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As a routine precaution during cataract surgery, we normally tape the patient’s head to the operating bed.  Our patients are sedated (wouldn’t you want to be sedated if someone was working on your eye?) but sometimes they wake up at unpredictable times.  Everyone metabolizes drugs differently.  So to prevent them from suddenly sitting up like the Cowardly Lion and quipping, “Unusual weather we’re having, ain’t it?” we gently but firmly run tape across the forehead and under the head rest.

May be a bit low tech, but IT WORKS.

In the past, we had this big ass roll of tape to make a couple of passes around the head (or more if the patient seemed likely to be a problem child.)  A typical roll might last for eight cases.

1inchtape

More than enough tape to get the job done!

Enter UPMC (the acronym for “U People Must Comply.”)  Someone, somewhere, in the vast corporate mind of the beast decided or calculated that  “single use” rolls of tape were more economical.  Or maybe they ordered 10 million rolls of the wrong tape.  Whatever, the reason, this is what we have to work with now.

singleusetape

The picture can be deceiving.  One roll of this single-use roll just barely makes one circuit over the head, so on most cases, we are now using TWO rolls of single-use tape to protect our cataract patients from their own involuntary movements.

Never mind the insanity of making rules to govern every situation as if every situation is identical, but isn’t this terribly wasteful?  At two rolls per case, we’re using about 8 rolls for every one of the larger multi-use rolls.  Is that environmentally conscious?

Rather disgusted, I told the nurse to just order the old rolls for us to use.

I was informed that we can’t do that.  This is what we are required to use.  Silly me.  This isn’t the United States of America.  I can’t be allowed to do what I think is in the best interest of my patients.

I’m going to go off on a rant right now (and several run-on and poorly structured sentences) so you might want to grab a Snickers and an English teacher.  Okay.  Do not grab an English teacher.  Unless you are Donald Trump.  Or you are married to said English teacher.

I am getting rather tired of people telling me, the surgeon, how to do my job.  I am told that I have to mark the patient’s eye.  (That is a good idea.  We always did it before, but . . . )  I am told where I have to mark it (in the holding room instead of the operating room where my chart is and with the patient in the proper position for the surgery–I know that sounds weird but when I operate I sit behind the patient’s head so his right eye is my right and his left my left, but when I face them in the holding area, my right is his left and vice versa–for someone who had operated for years the other way, it took some getting used to and I tried carrying my charts around, but now I have two charts, the previous patient and the next patient and of course I wrote on the wrong chart shortly into this new experiment which quite frankly made a simple but important safety act more cumbersome and difficult with no definable benefit), and how I am supposed to mark it (on the cheek below the correct eye, marker that won’t rub off easily (patients have to scrub, often with alcohol, to remove my initials tattooed on their face), and I have to include THREE initials, because I might forget who the fuck I am after following all these god-damned insane regulations.)  I am basically told what medications we can use because if it’s not in the hospital formulary, it ain’t happening.  I am supposed to date and time my orders–this is an outpatient procedure that takes 10-20 minutes in most cases.  How is dating, and worse yet timing, my signature of any benefit to patient care???  Anything I sign in the chart has to be on that date and within a fairly definable time frame.  I’m not supposed to wear a watch in the OR, yet I am supposed to time everything.  What the hell did I go to medical school and residency for?  I could have saved EIGHT years of my life and just had the federal government (The Joint Commission) and UPMC tell me what to do.  Maybe Trump will wipe out the Joint Commission after he’s done erasing the EPA.  And I am done digressing.

But I heard this single use tape experiment has been so wildly successful at improving patient care and cost-efficiency that UPMC is going to roll out their next great idea:  single-use toilet paper rolls.

toiletpaper

Because you shouldn’t be pooping on company time anyway!!!!

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Get it?  😕  Colon.  Oscopy.

I was really hoping to find some humor in this procedure.  This was my first colonoscopy.  Welcome to being 50!  It is like a right of passage.  I have read many stories over the years about this procedure.  Most of the horror surrounds “the prep,” which is a nice way of saying that Satan is coming down your colon with a supersoaker from hell.  And while that was mostly true, it was not as bad as I was expecting.

Granted, having to stay within 30 feet of the toilet for most of the night was not pleasant.  The time actually spent on the toilet was not pleasant.  I did get to play a lot of games on my iPad, so it wasn’t a total loss.

Here I sit and dream of glory, alone inside the lavatory.  (An obscure reference–leave me a comment if you know the source.)

