Short-taped in the OR

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.

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.

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.

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

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Golf Balls From Heaven

The call came at 11:45 p.m., waking me from sleep.

“I think your dad had a stroke.”

I don’t live far away, but that was a long drive, despite breaking speed limits and running a couple of red lights.

It took all of about two seconds to confirm my mother’s diagnosis.  I called 9-1-1 and the paramedics arrived shortly thereafter.

By the time we got to the ER, he could not move the left side of his body, and his left eye was drooped closed.  His speech was slurred and difficult.

They gave him TPA, a clot busting drug.  Within 15 minutes, he could move his left leg and within half an hour, he could move his left arm.  The facial droop improved, but his speech never quite recovered.

As we left his hospital room Friday night, he gave us a thumbs up gesture.  Perhaps our prayers had been answered and he would recover from this.  He was in the hospital in May with congestive heart failure, but had done well after that and was back golfing and teaching the residents at the hospital.

But at 4 a.m. Saturday morning, he went unresponsive and had trouble breathing.  They put him on a ventilator and took him for a CT scan.  One of the side effects of TPA is that you can hemorrhage at the site of the stroke.  But the scan showed no hemorrhage.  An EEG did not show seizure activity, but was markedly abnormal on the right side where the stroke occurred.  An MRI eventually showed bilateral cerebellar strokes and a new brainstem stroke.  There would be no recovery.

On the day we stopped the ventilator, I brought him a golf ball to hold, because he loved to play golf and I bonded with him playing that game, and a cold bottle of Sam Adams beer for the other hand. My dad was far from an alcoholic, but he really enjoyed a cold beer once in a while—something he hadn’t been able to enjoy since suffering heart failure in April.

He jokingly asked almost every person who came to visit him in the ICU last Friday if they brought him a cold beer. I couldn’t let him leave this world without his cold beer. So I swabbed it on his lips, and we all shared a Sam Adams. I left the golf ball in his hand.

The next morning, I went jogging, as I usually do about 6 days a week. I always leave my house, go down the back road of our development, and then take a trail that connects the cul-de-sac to the local high school parking lot.  I’ve run that trail for 14 years.

The day after he died, there was a golf ball. Lying in the road. Right in front of the trail. There is no golf course nearby. I have never seen a golf ball down there before.

I think somehow, some way, he left that there for me.

He couldn’t have left me the beer! My wife says that’s because someone else would have taken the beer, so I have to settle for the golf ball.

Sure, it probably fell out of someone’s golf bag–then out of their car.  But I suspect the odds of that happening on THAT day at THAT time after THOSE circumstances are worse than my odds of winning the POWERBALL tonight.

And even if there is a physical explanation, whose to say his spirit didn’t have a hand in making that happen?

It might not have materialized from Heaven, but my dad brought it to me just the same.

I miss you already, dad.

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