Intraoperative Reading

[Mokki]

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I'm trying to get a sense of how many people here actually read intra-op, and what you read.

FWIW, I feel guilty for doing so, even if I'm reading M&M or the latest A&A during a 12 hour ENT flap case that has been traintracking.

 

[IlDestriero]

When I'm sitting, I read the WSJ. I'm not going down like 2win.
I also read articles. Obviously not during critical parts of the case, micro preemies, etc. I also have some years of experience to both recognize changes and how to DDx and treat them quickly. The less experience you have, the harder it is to multitask in the OR. If I didn't read from time to time, I'd probably fall asleep.

 

[Idiopathic]

i believe that someone who is experienced is more likely to lose concentration or focus if they arent doing something stimulating. As long as you dont lose track of whats going on across the drapes and pay attention to the monitors, I think intraop reading is fine...im not sure how i feel about intraop facebook, though.

 

[doctor712]

Hi IlD,

What happened to 2WIN?

<When I'm sitting, I read the WSJ. I'm not going down like 2win.>

D712

 

[IlDestriero]

He got a mid 5 figure beating shorting a stock that did well. Unfortunately it was the one he used as an example of his trading habits, and how the market was going to tank. He was expecting a tidy 5 figure profit. Life goes on.
I was going to pull out and move into some international bonds, but I have not yet. It's a strange time. The fed is trying to generate inflation. It may not go as planned. Some are heavy in gold. I'm not going there. I think I missed the boat. Bubble? Probably not with the shady dollar. The shady euro is keeping the dance going.

 

[periopdoc]

You left the most obvious option out.

My preferred intraop reading.


SDN

- pod

 

[bongobingo]

This settles it. Anesthesiology is my #1 desired specialty.

 

[sevoflurane]

You left the most obvious option out.

My preferred intraop reading.


SDN

- pod

 

[cfdavid]

He got a mid 5 figure beating shorting a stock that did well. Unfortunately it was the one he used as an example of his trading habits, and how the market was going to tank. He was expecting a tidy 5 figure profit. Life goes on.
I was going to pull out and move into some international bonds, but I have not yet. It's a strange time. The fed is trying to generate inflation. It may not go as planned. Some are heavy in gold. I'm not going there. I think I missed the boat. Bubble? Probably not with the shady dollar. The shady euro is keeping the dance going.

I'd be very suprised if the Euro is around in 5 years. I really think the Germans are going to say enough is enough. They'll eventually get tired of bailing everyone out and demand the Mark back..... We'll see.

Interesting times.

In terms of hedging against a weak dollar, and the precious metals arguement, it seems to be taking on more of a life of it's own versus JUST as a weak dollar hedge. The interest in precious metals comes from GLOBAL investors hedging against risk of all kinds. Wealthy Europeans skeptical of their own currency (forget about the dollar for a moment) are going to put their money somewhere. I think this is happening across the globe....... There will be pullbacks, however.

 

[doctor712]

Sevo,
Thought about u tuis morning as I'm mid-flight
Right now and there was an add for a cool looking splitboard.
Can't post the photo on slow wifi but it's
Voile-USA.com
Voile mojo rx. 895$.
Now is your cue to snap a photo of it with your dog sitting
alongside. 🙂. This one is orange. Tons of ski ads
In flight mag this time of year. But no skiing in NYC where I'm headed.
D712

 

[sevoflurane]

.

 

[Gimlet]

I had never envisioned myself as someone who would read in the OR -- at least not during CA-1 year -- but early this year I had an attending whose fund of knowledge is fairly impressive in comparison to other attendings tell me, "Oh no, you HAVE to read during your long cases...you'd be doing yourself a disservice not to." Since then, I don't feel too bad about it. I print out chapters of Big Miller...takes me about 3-4 days to get through a chapter depending on my cases because the reading is so fractured with paying attention to the case going on, but I think it's been worth it.