Personally, I thought that drinking “the prep,” a concoction called Suprep that comes in two 6 ounce bottles of cherry flavored hell, was actually worse than getting rid of it.  I’m not a big fan of cherry to begin with, and that is probably a good thing.  My dad underwent a colonoscopy a number of years ago.  He mixed his prep at that time with Squirt, a citrus soda.  From that day on until the day he died, he could not bring himself to drink Squirt again.  And that name is kind of ironic, doncha think?

So if taking this prep turns me from cherry flavored anything, it is certainly not the end of the world.

It looks so innocent!

It looks so innocent!

And it was god awful.

Yeah, there was cherry.  With bitter undertones and a hint of maybe seltzer–or mineral water.  I think I detected some acetone or benzene, if my senses have not failed me from biochemistry.  The bouquet was nonexistent–it didn’t even smell like cherries.  And it was crystal clear, so you could almost convince yourself you were drinking water or vodka, until it actually touched a single taste bud on your tongue.

You see, you had to dilute this wonderful prep into 16 ounces of clear but vile crap that you must choke down before you have to run to the bathroom.  Twenty minutes.  That’s all it took.  And I had to down two more 16 ounce cups of water afterwards, or it would have sucked the water out of my brain.  I would have ended up a pile of dust floating in the toilet.  The beast had to be fed water.

So after choking down the cherry shit, alternating forced gulps with some coffee or white grape juice (you can’t drink anything with red or purple dye!) to try and save my taste buds, I then had to down 32 ounces of water over the next hour.  I’m not sure I drink that much water in a single day!  I drink–coffee, tea, soft drinks, wine, beer.  But only occasionally do I ever drink plain old water.

The first bottle came out explosively but without any accidents I am happy to report.  I did get baby wipes as recommended since toilet paper could be “irritating.”  By the time I was ready for bed, I was no longer living on the seat.

Unfortunately, bottle two had to be taken seven hours before my scheduled time, with another 32 ounces of water in the hour after that.  Then, no more liquids until after the procedure.  With a 9:00 appointment, I had to get up at 2:00 am to force another cherry jubilee down my esophagus, and through my intestines.

I was hoping that being half asleep, I wouldn’t mind the cherry crap so much.  I was wrong.  It was worse.  I have never drank gasoline, but if you throw some cherries in it, I imagine this is how it would taste.

Boom!  I’m back in the bathroom.  Cholera without the actual disease.

In the morning, I looked longingly at half a cup of coffee left over from the previous night’s escapades.  I carefully took a mouthful, swished it around my mouth to tantalize my taste buds and maybe absorb some through my mouth’s mucosa, before spitting it out in the sink.  I watched as the coffee went down the drain.  I was devastated.  But I didn’t drink anything!  I did not swallow!  (That’s what she said!)

So I arrive at 8:45, and I am back in the holding area with all my clothes off except for my socks, a hospital gown and a sheet to keep the young women from laughing at me, or at least, not laughing at that.  At 11:00 o’clock, they finally come to take me for the procedure.  Waiting that long was more irritating than the toilet paper.  And I’m a doctor!  There had better have been an exploding colon somewhere to delay me getting my damned coffee.

Anyway, I’m all ready to take notes about the actual procedure for this blog, to bring the colonoscopy experience alive for my readers my reader  the person who stumbled here by accident.  They ask me to lay on my left side.  And  . . .

Then I woke up.

Propofol

What a disappointment!  This is the closest thing to a sexual encounter I’ve had in years and I missed it!

And in case you care, my colon is just fine, thank you very much.  Not even a polyp.  Come back in 10 years.

And I finally got my coffee.

Seriously . . .March is Colorectal Cancer Awareness Month.  And if you are over 50, don’t be like dead-from-colon-cancer Rob Lowe–get DirecTV and a colonoscopy today.

ColorectalMarch

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So after trying to pick the golf ball off my sweater this morning, I still go to work.

As I am giving pre-operative instructions to my patient who is scheduled next week for cataract surgery, I get to the point in the discussion where I inform them what medications they should or should not take the morning of surgery.

In the good old days, I could just glance down at the list on my paper chart and know exactly what medications a given patient was taking.  (Or at least the ones they remembered or told us, but patient’s memories don’t improve with computerization anyway.)  But good old Uncle Sam has shot to hell the good old days of practicing medicine, and I must now click on a different tab to bring up medications.  The computer does not always respond right away, so sometimes there is a delay before any useful information can be gleaned from among all the “meaningful use” crap clogging up the health record system.

