Wednesday, July 22, 2009

You Can't Sue the Government Part 2 (in which 911doc ponders creatively)

So new interns come on board in all teaching hospitals July 1. It's now July 22. I wouldn't be at all surprised if something like this occurred. General Surgeon working with intern who plans to go into Psychiatry...

"Do you think you can get that trochar in this time?" (trochar is very sharp metal rod that would be punched through peritoneal cavity then be used to pump CO2 into belly to provide 'exposure' to see gall-bladder and retrieve it with a laparoscope (and to keep greenhouse gas emissions down)...

(Intern, angry, frustrated, sleep deprived, new to military, scared) "Yes Sir!"

Surgeon hands intern trochar. Intern, stepping up on small stool puts all her weight behind it and hubs it. Descending aorta pierced, Surgeon apoplectic, blood fills abdomen, patient's legs get blue, Vascular Surgeon scared shitless, knows it's a hopeless case, tries to punt, no one receiving, then finally gets an accepting somewhere else. Rest of story plays out. Intern being protected because it's still the General Surgeon who takes blame, and, who wants to have a national debate about residency training right now? We still have to get people to agree to rationing of care and all!

Just a guess of course. Travis AFB has a fine hospital and I know people there. I don't believe any General Surgeon worth his salt would make this mistake... it makes more sense that it was a trainee. Thoughts?


  1. Thoughts?

    Can you request "no noobs" in advance of a procedure?

  2. Not in the military - at least not when I was there.

    H the IH

  3. "There is no body cavity that can't be reached by a good strong arm and a 14-gauge needle."

    Or trochar, in this case.

  4. happy,

    i was in too, i actually don't remember my surgical month very well. i do remember holding retractors and being allowed to do a little. perhaps an upper level resident.

  5. Ambulance Driver.
    The House of God should be required reading for all folks in HealthCare.

    Not only are the Residents newly minted, there are also lots of newly minted RNs.
    That's why I never want to get sick in the summer.

  6. That was my guess on first reading this story, that it was an unfortunately-placed trocar/scissors/bowel grasper.

    One of the few things I remember about laparoscopic surgery, that they always harped on, was to never stick an intstrument in blindly. Maybe this is why?

    Interestingly, I can't imagine this happening if they did the chole the boring, low-tech open way.

    What a horrible thing to happen to this young man and his family.

  7. I took my 11-year-old son to the dentist yesterday, for a filling. Though he normally doesn't ask for the nitrous oxide, this time he decided to request it. He's not a shy child; in fact, he's the kind you want to stand close to in case you need to clap a hand over his mouth. I discovered that the gas made him even less inhibited.

    The dental assistant was preparing the compound they were going to use to fill his tooth. It was some new stuff that she had not used before, and another assistant came in to find out if she needed some help. She said "No," that she had watched the training video. Of course the boy heard this, and sat bolt upright in the chair. I've never seen anyone talk around one of those rubber dams, but he managed somehow. "You're telling me you watched a VIDEO?! You've never done this before, but you watched a VIDEO?! Don't you think you should go practice on a dummy or something before you try in in a person's mouth? I don't want to be a guinea pig! What if you mess it up?!"

    I was a little embarrassed, but the other assistant assured him she would stay and make sure everything was done correctly. I think I figured out which child I'm putting in charge of my living will.

  8. Interesting. My doctor is doing my surgery next week at a non teaching hospital. It is not a hospital I have ever had surgery at before, and I couldn't figure out why he wanted it at a hospital that wasn't his "main" hospital. Maybe this is the answer?

    He will be doing it laparoscopically first because my insurance said it has to be attempted before they cut me open. He has already told me he won't be able to do it that way, and he even has a gynecological onclogist assisting because he is sure he will have problems even when I am cut open. Wouldn't it be cheaper/more cost effective for the insurance if they let him just do one surgery instead of trying something he knows won't work first? Is this the kind of stuff you guys deal with every day? Seems quite frustrating!

  9. very interesting. we have really great sim labs to simulate a code of a neo code. New doc's and Nurses don't need to "PRactice on patients. we have such great technology that we can buy a fucking doll that delivers a baby. No need to use humans for practice anymore guys.

  10. They ain't pushin this off on no stinkin Intern...this has got Affirmative Action 3rd year Resident written all over it in Blood like the Manson Family did... Heck the Military Interns are still in their Orientatin Month, takin Sexual Her-ass-meant and Diversity classes, they don't start seein real patients till August...

  11. RADGIRL,
    deep breath. you will be fine. i doubt anyone other than your surgeon will touch you but you can certainly ask.

  12. Rad Girl, why in the world is your surgeon anticipating issues? My Lord Girl, what problem could he have finding something in a body like yours???
    OF is dreaming now...

  13. Rad Girl....
    Everything should be fine...
    Don't consent to the "Exam Under Anesthesia
    " though....

  14. Oldfart-the problem isn't in the finding part,it is in the removing part.I had 3 c-sections, an ovary removed and then a hysterectomy that left my cervix because it was adhered to my bladder and other things. To take it out now will be difficult. Hopefully this will be my last abdominal surgery ever, and hopefully my last surgery ever too. I love doctors, but this is getting ridiculous!

  15. Rad Girl,
    You're in my prayers for an uneventful & successful surgery. Please keep us updated on your progress when you're able.