The myopia of Dr. Surgeon.

This is an addendum to my story about Margaret, my patient from earlier.

True story:

Jo has parked in Margaret's room because Margaret requires 1:1 RN care. She needs the titrating of vasoactive meds, dialysis, ventilator tweaks. She wishes to have "life support" care withdrawn 36 hours from now. She'd had a complex vascular surgery the previous week, done by Dr. Vascular Surgeon, to improve the circulation to her legs and feet. She is 84.

Dr. Vascular Surgeon walks into room Monday morning at 0700. He and Jo exchange polite good mornings.

Jo: "I have some concerns I'd like to share with you about how Margaret's doing, once you're ready to hear them. Here's her chart if you'd like to look at it first." I hand him the chart.

Dr. S thanks me, leaves room with chart, comes back five minutes later. He looks at (but does not unravel) the dressing to her leg. "When did you change this last?"

Jo: "At four this morning."

Dr. S: "And how are the incisions doing?"

Jo: "Well approximated still, no signs of infection, her white blood count is still within parameters, some moderate serous oozing from the groin, mild from the leg." (No, really, I sound like this.)

Dr. S: "And her pulses?"

Jo: "I can doppler the PT's intermittently, but can actually palp the DPs. That's a new finding from last night, days wasn't able to find the PTs and could only doppler DPs on their assessment."

Dr. S nods, and covers her feet back up without confirming my findings. I'm sure that his note will record what I said verbatim. I guess it's nice to be trusted? As he washes his hands, he asks, "What are your concerns?"

Jo: "We've been unable to titrate her oxygen much lower, and her rate is remaining 7 to 10 over the vent despite the 40 mic's of propofol. Also, I've been unable to get her off that point five of dopamine. Her pressures are stable, despite the fairly high blood flow on dialysis."

Dr. S cuts me off: "I'm just the surgeon."

I glare. Jo: "Also, though she's on the propofol, we have nothing for pain. Maybe a little Fentanyl? And I can back off on the propofol?"

Dr. S: "Well, she shouldn't be having any pain since the surgery was X date. Looks like that's healing fine."

My. jaw. drops. I make a wide gesture to the room, to the machines. "How about the REST of what we're doing to her?"

Dr. S is drying his hands, pitches the paper towels and shrugs. "I'm just the surgeon."

He walks out of the room, and there's Jo, still got her arm dangling pointlessly in the air.