 

[Southpaw]

I had never envisioned myself as someone who would read in the OR -- at least not during CA-1 year -- but early this year I had an attending whose fund of knowledge is fairly impressive in comparison to other attendings tell me, "Oh no, you HAVE to read during your long cases...you'd be doing yourself a disservice not to." Since then, I don't feel too bad about it. I print out chapters of Big Miller...takes me about 3-4 days to get through a chapter depending on my cases because the reading is so fractured with paying attention to the case going on, but I think it's been worth it.

Agreed..and I do the same thing. 👍

 

[jwk]

Debates about whether it's acceptable or unacceptable clinical behavior aside, if something bad happens rest assured that everyone else in the room will be aware that you were reading/surfing/doing crosswords during the case, and even an untalented trial lawyer will burn you for it.

 

[fabfive5]

The more experienced you are the more you can SAFELY read...doesn't matter what it is (to a degree)

Stay away from Gold-heavy bonds/funds! (unless you bought them 5 years ago)

 

[silvester78]

When I do "easy" cases (such as arthroscopies under SAB, or surgeries under regional generaly) I print and read reviews from journals.
If I have long, but probably unpredictable cases, I prefer to read Q & A or case based books (such as secrets, yao etc), or "oxford Handbook" just to refresh my memory. After each question I give a visual "scanning" all around (monitors, ventilator, patient, surgeons, suctions etc), and every now and then stand up and inspect the surgical field.
No surfing, no sudokus, no newspapers. Only things associated with anesthesia.
And of course the beep of the pulse oximeter is high enough and no alarm is off!

 

[IlDestriero]

Debates about whether it's acceptable or unacceptable clinical behavior aside, if something bad happens rest assured that everyone else in the room will be aware that you were reading/surfing/doing crosswords during the case, and even an untalented trial lawyer will burn you for it.

I would disagree. It's definitely not that black and white. There has to be causation.

 

[pgg]

And of course the beep of the pulse oximeter is high enough and no alarm is off!

One of the guys (MD) I occasionally work with sets the monitors to CPB mode (alarms all disabled) while he reads his Kindle.

My all time favorite is still the senior CRNA at my residency program who would play minesweeper with the automated anesthesia record minimized.

 

[Bertelman]

My all time favorite is still the senior CRNA at my residency program who would play minesweeper with the automated anesthesia record minimized.

I'm most disappointed he chose minesweeper. If you're going out, make it worth your while. Angry Birds, maybe.

Seriously, I'm more likely to fall asleep playing minesweeper than diligently staring at the monitor charting q5min vitals q5min. That game sucked in 1995, and it still sucks in 2010.

 

[Bertelman]

I had never envisioned myself as someone who would read in the OR -- at least not during CA-1 year --

What did you really think you were going to do? Stare into space?

 

[doctor712]

I'm most disappointed he chose minesweeper. If you're going out, make it worth your while. Angry Birds, maybe.

Seriously, I'm more likely to fall asleep playing minesweeper than diligently staring at the monitor charting q5min vitals q5min. That game sucked in 1995, and it still sucks in 2010.

 

[Impromptu]

We are not allowed to read during cases. My feeling is the program wants us to look as professional as possible (wear white coats outside of OR area, even when going to get lunch), so that we have more pull and power when performing political maneuvers with the surgery services or dealing with the hospital administration. There might be some patient safety issue, too.

 

[pgg]

I'm most disappointed he chose minesweeper. If you're going out, make it worth your while. Angry Birds, maybe.

Yeah, she was a clown.

Other highlights (some alleged, some witnessed): reading romance novels intraop, performing epidural steroid injections on friends in her kitchen, getting caught stealing supplies & equipment from our hospital after taking a job at another place, rearranging EKG leads on a patient to make the ST depression go away.

 

[Mokki]

Oh my god. Were the ST depressions real (i.e, really ischemia/mi?)

...rearranging EKG leads on a patient to make the ST depression go away.

 

[pgg]

Oh my god. Were the ST depressions real (i.e, really ischemia/mi?)

Real enough to go away after some esmolol fixed the also-real tachycardia ...

 

[jwk]

I would disagree. It's definitely not that black and white. There has to be causation.

Dr. I, immediately preceeding the patient's unexpected cardiac arrest, what were you doing?

