Monday, June 15, 2015

What's the Prognosis Doc?

Predicting outcomes has never been easy. Here are some foolish prognostic indicators.


The surgery is performed late at night or on a weekend, even more grim if on a major holiday.

There is a long delay (45 minutes or >) between anesthesia start time and surgery start time

The circulator has to leave the room to flash sterilize an esoteric instrument during the middle of a case. Bonus negative points if it's a vascular instrument and the surgeon says to heck with the autoclaving, "Just pour some alcohol on it and hand it over."

The surgery is done with the table and/or surgeon in a novel and unusual position.

Overhead lights are adjusted 3 or more times on the same site during the same surgery.

A surgical drape becomes unsecured and drops to the floor in the middle of a case. When things are going bad and this happens it's like a Bovie  burn to your soul. You suddenly come to realize that it's not a tumor or aneurysm lying there, but someone who is a father or mother. I remember vividly an incident like this that happened over 40 years ago and it still brings tears to my eyes.

Both  kick basins in use simultaneously on the same case. I think this is how the term "Kick the bucket," may have evolved.

Surgeons shoe size is 6 sizes or > than the patients. Size 13 surgeon operating on a size 5 1/2 patient is not a good idea.

Patient has a tattoo covering the operative site. Yes, we had tattoos back in the day, and the surgeons spent more time worrying about approximating the edges of the wound so the tattoo lined up than any other aspect of the surgery.

The patient is a very nice guy/gal and is employed in a helping vocation like teaching, social work, or nursing. Why is it that the most pleasant people have the worst metastatic lesions and other intractable, inoperable problems?

The surgery occurs over the lunch hour with anesthesia and scrub nurses rotating in and out for lunch break. I always thought there should be a law preventing this practice, but it was common.

Two surgical specialties operating together on the same case. I was once scrubbed on the general surgery (abdominal) side of a bad trauma. The neuro guys operating simultaneously above declared that it was time to call it quits, declaring the patient dead  and my Doc said "Let's keep going,  more 3-0 on a curved, we're on a roll."  We could not get him to stop!

Arriving in the OR suite with an endotracheal tube already in place.

I can't really come up with any indicators of a good prognosis. For some reason with aging the bad things really stick in your mind. Patients with long standing problems that receive their care via frequent ER visits usually do very well. Another observation would be that drunk drivers can survive a wreck that would doom a sober person. In fact intoxicated traumas frequently do better than their sober counterparts.

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