Quilting Jewels in Surgery

Boy am I happy I "pre-wrote" the last few days' blogs. I haven't made time to eat or sleep or do most of life's basic necessities since Sunday evening. I've worked...(counting on fingers)...well, too many hours. You guys don't care how many hours I've worked; that is old news. Plus, you'd probably yell at me!

I simply must detail the last two days I've had. I spent all of Tuesday and most of Wednesday in Surgery at St. Fozzie's. I'm doing the current state analysis for my Six Sigma project. I do not know what to focus on until I observe the current processes and document their work flow. I've spent some time in the OR (a few times as a patient) and twice as a fellow at St. Fozzie's. Most surgeries start to look alike, procedurally. I'm getting used to the OR and no longer feel like I'm on Mars when I visit.

[In the back of my brain, I'm wondering if I'm trying to make sense of my own OR experiences and understanding what I went through as a patient.]

Anyway, I documented at least seven possible process improvements, just in Intra-op alone. I didn't even observe Pre-Admit Testing, Pre-op, Holding, Regional, Post-Anesthesia, or Phase II Outpatient. So my middle name on Tuesday was "Information Overload."

While I was up in surgery, I watched four complete cases. One was a gastric lap banding, during which a laparoscopic incision was made in the patient's belly button. The surgeon, using a camera to guide, placed the lap band around the top of the patients' stomach. It's a weight-loss procedure and the patients lose drastic amounts of weight. The second case, same surgeon, was a repair of the port they use to tighten or loosen the band itself (allowing the stomach to increase or decrease in size). It was transitioned to a full laparatomy and I was actually not faint as I gazed at a person's insides. Honestly, what got to me was the Bovie, the laser surgeons use to cauterize the blood vessels to stop the bleeding. Burning flesh is a scent you never want to smell.

So on Wednesday, we went back up in the OR to follow two additional cases. Learning from the previous day's flesh-smelling terror, I used the ol' doctor trick and put a dollop of Vick's under my nose. Worked like a charm! I was able to observe the orthopods reset a boy's arm (the cracking together of bones was a little gross) and then I watched a procedure that no man should have to endure...

The gentleman had a cancerous area between his testicles on the seminal tube that runs between them (I'll wait while you go check your Gray's Anatomy textbook). The surgery entailed a cutting open of the scrotum, removal of the cancerous area, insertion of "support" ligaments to keep the testes in place, and a re-sewing of the scrotum. I tried averting my eyes from the case (it was just weird), but how many people can really say they've seen a scrotum being cut open? And better yet, being sewed back up again? I really admired the surgeon who completed the suturing...she looked as though she was sewing her mother's quilt, not a poor guy's jewel case.

After the time in Surgery and a couple of meetings to discuss our preliminary results, I slipped out of my scrubs and back into my suit. I climbed in my car and drove across town for a big strategic planning meeting with the Chicago Boards. The planning meeting went well, but it went until almost 10 p.m. Again, I was acutely aware that I was the youngest in the room by 20-25 years, but I've beginning to develop a good rapport with several physicians (I *am* their kids' ages, after all). I learned a lot but by the time I staggered through the door to my house, I was among the walking dead. I honestly don't remember what I did last night...and 5 a.m. the next morning came awfully fast.

Is it bad that I hate my alarm clock with every cell of my body?!