Haven't you all heard this one before? The surgeon that just needs "15 minutes to do a quick I&D".
So you open a minor pack, open a minor tray and wait for the pt to roll in. The surgeon comes in, briefly glances at your table, pays attention during the Time Out, and then sits at the circulator's computer to write orders, dictate, follow up on labs, etc.
The pt is prepped, he goes out to scrub, comes back in to get gowned and gloved. You help him drape the pt and pull up your mayo stand. You have everything ready to go, and he says, "Oh. I need a doppler and an ultrasound machine."
So the circulator runs around madly trying to locate a doppler box, the ever elusive fancy new ultrasound machine, and calls central sterile for a probe. She comes back into the OR 10 minutes later, victorious in her search for the new ultrasound machine. Central sterile calls the room to inform the nurse that all of the probes are unsterile. So you have to wait for a sterile one.
The surgeon doesn't want to wait for a sterile probe for this fancy new ultrasound machine, so he asks for the old one. The circulator goes back out, looks everywhere for the old ultrasound machine, finally finds it after 10 more minutes of searching, gets a drape for the probe and sits down to chart.
"Can I please have a sitting stool?", requests the surgeon. The circulator gives up her stool, and stands while continuing to chart. "Can you please adjust my stool? It is too low." The circulator stops charting again to adjust the stool.
"I forgot to get some eye protection. Do you mind getting some for me?" The circulator is cussing the doc out in her mind, and gets the damned eye protection.
A harried resident rushes into the OR. The surgeon looks at the clock and asks why the resident decided to show up for a scheduled surgery 30 minutes late. The resident looks at the circulator accusingly, and says, "Well, if someone had PAGED me to let me KNOW that the pt was in the room, I would have been here on time!" To the surgeon's credit, he responds, "You are an R3. You know that surgery starts at 0730. It is YOUR responsibility to keep a pulse on when the pt arrives to the OR. I was here. Nobody paged me. So why should the circulator page YOU?" (I had to keep myself from clapping at this point.)
Ultrasound done, surgeon is ready to cut. Incision is made, exploration is underway. "Can I please have some 6-0 prolene? And can you please load it on my specialty Castro's?" The circulator runs out again in search of 6-0 prolene and calls central sterile for the specialty Castro's. We wait for 15 minutes while central sterile sends up the tray.
Oh dear, we hit a BIG bleeder. "Do you have a sterile tourniquet?" asks the surgeon quietly. The circulator goes out to find a tourniquet machine and the appropriate size tourniquet. 5 minutes later, she returns with the machine and asks the surgeon which size tourniquet he wants. "Oh, I think we have the bleeding controlled now. Don't bother."
The pt is VERY squirrely since he is having his procedure done under MAC. "Can I have some local please?" asks the surgeon. The circ returns with 0.25 Marcaine. "Um, can you please mix this with Lido 1% 1:1 with the Marcaine?" The circ goes back out to get the Lido.
Debridement begins, and we are coming down the home stretch. "I have been meaning to try that new bipolar that is on trial now. Do you think you can get that for me?" asks the surgeon to the circulator.
Not being able to stand this high maintenance charade one minute longer, I very 'un-PC like' responded, "Dude, you said you needed a bovie and a hemostat for this 15 minute case. You have been running the poor circulator to death. We have been in the OR for an hour now. Can you PLEASE land your plane?"
Moral of the story: NEVER believe a surgeon when he says that he can do ANYTHING in 15 minutes.
ChristineAdrianaRN, BSN, RN
1 Article; 168 Posts
My, you work with a needy doctor!
I had my first case of actually the opposite a couple weeks ago. We got a new heart doctor, and I don't know him at all, and with that, coupled with my newness, I wanted to make sure I was SUPER prepared. I am also experienced enough as a nurse to never believe the "Oh-I-just-need" spiel. It was a pectus bar removal, and he said, "Oh, I just need a knife and a heavy needle holder." "YEAH RIGHT," I thought. I opened up the whole pectus tray and had all sorts of stuff ready to open the kid's chest. When the kid came in, I realized with a sinking feeling that he might actually only need what he said. The bar had slid laterally and was almost poking out of the kids' torso. He cut the skin, the bar sprung out, and he grabbed it with the needle holder and yanked and that was it. It was literally a 10 minute procedure in total. I sighed and was like, "Can I get you anything else?!" and gestured to my heavily outfitted back table and he just smiled and said, "I told you all I needed was a knife and a needle holder."
I guess better to be prepared....!