear for the rest of fellowship :eek:
 
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dpmd said:
I imagine him doing that without thinking on guys, but realizing that with a woman the situation is a wee bit different.

My attending was telling me a story about the first transplant she scrubbed as a fellow and her staff asking her if she had underwear on. He then proceeded to tell her that he didn't. She had no idea what to say and didn't know if he was hitting on her or what. Then during the case when the blood soaked into and ruined her pricey underwear, she understood. It was an amusing story until she then said that she didn't wear underwear for the rest of fellowship :eek:
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My favorite technique to avoid this was to place a piece of adhesive dressing (10-10 drape or ioban) across my torso...made the OR gown a little more waterproof. Still, not a perfect technique.
 
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Ooooh, I like that idea. I might try that next case that I expect lots of fluids to be spilled. Do you put it on the gown itself, or on your clothes underneath?
 
dpmd said:
I imagine him doing that without thinking on guys, but realizing that with a woman the situation is a wee bit different.

My attending was telling me a story about the first transplant she scrubbed as a fellow and her staff asking her if she had underwear on. He then proceeded to tell her that he didn't. She had no idea what to say and didn't know if he was hitting on her or what. Then during the case when the blood soaked into and ruined her pricey underwear, she understood. It was an amusing story until she then said that she didn't wear underwear for the rest of fellowship :eek:
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Ugh, that's gross. I'm not particularly paranoid about some blood splatter on my scrubs/skin, as long it's not into my eyes, but I did get pretty skittish when I got some Hep C blood on my shoe. I have to imagine the Hep C titers are higher in the transplant population than most other patient populations.
 
You know, vascular surgery would be great if it were just:

1. Fem-pop
2. Fem-clot
3. Fem-chop

The latest iteration for me is:

1. Something-something bypass at Outside Hospital
2. Fem-chop x1
3. Me having to intubate the pt at midnight in June
4. Got sort of better, saw the pt in clinic a few times over the ensuing months
5. Fem-clot
6. tPA
7. Fem-clot
8. Ax-fem + additional shenanigans for an entire day of weekend fun a while back.
9. Fem-clot
10. tPA
11. Holy hemorrhagic stroke
12. At least this time at midnight, the pt was already intubated

This probably won't end well.
 
TheProwler said:
You know, vascular surgery would be great if it were just:

1. Fem-pop
2. Fem-clot
3. Fem-chop

The latest iteration for me is:

1. Something-something bypass at Outside Hospital
2. Fem-chop x1
3. Me having to intubate the pt at midnight in June
4. Got sort of better, saw the pt in clinic a few times over the ensuing months
5. Fem-clot
6. tPA
7. Fem-clot
8. Ax-fem + additional shenanigans for an entire day of weekend fun a while back.
9. Fem-clot
10. tPA
11. Holy hemorrhagic stroke
12. At least this time at midnight, the pt was already intubated

This probably won't end well.
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I think vascular would be great if it were just carotids. Between the rotting feet and patients dropping like flies, I think there is plenty to dislike.


Marilyn Monroe is on the cover of vanity fair this month.....and I'm having a hard time giving a ****. Is anyone else not mesmerized by this person? Seems like she was kind of crazy....and addicted to drugs that killed her, like many many other famous people. So she was in a bunch of movies......so was pauly shore. Slept with powerful men.....doesn't sound like an exclusive club to me. I read playboy (for the articles....ladies) and I still don't get it.

Is there something obvious I'm missing?
 
Thanatos said:
Marilyn Monroe is on the cover of vanity fair this month.....and I'm having a hard time giving a ****. Is anyone else not mesmerized by this person? Seems like she was kind of crazy....and addicted to drugs that killed her, like many many other famous people. So she was in a bunch of movies......so was pauly shore. Slept with powerful men.....doesn't sound like an exclusive club to me. I read playboy (for the articles....ladies) and I still don't get it.

Is there something obvious I'm missing?
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She had a charisma that really worked, and had some nice jugs on her. Show me a pretty girl with a brain and not completely insane (ugh - rhyme was unintentional), and there's your belle of the ball.
 
Bumpin this, we need some discussion.

Certainly not everyone is working too hard/switched to decaf/stopped (or started) drinking.

Last month I had one PA student outshine, out work, and completely outclass my 4 medical students (combined). I wrote her an outstanding evaluation, but it bothers me that the pre-MD's couldn't hold their own.