And instead of waiting for the computer to unfreeze, I ask the patient what medications they are on.

Generally speaking, they should only take “essential” medications such as those for heart, breathing and blood pressure the morning of surgery with a little sip of water.  Not every patient knows what their medications are for, so I like to review the list with them.  And some medications should still be taken even if they don’t fall into those categories, such as anti-seizure medications.  Others, like Flomax, should be stopped a week before surgery.

I am still waiting for the list to pop-up and I couldn’t understand what the patient answered as to what medications he was taking.  Three sets of ear tubes as a child and multiple infections have left me with a modicum of hearing loss.

So I ask him again what medication he is taking.

He answers again, but I still can’t quite understand what he is saying, and what I think he said, isn’t a drug I am familiar with.

Still no answer from the Obama-care computer.

And then I make a fatal mistake.  I am embarrassed to have to ask the patient a third time to tell me the name of his medication.  I am also impatient because my computer is useless to me at this moment.  So I think that trying a different tactic might help facilitate me finishing this discussion and moving on to the next embarrassment patient.

If I don’t know what the name is, I can still make a decision based on what he is using it for.

So I calmly ask him what he takes this medication for.

Fortunately, he either didn’t hear me, thought I was a complete idiot, or wisely chose not to answer.  At this moment, the computer manages to find the list of medications and display to me that my patient is taking Viagra.

ViagraFalls

And I, his eye doctor, just asked him why he was taking this.

EPIC FAIL.

So what would you say in this instance?

I stammered, as my tech tried not to laugh out loud, “I guess you can skip taking that the morning of surgery.”

Stamping out blindness is never easy or for the faint of heart.

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Money4Nothing

That ain’t Twerking . . .That’s the way you DO it!

And my chicks for free!

The Daily Post asks . . . If you’re like most of us, you need to earn money by working for a living. Describe your ultimate job. If you’re in your dream job, tell us all about it — what is it that you love? What fulfills you?

For those of you who follow my blog, you know that I am, by profession, an ophthalmologist.  An eye doctor/surgeon.  And while I do like my job–I really enjoy giving cataract surgery patients the gift of better sight–there are certain things about my job I do not like.

I really do not like our government and its bureaucratic intrusion into my practice.  I wish they would just leave me alone to do what I was trained to do.  Dealing with insurance companies makes me want to stick needles in MY eye!  Obamacare is just worse and more of it!

I loathe computer medical records.  Electronic Health Records.  EHR.  Errrrr!  Meaningful use = meaningless abuse.

I really don’t like having to get up at a set time every morning and living my life to a schedule.  Didn’t bother me years ago, but as I have aged, I really look forward to sleeping in on weekends!  I could get used to doing that every day.

I don’t like call.  As I have turned 39 for more than a few years, the ER calls in the middle of the night really bother me.  I no longer can fall back to sleep right away which affects my next day’s performance.  I already work a very busy schedule and additional add-ons are just additional stress right now that I could do without.  It is what it is, though.

So, in a nutshell, right there is my dream job . . . making the same amount of money I currently make (more would actually be better since I still live paycheck to paycheck with my doctor’s salary) but not having a set schedule, no call, and still do what I enjoy doing.

I enjoy running.  Can’t see anyone paying me what I make now to simply run.  And I am certainly not an elite/Olympic runner.  If I have to compete to get paid, I will starve.

I enjoy golfing.  And while I could make more than I currently make being a great professional golfer, I am not a great golfer.  I’m not really a good golfer.  I’m not worthy of playing with Tiger Woods.  I’m not really worthy of playing with Tiger’s woods, or even carrying his clubs.  I have probably lost a few balls in Tiger’s woods and if not, I certainly could manage that.

I also enjoy bowling, but I don’t think my current 192 average is good enough to keep my salary level where I am.  Nothing more pitiful than a starving bowler.

I’ve always dreamed of being the head coach at Penn State, and that would certainly pay better than my current gig.  But as passionate as I am as a fan, I do lack the X’s and O’s to actually be a football coach.  And looking at the hectic schedule that our new coach is living–travelling on the recruiting trail–I don’t think I would enjoy that schedule.

I am thinking Penn State University president.  The job may still be open, but I think they will be announcing a new president shortly.  I have not the experience nor qualifications, but there would be no bigger promoter of the University that I know of.  I can cut a ribbon without cutting myself.  I think.  I could ask people to donate money.  I’m not sure how I could handle dealing with our State Legislators, since my opinion of monumental idiots lawmakers in general is not very high.  The schedule probably isn’t as flexible as I’d like, so I think this is a no-go as well.

