tales from the operating room of the VA and a late memorial day tribute

The other day D, the intern (I like to think of him as the chief's intern: "cheifly" in charge of all the crappy things concerning surgical patients that the attending and higher level residents won't do), got stuck on the phone for 2 hours trying to find a next-of-kin to get a permission from. Let me set it up: the attending, who won't put in an AV fistula (basically, a dialysis tube) himself (because, hmmm, he's lazy?--D's still trying to figure that one out) didn't consent the patient for this procedure because he was going to pawn it off on the Interventional Radiologist. The problem--the patient needed dialysis within the next 24 hours, but by some law you can't consent a patient within 24 hours after they've been under the 'influence' of anesthesia. The problem was that the attending took the man into the OR (under anesthesia) for some other minor procedure and the Interventional guys wouldn't do the feeding tube (they tell this to D, of course, not the attending) because the patient was ALREADY on the operating table and a surgeon can put in this tube just as well as they can. (Did that make any sense--sorry if it didn't). Who is the correspondent in this battle of turfs and stupidity? Yes, that's right, my husband, who had nothing to do with the problem until after he finds out the great attending didn't consent the guy (which would have taken 10 seconds: Dr: "Will you consent to a fistula placement so we can give you dialysis?" Patient: "Yes."), gets stuck calling Radiology, calling the patient's Primary Care Dr., calling his Nephrologist, etc., AND THEN calling around to find a next-of-kin who is actually home. He finally gets ahold of a sister who lives in Oregon who says, yes, a central line would be okay (and is probably wondering why in the heck the Dr.'s are calling her!). D's main consolation in this wasted 2 hours is that he gets to scrub in and put in the central line himself.

Anyway, to get to the point of the story (because really that was just a venting session courtesy of Dr. D): when the man wakes up from surgery, the conversation goes something like this: D says, "Hello, Mr. X (name changed). I talked to Shirley on the phone today and she gave us a consent to put in your dialysis tube."

Mr. X, "Oh, Shirley, I haven't seen her in months. How is she doing?"

D, "She's doing well."

Mr. X, "Did you tell her that you cut open my head and put a computer inside?"

D, "No. . . . .but I did tell her the sex change surgery went over without any complications."

At this point, Mr. X doubles up laughing and the med student who is following D around (perhaps looking up phone numbers?) get this look of horror on his face. He can not believe my husband actually said that to a patient. When D and his sidekick leave the patient's room, D looks at the med student and says, "Gotta love those Vets."