In more amusing news, last week I got a call from one of those ubiquitous outside hospitals wanting to transfer a patient with free air from a presumed perforated DU. My attending refused the transfer on the grounds that this particular outside hospital had surgeons available (that he knew) and that, you know, they should just kind of handle this...soon. So they did what any normal outside hospital would do: they called our medical ICU for transfer of a "complex" patient and just neglected to mention that the surgery service had previously refused. My friends in the MICU accepted the transfer, stuck the patient in a bed and then promptly consulted us for management of "pneumoperitoneum." The best part is they called again 2 hours later complaining that the patient shouldn't be on their service because there were no "medical" issues. Somewhere my attending is still yelling at someone.....but at least its not me
 
Thanatos said:
In more amusing news, last week I got a call from one of those ubiquitous outside hospitals wanting to transfer a patient with free air from a presumed perforated DU. My attending refused the transfer on the grounds that this particular outside hospital had surgeons available (that he knew) and that, you know, they should just kind of handle this...soon. So they did what any normal outside hospital would do: they called our medical ICU for transfer of a "complex" patient and just neglected to mention that the surgery service had previously refused. My friends in the MICU accepted the transfer, stuck the patient in a bed and then promptly consulted us for management of "pneumoperitoneum." The best part is they called again 2 hours later complaining that the patient shouldn't be on their service because there were no "medical" issues. Somewhere my attending is still yelling at someone.....but at least its not me
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Let me guess...it was around 4:30p on a Friday.

Fortunately our hospital system has a centralized transfer line--precisely to avoid those kind of bush-league moves. That being said, the word from on high is that you aren't allowed to decline any patient...ever.
 
Thanatos said:
Last month I had one PA student outshine, out work, and completely outclass my 4 medical students (combined). I wrote her an outstanding evaluation, but it bothers me that the pre-MD's couldn't hold their own.
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Happens more often than I'd like. Some of them are excellent.


FaytlND said:
Let me guess...it was around 4:30p on a Friday.

Fortunately our hospital system has a centralized transfer line--precisely to avoid those kind of bush-league moves. That being said, the word from on high is that you aren't allowed to decline any patient...ever.
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Obviously I don't know your hospital's policy, but my guess is that they can't turn down any appropriate transfers. In that case, you should be able to block a Friday afternoon transfer for appendicitis. If it's even bordering on legitimate, then you're probably just stuck.
 
Thanatos said:
Last month I had one PA student outshine, out work, and completely outclass my 4 medical students (combined). I wrote her an outstanding evaluation, but it bothers me that the pre-MD's couldn't hold their own.
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what did the PA student do so right that the med students didn't do?
 
TheProwler said:
Obviously I don't know your hospital's policy, but my guess is that they can't turn down any appropriate transfers. In that case, you should be able to block a Friday afternoon transfer for appendicitis. If it's even bordering on legitimate, then you're probably just stuck.
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That's what I'm saying: there isn't anything inappropriate. That's the company line. I know attendings who have tried it, and they get called into the principle's office. Much of it has to do with referral patterns and a particularly ugly competition between our health system and the other big one in town.
 
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TheProwler said:
Happens more often than I'd like. Some of them are excellent.



Obviously I don't know your hospital's policy, but my guess is that they can't turn down any appropriate transfers. In that case, you should be able to block a Friday afternoon transfer for appendicitis. If it's even bordering on legitimate, then you're probably just stuck.
Click to expand...

FaytlND said:
Let me guess...it was around 4:30p on a Friday.

Fortunately our hospital system has a centralized transfer line--precisely to avoid those kind of bush-league moves. That being said, the word from on high is that you aren't allowed to decline any patient...ever.
Click to expand...

We are allowed to decline we just very rarely do that. In this case my attending declined on the grounds that this person needed to go to the OR sooner than the 12 hours it would take to transfer and they have these services available, so why transfer?

armybound said:
what did the PA student do so right that the med students didn't do?
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Better prepared for cases, volunteered to do every late/emergency case (while my med students were always conspicuously absent when the 5pm case was about to go), answered more pimp questions correctly, came in earlier, stayed later, gave better presentations, did not complain constantly. Adapted faster, helped on rounds, did not complain constantly (worth mentioning twice). It wasn't even close.
 
INSPIRIS
Inspired Care for the Frail Elderly


Yep, that's what I want to see on the FAX cover sheet for a new patient referral.

She isn't just 93 yo, she's frail. (Its not like 93 is that old *out here* I just like the name of the facility; while here 97 is my oldest so far.)

Its from the Dermatologist next door who was ruling out Mycosis Fungoides vs Amelanotic Melanoma.
 
Lee: Bit-o-trivia -- when they were writing the pilot for Scrubs, the writers posted on SDN looking for funny stories. There's the belief that "Dr. Cox" is named after our own "Dr. Kimberli Cox".


