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 She wishes to have "life support" care withdrawn 36 hours from now.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.

If I ran the world...

...people wouldn't hurt so much. Don't like pain, generally speaking. I think it's bad. That's my professional opinion.

If I ran the world, surgery wouldn't hurt. Actually, if I ran the world, coronary artery bypass surgery wouldn't be necessary because everybody would eat a lot more broccoli. Less cow, which has cholesterol and higher in fat. My point is that sawing open your sternum and ripping out busted plumbing by replacing it with plumbing elsewhere in your body would be a kinder, gentler process...kinda like in Star Trek where there are whirring lights and funny noises and no blood does brain surgery plus recovery time in 25 seconds. I vote for that.

Smoking? Think that's bad, too. I'm even an ex-smoker, and not one of those rabid ex-smokers who purged themselves and now wishes to purge the world of this evil. When I drink, I want a cigarrette. Or two. And on occasion I just want one, anyway. Even though I think smoking is bad, a thought grounded in mountains of scientific evidence. A sixty pack-year habit? That's bad.

Also, if I ran the world, people wouldn't drink a quart of whiskey per day. Generally against that, too. Think it's not good, just not healthy. If I ran the world, we'd all deal with our realities in much more productive and happy ways.

These are my opinions. Thing is, I do not run the world. I do not make other people's decisions. I do not *want* to make other people's decisions. It would be a debacle if I ran the world...for one, there'd be too few accountants in it. And a lot less math. Um. And beetles! I'd get rid of all beetles, especially box elder bugs I HATE those.

But I'm on board with the idea that math is probably necessary for stuff. Accountants do things that have (dead dull) use. I am not on board that beetles serve any function, as they do not till earth, do not pollinate, do not actually appear to do anything useful in the ecosystem. However, I am not an entymolygist and I could easily be wrong on this point. (And why does anything NEED six legs!?!)

....I had a point.

If he hurts, give him the fscking medication. Do not give one tablet of Vicodin for 10/10 pain ("because he always says 10/10.") Give him fscking Dilaudid. Because when I get to him, his respirs are 32, his face is grimaced and his hands are balled around wads of sheets. How are you seeing, "A tab of Vicodin" here?

The world is not as we fashion it to be. The world is never as we would fashion it to be. It is only what it is. People only are who and what they are, and they come to us who and what they are. Can we quit trying to change them to think as we think, do as we do, and feel as we feel?

He hurts. Your feeeeeeeelings about his pain level and his habits and decisions are a complete nonsequitur. If you feeeeeel like a drug-pusher, fine, vent it in the medroom because we all do it, we all need to do it. But push the fscking med. You don't run this place. Relax, that's a good thing.