Special Request from VIP's

[Noyac]

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I received a call from the CFO of my hospital asking me to do the anesthesia for his 2 yo daughter's surgery. What is different about this request was that after the conversation in which I said I would be happy to do this, he asked me if these types of cases made me nervous. I didn't really understand what he meant but what he was getting at was if treating VIP's and their family members made me uneasy. Well, they don't but I do remember a time when they may have. I remember being nervous doing an awake fiberoptic intubation on the CEO of my hospital my first or second year out of residency for a cervical fx with neurologic impairment. But they don't bother me any longer. So I was wondering, when does this change for most folks? For me it must have changed with experience. Of coarse, the case does have something to d with it. If it is a case that you haven't done in awhile or have not done many of, this may be nerve racking as well.

What about the rest of you?

 

[militarymd]

As Chief of my department, I get a lot of requests. CEO, his wife, CNO's husband, chief of surgery's daughter, etc.....

I always get nervous, and I hate doing them.

I feel that I can only look bad doing these cases. They ask you because they think you're the best and expect things to go perfectly....and when things don't go well, and they will occasionally, you just look bad....or at least that's how I feel....

I recently did a state senator's wife's epidural...skinny, perfectly healthy lady....her block was a little higher on once side....after I struggled a little....this is immediately followed by a perfect slam dunk in a 240 kg non-insured patient.

 

[Noyac]

Absolutely right Mil.

Its the opposite of your sicker than **** pt were you can't lose. If the pt dies then thats what was expected and if the pt does well then your the hero.

But I do see it a little differently. If and when the case goes well then it does reinforce their opinion of your skills even though the outcome was expected. These folks request you for a reason and you can verify their beliefs (whether right or wrong) that you are the best at the time (even though we know that the others can do the case just fine as well). I used to think, " let the other guy do these cases." I don't think this way any longer. These cases can also boost your standing in the group, hosp committees, negotiations, etc. They can also hurt you if things don't go so well as you can imagine.

So there are many ways to look at it.

 

[militarymd]

I always do them...even post call...

but I am more wary of the "consequences" if things aren't "perfect".

 

[Planktonmd]

I truly think that when one is treated as a VIP one ends up getting inferior care compared to the average (non VIP) patient.

 

[jetproppilot]

I truly think that when one is treated as a VIP one ends up getting inferior care compared to the average (non VIP) patient.

Whats unfortunate for these people that put in special requests is they don't understand how it puts people "on edge". At least it does me.

I agree with you guys.....I don't like doing them.

At 1st gig where I was for eight years we all got our fair share since it was a small town...I stopped coming in post-call/days off for special requests, as did most of my partners. We were all good so we'd defer to each other & tell the requestor "I'm not gonna be there but my partner Dr X will take care of you. I've spoken to him and he is expecting you."

Life is too short to waste days off at the hospital. And it wasnt like I was robbing special request patient of anything since my partners were just as good if not better than me.

 

[jwk]

Quite a while back, we had one of the wives of a local professional athlete come through for a routine delivery. Lets just say her epidural was less than stellar. Of course this athlete was then interviewed for one of the 11pm local news shows, and they asked how his wife was doing, and he said, "everything was great except her epidural didn't work too good". Ouch!

 

[coprolalia]

I got the "luck of the draw" one time. Chief of Cardiology for an EUA, who'd requested one of our "name brand" anesthesiologists. Guess who got to do the case? Yours truly. I suffered the most serious case of ball sweat and sphincter pucker only rivaled by the time I was in the fourth grade running for class president and was required to give a speech at assembly in front of the whole school.

Somehow, I was going to be "Dr. Bigwig" (my attending's) assistant for the case, which meant I was doing the case. So, what did we do? Pure propofol for a prone/jacknife EUA. No airway. 😱 I'm a CA-1.

I run the propofol at 200mcg/kg/min while he's laying on the stretcher. Roll him over into position and get him comfortable. THEN slap the monitors on just as he's starting to drift off. It was 40 minutes of jaw-thrust hell. Turn the propofol off, roll him back over, he's waking-up on the stretcher - combative - and to the PACU. After about 10 minutes in the PACU, I thought he was going to add my name to his last will and testament. "Oh, man. Wow! WHEW! Are we done? We're done. I didn't feel anything. This is great. Oh, man. Wow! Are we done? WHEW! We're done, right? Great job! What was your name again?"



-copro