BULL S HITE
 
Consigliere said:
Lee: Bit-o-trivia -- when they were writing the pilot for Scrubs, the writers posted on SDN looking for funny stories. There's the belief that "Dr. Cox" is named after our own "Dr. Kimberli Cox".


BULL S HITE
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Nope. The story about a Scrubs writer posting here is true. I doubt that I was the source of the character's name (at the time I used my real name as my user name), but it became popular SDN Lore...and not started by me.
 
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Winged Scapula said:
INSPIRIS
Inspired Care for the Frail Elderly


Yep, that's what I want to see on the FAX cover sheet for a new patient referral.

She isn't just 93 yo, she's frail. (Its not like 93 is that old *out here* I just like the name of the facility; while here 97 is my oldest so far.)

Its from the Dermatologist next door who was ruling out Mycosis Fungoides vs Amelanotic Melanoma.
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I had a 102 yo woman referred to me for gallbladder problems after a surgeon in a nearby town said she was too high risk to have surgery. She and her 80 yo daughter were not with it enough to answer whether she was even symptomatic. I concurred with the other surgeon. :laugh:
 
Consigliere said:
Lee: Bit-o-trivia -- when they were writing the pilot for Scrubs, the writers posted on SDN looking for funny stories. There's the belief that "Dr. Cox" is named after our own "Dr. Kimberli Cox".


BULL S HITE
Click to expand...
Thank you for your enlightening and uninformed opinion on this matter.
 
Smurfette said:
I had a 102 yo woman referred to me for gallbladder problems after a surgeon in a nearby town said she was too high risk to have surgery. She and her 80 yo daughter were not with it enough to answer whether she was even symptomatic. I concurred with the other surgeon. :laugh:
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Thats always a good sign, when they both come in totally out of it! Good for you for saying no though, these never seem to end well. The worst prognostic indicator for me is when the family drops them off in preop with a suitcase and then goes on vacation (true story).

I wish I worked for people with the cojones to say no in more of these situations.....we would have done that gallbladder and then stuck them in the ICU for a month and marveled about how they won't come off the vent, the creatinine keeps rising, etc....
 
Thanatos said:
Thats always a good sign, when they both come in totally out of it! Good for you for saying no though, these never seem to end well. The worst prognostic indicator for me is when the family drops them off in preop with a suitcase and then goes on vacation (true story).

I wish I worked for people with the cojones to say no in more of these situations.....we would have done that gallbladder and then stuck them in the ICU for a month and marveled about how they won't come off the vent, the creatinine keeps rising, etc....
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Most of the time, our staff are pretty good about talking marginal/non-operative patients out of an elective operation, especially if they're minimally symptomatic.

We end up in ugly situations when something gets transferred from Outside Hospital after they did something they shouldn't, or when someone who has a tenuous grasp on life shows up with free air.
 
Smurfette said:
I had a 102 yo woman referred to me for gallbladder problems after a surgeon in a nearby town said she was too high risk to have surgery. She and her 80 yo daughter were not with it enough to answer whether she was even symptomatic. I concurred with the other surgeon. :laugh:
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:laugh:

I get a lot of these super elderly with fungating, locally advanced cancers. I enjoy them since it tends to be an easy consult in most cases, although there was one 95 yo, when I suggested we consider neoadjuvant endocrine therapy yelled, "My mother lived to be 109, we're not leaving this cancer in me!"

She's done well and the Arimidex has dried up that ugly thing, with no clinical or radiographic evidence of progression although she still talks about having surgery. I've managed to waive her away for a couple of years now.
 
Thanatos said:
Last month I had one PA student outshine, out work, and completely outclass my 4 medical students (combined). I wrote her an outstanding evaluation, but it bothers me that the pre-MD's couldn't hold their own.
Click to expand...

I see this frequently. It's a different story once the two groups graduate though. Somehow the med students get their act together later on.
 
any advice for dealing with making mistakes? I expect to make some mistakes, not be able to get a line, underestimate how sick someone is, etc until I get more experience, but I really, really beat myself up over it. I feel like I should be upset about it because it helps me avoid the mistake again in the future, but I'm not sure if I should get so down on myself for it.
 
filter07 said:
I see this frequently. It's a different story once the two groups graduate though. Somehow the med students get their act together later on.
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I think he got charmed by her PA friendly face, as Freud said, Eros and Thanatos.
 
I'm already here in Vegas...


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:p let's find some time to meet!


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Winged Scapula said:
Well the "ladies" and @surg (he's no lady) enjoyed it. A lot more clinical than in past years, typical cold conference rooms, the requisite Silverstein vs Dixon sparring, good weather and great shoes!

