Tuesday, December 13, 2016


Old time surgeons were at the top of the hospital food chain, the captain of the ship, and sometimes misguided blowhards with overstuffed egos. Overconfidence combined with a condescending, paternalistic attitude toward patients  added up to surgisplanations which minimized operative risks and the true extent of surgery, overstated benefits and touted the operators surgical superiority. If anyone questioned these surgisplainers their response was "I just explain procedures in the language a patient can understand."  They were elderly and often wore expensive wool suits that smelled of moth balls.  I think these are the surgeons Dr. Slambow had in mind when he pontificated that, "The only surgery that really benefits the patient is repair of traumatic injury."

A semi-demented old coot of a surgisplaining  gynecologist always explained a D&C with the same practiced, scripted, delivery, "I'm just going to do a little bit of Dusting and Cleaning in there." This was delivered in a demeaning and  condescending tone of voice to rightfully frightened ladies from an obese, imposing man. He was a jerk of the highest order and if he had been accurate in describing his operative method it would have sounded like this: "I'm going to visualize your cervix by inserting a weighted speculum that tips the scales about as much as my overhanging pandus, then stabilize your cervix by piercing it with two converging sharp points of a tenaculum. While I yank put traction on the tenaculum, I will ream out dilate your cervix with stainless steel cylindrical devices called dilators that progress in diameter to the size of my stogie  so I can scrape the inside of your uterus with a curette. I learned the finer points of curettage by mimicking my cat pawing like a sabertooth tiger at his scratching post. You don't have anything to worry about.

A foreign body  be it a stray sponge or rogue instrument found in a patient after surgery meant that the scrub nurse and circulator on the case would be immediately fired and the surgeon had to come up with some surgisplanin regarding the need for re-operation. This situation presented itself when I was working in neuro ICU with a patient that had undergone a spinal fusion.   I was so tempted to make a copy of the X-ray report and anonymously mail it to the patient, but never did. If I had it to do over, I think that I would have made that copy. The neurosurgeon's surgispanation; "the X-ray showed us something that was not visible during surgery (yeah..because you did not see it and the nurse could not count to 10) that we need to go back in and correct. When I was a scrub nurse, nothing made me feel worse than re opening a partially healed surgical wound. Incising healing tissue just goes aginst the grain. Things like that are just not supposed to happen. The patient had the sponge removed and did just fine post-op. She walked out of the hospital none the wiser of the errant sponge that was left behind during the initial surgery.

There was an old geezer of a neurosurgeon well past his prime  that always had a clever surgisplanation for his patients. His description of a crainiotomy went like this, "We are going to make a little trap door in your head so we can fix you up as good as new." That's it. Now it's time to sign the consent.

If there was a prize for the most understated surgisplanation this one would win the grand prize. Here is what the truth of the matter amounts to. We are going to shave your head bald and after anesthesia induction you will be  positioned in a very dangerous upright  sitting position where it is possible for ambient air to enter a major vessel and cause serious disability. Then I'm going to cut through your scalp which will bleed like the dickens and you better hope the scrub nurse can load Raney clips lickety split. When we get to that nasty AVM, I will try to remove it from vascular circulation before it bleeds too badly. Then we will close and finally, I will drill holes in your bone flap to wire it back in position, Most patients that have there brain handled like this have serious personality changes but don't worry you have good health insurance.

Thankfully these surgisplainers are extinct. The last time I had a procedure, the surgeon carefully explained all possible complications. It was really hard for anyone to trust old time surgisplainers whether they were patient or nurse. I know they used to creep me out.

1 comment:

  1. You had me rolling on the floor with your D&C procedure surgisplainin'!!