Thursday, June 26, 2014

Last Minute Decisions and Iffy Results



Last Minute Decisions and Iffy Results



So this morning I made an error. I call it an error, say of judgment, rather than a mistake, because split semantics aside, it came off a gamble I took which didn’t pay off as it should have because of unexpected circumstances beyond my anticipation.  There was this case we had posted for surgery a week (10days?) ago and back then we had reviewed the case and had decided to go for a full thickness (epithelium+ connective tissue+ periosteum) flap. But today when the patient turned up for surgery and was prepped, anaesthetized and ready to be operated on, I took a long, long look at the operating site and my surgical judgment (my intuition?) telling me that with a split thickness flap (a half-way flap) will give better results and also help in preserving the donor site from where I was going to harvest the graft and then stitch it to the new (deficient site), I made the split-second decision to go for the tougher to do split thickness flap instead of the agreed on protocol and proceeded to raise a beautiful split flap. And then came the anti-climax. 

The theatre staff handed me 3-0 sutures which is what they had ready for a full flap while I prefer to use a 5-0 suture (thinner one) to stitch a thinner split flap. Although the theatre IS  supposed to have all sizes of sutures at all times (for all surgeries) somehow they did not have what I wanted right then and I had to make do with the had – a 3-0 size only which dint really fit the thin flap I had taken. So I wasn’t really satisfied with the end result of my surgery and will eagerly wait for next week when the sutures come off to see the result – fingers crossed. 

The thing is I am still in a dilemma about whether I should have stuck to my original surgical plan frozen a week ago or should I have made the call to change the design at the moment of surgery. Do good intentions excuse an error of judgment? What if the gamble had paid off, as it would have if the nurses had properly stocked the operating theatre? There are so many “IF’s” but no clear cut answers. The only thing of certainty is I took a risk and it didn’t come off as it should have – maybe a 70% success rate only- which may be good enough for the patient but still is kinda hurting to my ego. So was I justified in giving precedence to my surgical skill over the team decisions by invoking my privilege as the operating surgeon? The jury’s out till the sutures come of…and till then feel free to pop in with your views on what I should or should not have done.

Thursday, June 19, 2014

No Shame In Saying I Don’t Know, Is There?



No Shame In Saying I Don’t Know, Is There?



So they called me today all of a sudden in the middle of my canteen break (for those of my readers from countries which were never under the shadow of the British Empire – a canteen break is a midmorning visit to the in-house cafeteria – say around 11am- for a coffee/tea) with an emergency call and unlooked for appearance of a postgraduate student standing beside my cafeteria table, staring morosely down at my tea before saying “they want you back at the department sir, something not right with the laser”.

So I leave my half drunk tea on the canteen table with a look of longing and hurry back to the surgery room screaming “What? What? What? What happened?” to find the two guilty persons who tried to use the laser unit in my absence (temporary/tea break) adopting an unconcerned “we are not responsible” look. Seems they had tried to do a case (a surgery) all by themselves and the laser had malfunctioned and they tried to lay the blame solely on me saying that “you were the last person to use it” to which I replied irritably “yeah and I left it in good working condition just a few minutes ago”. For I knew they were trying to pin the blame of the malfunctioning unit on me and try to appropriate my next month’s salary towards repairs for the at-fault laser unit- on the principle that the last person gets blamed and foots the bill. 

So I went up to the unit and checked it and found it was working fine. Surprised I asked them to demo to me what they were doing with the laser. So they sat there the two of them and applied the laser to the anesthetized patient and waited for it to start cutting and then after a few minutes they turned towards me and said “See, its not cutting”. Whereupon I asked one of them to vacate the seat and sat down took the laser in my hand put it near the surgical site, operated the foot switch, cut the tissue and showed them “see, it works now, by magic”. The poor fools had not realized that the laser operated with a foot switch which they had comfortably left all alone between the two of them and neither of them operating it and they had thought that you just need to point a laser at something for it to start working. And of course they had thought they could do it in my absence in the mistaken belief that what he does we can do too- without learning at least the basic functions of the machine. 

Which shows once again that people would pretend anything except to accept their ignorance of something. I hope they all realize soon that it’s never too late or too much to ask for help and its definitely no shame to say those three magic words “I don’t know”.

Tuesday, June 17, 2014

Lasers Vs Conventional Surgeries



Lasers Vs Conventional Surgeries

For those who ask me why lasers, well I got a one word answer for you (well, actually two words) – no sutures. Remember those sharp curved long needle things with threads attached to them which doctors poke into your body umpteen times and use weird contortionist positions to tie them into knots (knot after knot after knot?) well those stitches or sutures are “gone with the wind” baby when it comes to laser surgeries. Now coming to the other side of the argument that lasers are expensive to use and why surgeons are pushing lasers more than scalpel surgeries all the time and is it because it’s convenient for them and not for the patient. Well, I agree that surgeons more and more prefer to use lasers nowadays for even the simplest and shortest of surgeries. But it’s not only because of its convenience given that a laser surgery is done in a clean and bloodless field for laser automatically coagulates (clots) the blood vessels- thereby preventing bleeding and thereby allowing the surgeon to see what actually he is doing with sharp instruments and voila you get great results, which is what you want right?. And because the surgeon can work calmly with no blood and clear vision of the operating site – even in extremely bleeding sites like, for example, the tongue which is notorious for its rich blood supply and for bleeding excessively even for minor injuries and hence tongue injuries are a real bitch to treat (sample case below of a tongue tie patient -with a pronounced lisp- being treated by me with a laser during a tongue release surgery). And of course the USP of lasers – no stitches. Now tell me isn’t a laser worth the price?

The Tongue-tied patient


Me using the Laser to cut

Pulling back the tongue with a temporary stay suture to expose the undersurface

The End. Finis. Bye-bubyee