7A to 7P Again

My turn in the on-call barrel again today. I’m on the 7 am-7 pm day shift, first call. It’s now nearly 8 pm and I’m still working, which is often the case. Our practice’s custom is to finish the cases we start, except in exceptional circumstances.

There’s no general agreement or “rule” on how we handle these cases that crop up near shift-change time. This case was posted for 6 pm, which everyone knows is tongue-in-cheek. A Saturday evening case near OR-staff shift change simply is not going to start on time. If I have reasonable confidence that a case will end by 7pm, or shortly after, I’ll do it. This one was less certain, so I decided just to suck it up. At this point, my evening is spoken for, so another hour or so in the OR won’t make or break it.

Anything later than that, or certain to last for hours on end, and I’d have asked the incoming person if s/he wouldn’t mind coming in a bit early. I did that very thing for a partner a few weeks ago, and was glad to do it. Common sense – and common courtesy – should prevail whenever possible.

Plus, there are some cases you don’t want to turn over to someone else after you’ve started them, because it can be hard to get into the “flow” of a case if you haven’t handled it from the start. That’s not a big deal for the “simple” stuff; a good bit of what we do could be handled by a docile chimpanzee.

This case is kinda in-between simple and not simple. The patient is a middle-aged woman with an intestinal obstruction due to a section of large bowel twisting upon itself, thereby interrupting its own blood supply. When bowel becomes ischemic from lack of blood flow, its walls can begin to break down and leak bacterial toxins into the bloodstream, causing sepsis. This syndrome of overwhelming infection, and end-organ complications, can rapidly kill. Things have not yet gotten to that point, thankfully. She’s been stable for me, but I think she might be in for a rough few days.

I started the day with an early back operation, lasting until around noon. Uneventful. Had a few loose ends to tidy up on our Acute Pain service, which I’m also covering this weekend, so I didn’t get to spend much of the afternoon at home before this case was booked. That’s how it goes. You never know what’s gonna come in across the transom. Therein lies both the challenge and the terror.

I do it all over again tomorrow morning. I’m third-call, day shift. Hoping to sleep in a bit, maybe have my coffee in my pajamas, on the porch. There, I’ve jinxed myself.

Michael Sebastian @mikeseb