Wednesday, October 11, 2006
My aunt tells me this: (I have no recollection, but it makes some sense, considering.) My dad, she says, was taking me and my brother to a baseball game one day, when I must have been around five. Excited at the prospect, I ran up the street to tell my friend, instead of heading to the car; engine likely already running. My dad was many good things, but patience was not an attribute. As he drove off without me, I ran after them, crying; then stopped and stood there, crushed.
I really hate being late.
Throughout my career, the only schedule more sacrosanct than my office was that of the operating room. I was close to insane about it. For reasons I could never understand, some surgeons are never on time, routinely showing up at least a half-hour after their scheduled start time. It is, in my opinion, the height of rudeness: start your case list late, and the effect dominoes through the day and into the night, screwing up the plans of patients, OR personnel, other surgeons. I know: things happen. Even I arrived tardy once in a great while. But I know from 25 years' experience: on time can be done. Most often, I arrived in the OR at least a half-hour before my scheduled time. I never wanted to be the cause of a late start -- and late starts drove me crazy.
Making it worse, I always felt that a start time is a cut time: at 7 a.m. I expected to drop the knife, not see the patient rolling down the hall on a gurney. In fact, most ORs came not only to expect and appreciate it, there were a few that loved to see if we could get the first bandage on by the scheduled start time (especially likely if the first case were a pediatric hernia.) And when I had several cases lined up, I'd help move the patient on and off the table, get stuff for the nurses, help set up equipment. As a result, I got great turnover times (the time between cases): the whole crew would get into it. Which made me feel good, because if I delayed the surgeon scheduled after me, I felt like a criminal. It almost never happened, whether I had one case on the list, or six. Besides, I had patients to see in the office, and it's even worse to make yourSELF late!
Which brings up another point: when I told the OR scheduler that a case would take twenty minutes, or an hour, or three, I meant it. Orthopedic hours, as far as I can tell, have somewhere between 90 and 120 minutes in them. Plaster, I guess, affects the space-time continuum. Once again: things happen. A twenty-minute appendectomy can take a couple of hours; the belly can hold surprises. But I know it's possible to be pretty predictable, because I was.
I took call at least every third day/night, often more. My practice was no less busy than anyone else's. Yet I managed to run my office like a damn train schedule (the non-Amtrak kind, of the days of yore). My nurse would schedule a patient at 10:05, and tell her "That means ten oh five!" Got lots of incredulous compliments. Both of us did.
There are no mysteries here. I don't have any special secrets other than to be thoughtful when scheduling, and to be fanatical to the point of insanity. It's a good thing for everyone, with the possible exception of oneself.
Oh yeah. One more thing. I'm writing this in the surgery lounge, waiting for the surgeon I'm supposed to assist to show up. So far, we're an hour late. And counting. Counting. Counting.