Walking to the board in the evening to assess what’s going on for the evening, I see my favorite general surgeon walk by Dr S. I run up to him excited, hoping he is the working surgeon tonight with me, he greets me, and lets me know that he is in fact not on call. Dang, my happy bubble immediately popped. He let me know that Dr. B is on call tonight. Dr B is the kind of surgeon that doesn’t allow questions, while also expecting you to magically know everything, and may cuss you out at any moment. Not a pleasant surgeon to spend the evening with. I ask Dr S. what he is doing at the board then, he lets me know about a patient upstairs that is not a surgical candidate, he tells me that he wrote a note in the chart as such, and if Dr B adds her on, don’t call me for help.
I try to start digging information out of Dr. S, but I can tell that there must have been some heated words between the surgeons, and he isn’t going to disclose much. I beg Dr. S to come if I call, offering him treats or promising to give him a start anytime he is short on a circulator any other day. He laughs, and just gives me the look, you have been warned. Dr S leaving, watching the double doors to the board close I catch a brief glimpse of Dr. B approaching, I take a deep breath.
As Dr.B approaches I see the look written all over his face, “I have an add on”. I grab my pen and paper and write down the details. Calculating the time, and when to get the patient, getting myself as prepared as possible for the case. Reviewing the history and physical, the patient has a coagulation disorder (bleeding). Looking at her CBC and figuring out what types of blood products I can anticipate needing. The late hours in the hospital are not quite the best times for the more difficult cases, as the resources are so thin to be able to get things quickly if need be. I am convinced that this is more than ego, that Dr. B just hates me.
I give my evening scrub tech Susie the entire scoop on the patient, recent surgery with blood clotting issues with vascular, the recent labs, for her to be able to set up her back table and mayo stand. The more we can anticipate the better it is for both of us. I ensure the blood products are in house, blood bank informs me she has a special type of blood requirement and that if we did need blood quickly it would be O-. I feel like this is my omen for what’s to come.
Getting the report from the preop, and introducing myself to the patient, I quickly assessed the situation. She is alert and oriented, explaining she has a feeding tube, as well as a colostomy. She reported recent abdominal pain; they believe some bowel is twisted. I saw some stool in her colostomy, which is why I’m sure Dr. S was just going to give it time to see if it would work itself out. She is a very frail woman; you can tell she has been through a lot in her life. I verify all the safety checks, and wheel her back to the operating room. Placing her onto the table, assisting in hooking up the monitors, I held her hand and asked her where she was from, trying to calm her down at that moment. She explains that she is from a beautiful farm area in Kentucky, and I squeeze her hand as she drifts off to sleep.
After prepping the patient, I call Dr. B to the room to start. He approaches the field, he has also brough a resident with him. They drape out the patient and make incision. Within minutes I hear Dr. B asking for lap sponges and suction, I keep a close eye on the suction canisters. Bleeding……lots and lots of bleeding. I approach anesthesia to assess vital signs and discuss what they will need from me. They ask me to go ahead and get blood, calling the blood bank, and asking for the O-. Bleeding is such a tricky situation in the operating room under normal conditions. You must visualize what’s bleeding, to be able to stop it, yet the bleeding blinds you. Now add on having a blood clotting disorder and the speed this can transpire is increased tenfold.
I can see the stress in Dr. B’s eyes, frantically searching for where the blood is coming from, the resident standing there looking frightened, while holding a suction. You begin to see the transfer of stress from Dr. B, blaming the resident for not retracting well enough to the scrub not handing him the 6 inch instrument instead of the 6.5. Trying to grasp control over the case, by displacing his anxieties on everyone in the room, he begins to yell at anesthesia for the patient not being paralyzed. Anesthesia isn’t putting up with his nonsense, as they are fighting up top to replace fluid as well give pressors to maintain life.
I am opening lap sponges by the 20 at this point, watching the door for the blood products. Anesthesia keeps asking me for updates, expressing that it’s on its way. I’m not sure who has the most anxiety currently, the surgeon who has the pressure to clamp the bleeder, or anesthesia who is responsible for giving him the time to find the bleeder by using drugs and products to maintain life. The room tension is heavy, everyone aware of the gravity of the situation.
The blood product arrives; I quickly verify the product with anesthesia and help assist placing them in pressure bags to infuse as quickly as possible. I sense some relief from anesthesia, while Dr. B is still struggling. It doesn’t matter how much blood we give, if he isn’t able to stop the bleeding the end will still be the same. I am also grabbing all other surgical clotting items, surgicel, floseal, anything I can think of and bringing it to the room. Not offering them yet, this particular surgeon must come up with the idea for it to be good.
Sometimes when surgeons catch themselves in this situation, they may ask to call another surgeon, general or vascular, Dr B remains quiet. I am inferring that there were probably notes from both Dr S and vascular that this patient wasn’t a surgical candidate, so the options for help were limited. Dr. B struggles for another hour attempting to find the source, while we transfuse up top, until he announces that we will pack her closed. Announcing he was leaving 6 lap sponges in. So, in essence, just placing cloth inside her to absorb it and hoping closing her up tight enough she eventually will clot off. I knew that would not be the case, he was giving up.
Closing and transferring the patient straight up to the ICU, I had just a horrible feeling, I didn’t even really have anything to give in report, we literally did nothing but cut her open and give blood and never stopped the bleeding. I knew that she wouldn’t not make it through the night. Stopping by the board on my way back to the OR I catch Dr. B writing on the board, “bring back closure”. I just wanted to scream, knowing that she would not be coming back. She wouldn’t make it through the night.
Dr B is one of the strongest ego’s I had met until this point in my operating room career. The type of man that is not approachable in any fashion. Who feels his capabilities are superior to others including his partner who wrote “not a surgical candidate”. I wish this woman knew his intentions; the intentions of this surgery were nothing more than a gamble with her life. Not to heal her for healing as Dr B explained, to fix her to prove to Dr S that he was a superior surgeon. Maybe if this woman would have listened to Dr S, she may have spent some days scared waiting to see if it worked itself out, but listening to the egotistical hope offered by another surgeon, trying to prove a point about his abilities.
I will never forget the happiness in her eyes as she drifted off the sleep telling me about her life on the beautiful farm, the last thought she voiced. Me being the last person she heard on this side of things, I hope I offered her humane comfort in a time I knew would be her last. She died an hour after returning to the ICU.