I could be a professional blogger if somebody wants to pay me what I’m currently making.  Yeah, I don’t see that happening.

Professional lottery winner?  I’m so there.  I just need to win the freaking Power Ball!

I’ve always thought stand-up comedy would be great.  I’m currently the entertainment for our annual office Christmas party, but that’s a once a year gig.  Not sure I could pull it off on a regular basis.  Maybe if I had a team of joke writers.  But the whole stand-up thing is not my style.  One of the things that drew me to eye surgery in medical school is that you can do it sitting down.  I guess I could be a late-night show host–a little actual standing followed by sitting behind a desk drinking coffee.  I could drive around like Jerry Seinfeld and drink coffee with other comedians.  I could drink coffee with just about anybody, especially if I’m getting paid well to do it.

I do dream of being a “professional” writer some day.  I have several novels in very stages of completion.  I blame my day job for the lack of time needed to actually finish and publish these projects, but we all know that is just an excuse.  And I have heard that publishers can be downright nasty with deadlines which would annoy me.  Sometimes the muse inspires me; sometimes the muse perspires me.  You just never know when the words will come.

It looks like for now, I’ll have to stick with taking out cataracts.

That’s not working.  That’s the way I do it.

Lemme tell, eye docs ain’t dumb.

Maybe get a blister on my little finger.

Maybe get a blister on my thumb.

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What’s Your Emergency?

In honor of 9-11, I am going to digress on a topic of emergency medicine today.

As an ophthalmologist (or pretentious eye doctor depending on how you pronounce it) I occasionally get paged when I am on call.  Perhaps less so than an orthopedic surgeon, pediatrician, or cardiologist, but more so than your busy dermatologist or geneticist.

After business hours at night, on weekends and on holidays, our office is closed.  The answering machine at our office clearly states
that our office is now closed.  There is an option to leave a message.  Then, the recording tells our patients that if this is an emergency, to call the answering
service.

As an intern many years ago, I was introduced to the wonderful world of being on call.  I was awoken at 3 a.m. by a patient who asked if it would be okay to take an aspirin tablet that had fallen on the floor.  I.  Kid.  You.  Not.

How bad does your headache have to be to take this?

Does the five-second rule apply here?  Is there fuzzy stuff on the tablet, or does it look clean?  Can you rinse it off quickly and pop it in your mouth before it melts?  Might we just consider the possibility of throwing it away and taking another one that has not contacted the floor?

Labor Day weekend, I got a call at 7:30 am Sunday morning to refill a prescription.  The patient normally sees another doctor we were covering.  She didn’t know the name of the drop but thought it began with a P.  It had a green cap.  That actually was helpful, since it narrowed it down to pilocarpine, used for some forms of glaucoma.  But it comes in an array of strengths ranging from 1/8% up to 4%.  Of course she didn’t know which one she was on, but she knew she was going to run out before Tuesday.  And guess what, after several calls later, her pharmacy was closed anyway.  So much for sleeping in.

Seriously?  I take a baby aspirin daily ever since I had an episode of atrial fibrillation.  When I notice there are only about 7-10 tablets left in the bottle, I put it on the grocery list for my wife to pick up more.  She usually shops at least once a week, so I get my new bottle before the last tablet is gone.  Is that so hard?

Granted, you can’t see the drops in your medicine bottle, but you can generally tell, particularly if you have been using drops for years, when you are about to run out.  Plan ahead people.  Don’t let those pesky holidays creep up on you.  Buy a calendar.

Once, on Good Friday, a lady called complaining of itchy eyelids.  Now while that could sound like an emergency, most eye doctors will tell you it is not.  Uncomfortable perhaps, but not generally vision threatening.  This lady was the patient of another eye doctor as well.  Apparently, I am the only April Fool who takes call on holidays anymore.  Or I’m not smart enough to sign out to someone else.  Whatever.

So I ask her how long her eyes have been itching.

On or off.  For about a year.

This is an emergency????

Has she seen anyone else about it?

Oh yes.  She saw a dermatologist who prescribed a cream for her face that worked.

Did she call her dermatologist back?

His office is closed today.

Imagine that!

But he told her previously that she could use it on her eyelids as well, but she wasn’t sure she should.  The eye doctor I was covering for told her she could use it as well.  Apparently, she wasn’t convinced and needed a third opinion.  On Good Friday.  That has the weight of the Father, Son AND the Holy Spirit behind it as well.

