Friday, October 13, 2006
One of my mentors (in my book, I referred to him as Ken Rockford, and described him as a "goddamn grenade") used to go crazy if anyone said "Oops" in the OR. It was a ticket to the exit door, quite unceremoniously. Indeed, it makes sense: "oops" is not exactly the thing an awake patient would want to hear from the other side of the ether screen, knowing people were taking liberties with his various parts. But, when you think about it, the term is as common as an itch: saying it, in most cases, is no more conscious or important than scratching your head. The word is quite loosely tossed around, at the least of opportunities.
I was thinking about it as, for the millionth time, I let an "oops" pass my lips this morning in the OR. The occasion: placing a simple stitch in the skin, closing the small stab incision I described a couple of posts ago. One end of the suture slipped through my fingers as I tied it, leading to exactly zero problem, and taking an extra two seconds as I picked it up and finished the knot. But "Ken Rockford's" voice shouted in my head as loud as if he'd been in the room. The patient was asleep; no harm, no foul.
Hernia repair -- about which I plan to put up a few posts in the near future -- is an operation I liked to do under local anesthesia; in fact, in training we used to make a big show of having our patients get up off the OR table and walk to the recovery room. And of course, I did lots of minor office procedures, and some less-than-minor things (breast biopsies in particular) in my office, on people who had reason to be nervous. Yet I never was able entirely to rid myself of the ooperative. Moreover, I tended to gab away at or with my awake patients; joking, telling them what I was doing, talking baseball, kids. So the sudden interjection of an oops tended to be a show-stopper. "What was that, doc? What's going on?"
In truth, I can't think of a time I actually got a question like that, because -- unable as I was to expunge the expression from my lexicon -- I was sensitive to it the minute it passed my lips, and I always managed to follow it with "sorry, sponge on the floor," or whatever truthful explanation there was. And then I'd often tell the patient about Dr. Rockford. Most people never seemed at all bothered. On the occasion when something of significance had happened, I'd likely say "oh, look at that. Got a little bleeding here, so I'm going to shut up while I fix it." Evidently, it would be said with enough calm that there'd be no headward panic. No emptying of bladder or bowels.
Given that in most ORs the default situation is a sleeping patient, it's not a rarity for someone to pop in and start talking, occasionally about things better left unsaid at that moment. I'm quite good at pantomiming "The patient is awake," even with a mask on. If anyone writes a book with that title, and I get it in a game of charades, I'm gonna kick butt.
I'm told -- I'd prefer to think it's a suburban legend -- that somewhere, sometime, some patient brought suit against his surgeon because during a procedure he heard the surgeon say "Oops." Convinced that it meant something bad had happened, he sued -- either for pain and suffering from the fright, or because there must have been a coverup. It's a good story. I think of that, right after the image of Ken Rockford tossing me out of the room way back then, whenever the word slips out. I wish I'd get over it.