Watching the vital signs as I always do.

Hmm, Dr. I, Nurse J and Tech K, as well as Dr. L, the Surgeon have already given testimony that shortly prior to the incident in question, you were engrossed in the day's New York Time crossword puzzle. Is that correct?

I don't know, I might have, but I doubt it.

Dr. I, all three of these individuals additionally stated that it is quite the norm for you to be doing crossword puzzles and reading the paper while doing your cases. Is that correct?

Well, uh yes, but it doesn't distract me from caring for my patient.

I see - how long a period of time do you think you don't look at your patient or the monitors while doing your crossword puzzles?

I don't know - 30 seconds, a minute maybe.
I see, and how long before the patient's heart stops will it take before your monitor indicates there is a problem?

Usually there is a 30 second delay.

I see. So, by your own testimony, the patient's heart could have stopped for at least 30 seconds before you noticed it, is that correct?


Doesn't play too well, does it?

 

[silvester78]

reading romance novels intraop...

When I was in residency (I finished approx. two years ago), I had a consultant who kept her 500 plus pages novels in the machine's drawer (together with BP cuffs)!!! As soon as the surgeon started the case, she sat on the chair, put her glasses on, took the book off and started reading!!! And the resident took over the case!!! (oh, she also stopped every 5min, to write down the notes!!!)
The three months I spent with her, she told me nothing about anesthesia, she finished more than 10 novels but I had a great time. she had an excellent sence of humor and she was a very good person!!!

 

[doctor712]

When I was in residency (I finished approx. two years ago), I had a consultant who kept her 500 plus pages novels in the machine's drawer (together with BP cuffs)!!! As soon as the surgeon started the case, she sat on the chair, put her glasses on, took the book off and started reading!!! And the resident took over the case!!! (oh, she also stopped every 5min, to write down the notes!!!)
The three months I spent with her, she told me nothing about anesthesia, she finished more than 10 novels but I had a great time. she had an excellent sence of humor and she was a very good person!!!

No offense to any intraop readers, especially those who read romance novels during cases with a resident nearby, but if I'm earning $52K a year in CA-1 to transition from being a harm to a human being as an MD, to a competent perioperative specialist, I'll be damned if i let that doc drag my as$ down for more time than it takes to realize it's her norm. I'd walk straight into the PDs office and ask to get switched to an attending that gives a crap about teaching me something. there are shades of "teaching" gray. but this is nowhere in the mix. i'd have no time for that. i'd rather speak up to that attending first, get her annoyed, have her pimp me to death for the rotation, than spend a day learning zilch and watching her read romance novels and teaching me nothing. call me crazy and reactionary. i've seen amazing and lazy docs and all in between, but teaching is teaching during cases of anesthesia residency. 👎 hell, the PD down here who i work for has taken me and the resident aside to use the whiteboard and show some basic gas laws, so you could, say, calculate how much nitrous is in the bottle if you had no other way of knowing. you know, avogadro, moles, liters>grams>moles and such. that's my level. that's not lazy. this woman would make my blood boil. as a student, i feel that, and perhaps only that for the next 8 years, is my sole right. teach me. i know i'll get a few reality checks along the way, i can see this already in different academics, i'll learn to handle accordingly. but 3 months of wasted time ain't gonna happen if i can help it.

D712

 

[silvester78]

but 3 months of wasted time ain't gonna happen if i can help it.

First, I should clarify that I live and work in europe. And the relationships among residents and consultants in that hospital weren't so much under strict directions. In the hospital I spent "those" months (with the consultant having most , almost the sole responsibility for the case) the consultant didn't have much obligation to teach us. It was upon his/ her mood to do so.
Nevertheless, I don't think that three months with full time neurosurgical program, up to 80 hours every week spent in hospital (OR, ER, pre op and post op visits) are waste of time. Every day I studied for the next day cases, search for the same day problems that arised, asked other consultants and participated in two to three scheduled cases every day. Not so bad...
I have very pleasant memories from those three months...
And I always have a good word to say about that consultant, who kept her novels in the drawer!!!