When's the Bahamas?
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Sounds amazing!

Bahamas is the second week of June... Holding my breath my passport arrives in time!
 
ImageUploadedBySDN Mobile1423959170.640337.jpg


Happy VDay every one!
 
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Questions for all the non-plastics/ENT people out there:

Why don't you have Adson-Browns in your case carts? Sometimes I'm closing up some thin-skinned 98yo lady and the regular old toothed Adsons can really macerate the skin edges. My love of Adson-Browns is only eclipsed by my hate of toothed Adsons that don't have the textured area just inside the teeth, making grasping your needle impossible.

PN0823_detail.jpg
 
VisionaryTics said:
Questions for all the non-plastics/ENT people out there:

Why don't you have Adson-Browns in your case carts? Sometimes I'm closing up some thin-skinned 98yo lady and the regular old toothed Adsons can really macerate the skin edges. My love of Adson-Browns is only eclipsed by my hate of toothed Adsons that don't have the textured area just inside the teeth, making grasping your needle impossible.

PN0823_detail.jpg
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I hate those non textured adsons with a passion that knows no bounds. It is only with the utmost restraint that i don't throw them across the room if someone hands them to me. Seriously, why do they even have them?
 
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VisionaryTics said:
Questions for all the non-plastics/ENT people out there:

Why don't you have Adson-Browns in your case carts? Sometimes I'm closing up some thin-skinned 98yo lady and the regular old toothed Adsons can really macerate the skin edges. My love of Adson-Browns is only eclipsed by my hate of toothed Adsons that don't have the textured area just inside the teeth, making grasping your needle impossible.

PN0823_detail.jpg
Click to expand...
That's exactly why I DO have these on my case cards.
 
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New instrument of evil:

Uninsulated bipolar cautery. Like, the entire length is uninsulated. All metal. The entire thing conducts electricity. 7 inches of malevolent flame.

Why does this instrument exist?

Our peds hospital does not stock insulated bipolars. Whenever we operate there, I need to steal a supply from main OR.
 
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VisionaryTics said:
New instrument of evil:

Uninsulated bipolar cautery. Like, the entire length is uninsulated. All metal. The entire thing conducts electricity. 7 inches of malevolent flame.

Why does this instrument exist?

Our peds hospital does not stock insulated bipolars. Whenever we operate there, I need to steal a supply from main OR.
Click to expand...
Seriously. I've actually seen flames inside the breast with these things.

One of my plastic surgeons refuses to use the insulated ones, telling the staff that she's not "scared" of the Bovie like I am. :rolleyes:
One of these days when she gives someone a PTx or the field catches on fire, I'll be scared then.
 
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Winged Scapula said:
Seriously. I've actually seen flames inside the breast with these things.

One of my plastic surgeons refuses to use the insulated ones, telling the staff that she's not "scared" of the Bovie like I am. :rolleyes:
One of these days when she gives someone a PTx or the field catches on fire, I'll be scared then.
Click to expand...

Oh god. I can't even picture what an uninsulated bipolar looks like. We don't even use uninsulated bovies....
 
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On a long and lonesome hallway
East of the O.R.
You can listen to the Attending
Moanin' about his one long lost love
You can think about the woman
Who gladly left you the night before

But your thoughts will soon be wandering
The way they always do
When you've been on call 16 hours
And there's 20 more to do
And you don't feel much like roundin'
You just wish the call was through

See here I am
On call again
There I am
Up on the stage
Here I go
Playin' the heavy again
There I go
Answer the page

Well you walk into the E.R.
Strung out from another page
And you feel their eyes upon you
As you're shakin' off the hatred
You pretend another admission doesn't bother you
But you just want to explode

Most times you can avoid admitting them
Other times you can't
All the same old cliches,
"Does that belly pain need a CT scan?"
And you always seem outnumbered
You don't dare take a chance

Here I am
On call again
There I am
Up on the stage
Here I go
Playin' the heavy again
There I go
Answer the page

Out there in the O.R. spotlight
You're a million miles away
Every ounce of pent up rage
You try to contain
But it pours out your body
When another consult comes your way

Later in the evening
As you lie awake in the call room bed
With the echoes from the Attending yelling
Still ringin' in your head
You smoke the day's last cigarette
Rememberin' all the regret

Ah, here I am
On call again
There I am
Up on the stage
Here I go
Playin' the heavy again
There I go
Answer the page

Ah, here I am
On call again
There I am
Up on the stage
Here I go
Playin' the heavy again
There I go
Answer the page...
 
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