Let me think about this one.  Hmmm.  The cream worked for the rash on your face.  Two doctors, including an eye specialist told you to use it on your eyelids.  Your eyelids are itching?  It’s Good Friday.  .  . I got nothing.  I don’t know what to tell you (although I know what I’d like to say) but maybe, just maybe, you should try the medication.  It’s a shot in the dark here, but if your eyes are bothering you enough to call a professional on a holiday, then I’d go for it.

I don’t want to sound insensitive.  It’s not that I don’t care about your itchy, watery eyes that have been bothering you for months.  Just don’t call me on a holiday or on a Saturday afternoon when Penn State is playing football.

I’m sure every job has its moments.  I imagine that most grocers have received phone calls at three in the morning asking whether or not it is okay to drink
milk that is one day over its expiration date.  Don’t you wonder about that?  It’s only one day.  But you don’t want to get sick.  It smells okay, but you just can’t
be sure, can you?  Better call and find out right now!  Oh, and I just noticed I’m running a little low on toilet paper . . . could you send some out in the morning?  Thanks!

Today is 9-11.  What’s your emergency?

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The old adage goes, a stitch in time saves nine.

Nine what?

Google is my friend, and a perusal of this site yields the following:

Meaning

A timely effort will prevent more work later.

The ‘stitch in time’ is simply the sewing up of a small hole or tear in a piece of material, so saving the need for more stitching at a later date when the hole has become larger. Clearly, the first users of this expression were referring to saving nine stitches.

Now you may be wondering what all this has to do with anything.  I’m right there with you.  Haven’t a clue.  Wait.  What?

Certain innocuous phrases can really be lies in disguise.

The check is in the mail.  (I have no intention of paying you.)

That dress doesn’t make you look fat.  (You look like that no matter what you wear.)

Of course I respect you.  (But please God, I hope she leaves in the morning before I get up.)

The doctor will see you now.  (Hope you brought a Snickers . . . you’re going to be here for a while.)

Wait.  What?

On behalf of all doctors out there, I must protest.  I resemble that remark.  There are usually very valid reasons why you had to wait so long, and these often don’t involve golf or writing a blog.  Having been in practice for over 20 years, I can tell you there is no perfect schedule.  If you book light, there are cancellations and the doctor ends up sitting around idly pumping his sphygmomanometer in private.  If you book heavy, EVERYONE–and their siblings–show up and you have twenty emergencies added on as well.

I have also noticed that the patients who complain about having to wait so long to get an appointment, are often the ones who complain about how long they have to wait in the office to actually be seen.  So you want me to jam you into my schedule sooner and make all the other people simply disappear so you don’t have to wait?  I’m not a magician, and if I were, I wouldn’t use my sorcery for scheduling.  I’d be waving that wand for some winning Powerball numbers.

There is no perfect schedule and most doctors try their best not to make you wait unnecessarily.  After all, we’re not lawyers–we’re not billing you by the hour, even if it seems that way sometimes.  And if I could clone myself and be in two places at the same time, I’m sorry to say that one of us wouldn’t be here seeing you in this office–one of us would be out having fun somewhere.  Actually, if I were able to clone people I could probably just retire.  But I digress.

And blaming it all on the scheduling secretary isn’t fair either.

What most people fail to realize is that doctor time is different from non-doctor time.  It’s kind of like dog years.  One year for a dog is like seven human years.  So when the nurse tells you the doctor will be in to see you in a few minutes, she’s not really lying.  You have to multiply that number by 7.  A fifteen minute wait will actually be 105 minutes, but what’s a few minutes between friends?  If you are a subspecialist, that number might be 10 or 12 x longer.  Restaurants do the same thing, but the multiplier is generally less.  If you think your table will be ready in 20 minutes, be prepared to stand around for 40.

I have explained this phenomenon to a number of irate patients over the years.  It’s kind of like trying to explain Einstein’s theory of relativity to someone other than Einstein.

But one elderly gentleman unfortunately “got it.”

He handed me his medical bill for $70 along with a ten-dollar bill, saying that he was paying me in patient dollars.  You just have to multiply it by 7.

Payback is a bitch.  (Payback is a bitch!)

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Glasses Half-Empty?

Frank and Ernest are living the EyeLife . . .

Oh, [bleep] my glasses are empty 

That sucks.

We will never, never be

anything but loud and nitty gritty, dirty little freaks

So raise your glasses!

Sorry.  Went a little Pink there.

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