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AANS Neurosurgeon | Volume 28, Number 4, 2019

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Thoughts from the Other Side of the Preoperative Curtain

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At some point in a surgeon’s world, they progress from provider to consumer, from surgeon to patient. I have crossed that particular threshold and sit in the preoperative holding area in a flimsy hospital gown, devoid of my assumption of personal power as a surgeon of local renown, my white coat and scrubs stripped, sitting without my socks and even my underwear – just another lump of humanity awaiting judgement of my fate. My mind wanders to the past 40 years of placing others in my exact situation on this morning.

The questions pile up as I muse. 

  • Was I always kind to my patients?
  • Did I try to allay their fears?
  • Was I as concerned with their schedule as mine? 

I would like to think those questions can be answered in the affirmative, but my view of my motives and appearance to others is obviously biased. Like my patients, I also carefully selected my surgeon, hospital venue and anesthesia staff. Uncertainty creeps in as I do not know my surgeon’s anesthesia team like I know mine and the hospital is unfamiliar. I wonder how they will react and handle the little things that make a difference. Will they let a resident or certified nurse anesthetist (CRNA) have a shot at my intubation or arterial line? Are they as critical as I am about “little things” like line sterility or air in lines?

Standard of Performance

We tend to look to ourselves as a standard for performance: I am no exception. Looking back at my career, were there any times when I did not do everything in my power to insure the best possible outcome for my patients? Will my surgeon be as meticulous with hemostasis and wound closures as I would be? After all, the only part of the procedure that the patient sees is the closure, so it should reflect the surgeon’s care and signature.

A little worry turns to reflection about the way I have handled both routine and difficult procedures:

  • Were my efforts universally adequate to the task at hand? 
  • Were there areas where I could have done better, learned more, provided more?

And of course, what of that ultimate question that we as surgeons share, born of our own ego and experience, “Is there someone else who could have done the case better?”

Self-reflection

Self-examination of performance is best done frequently and with brutal honesty, so I ask myself whether or not I examined with the enthusiasm required. It is a different level of internal response than the required morbidity and mortality conference institutionalized in all of our hospitals. Returning to the present preoperative moments, I wonder if my chosen surgeon has the same value of self-assessment that my partners and I have valued. I think so; I hope so.

While I ponder, there is a constant interruption of thought by EKG technicians, phlebotomists, prep nurses and pages of consents in triplicate designed to transfer liability from the hospital to the provider. These are documents meant to be signed, but never actually read. All these interruptions disrupt cogent thought, like the swirl of activity at a professional sporting event distracts from the product on the floor. 

The Patient

The transition from provider to consumer represents a bit of a bridge over a chasm both deep and wide. The bridge is built on knowledge of outcome (both good and bad), acceptance of risk (as we know it better than most) and faith in others, rather than ourselves. The willingness of a person to override their fears and allow another to anesthetize and cut into their body is a rather awesome level of acceptance of risk and faith. In my opinion, this is greater for the “civilian” population than those of us with medical credentials, and as such, they deserve our overwhelming respect in that they hold us in such great esteem as to allow and request it. We as physicians know this, but seem to rarely acknowledge it.

All of this comes full circle to me sitting on a gurney in a thin gown with nurses, technicians and doctors buzzing around while I blather on in a Versed-induced fog. How will my joint replacement work out? I say a brief prayer, knowing that my physician will do his best, secure in his skill and excellence, but primarily in God’s providence. I will find out the details when I awaken. Like all patients.

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