110%er [6063]
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In physical pain this morning
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[20]
Posted: Nov 3, 2020, 8:23 AM
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I started a case yesterday at about 12:30, a Type IV paraesophageal hernia on a 50 some odd year old guy with a BMI around 30. His whole stomach, transverse colon, omentum, duodenum, and tail of his pancreas were all in his chest. He had pain every time he ate, shortness of breath, and had lost about 40 pounds in the last six months. I spend about 4.5 hours on the robot and it just was not coming down. The hernia sac was stuck all to both lungs, the heart, and the aorta. So I decided to open him and called my senior partner to come help. I am in utter shock that the old heads used to routinely do this case open, it is physical and back breaking labor. I had by elbow at this mans hiatus with my entire forearm in his right chest pulling down incarcerated omentum to finally get it all to pull down. Took us another hour to clear all the hernia sac off the hiatus and get it exposed, then I used about 8 pledgeted ethibond sutures and sewed it back together in the deepest hole I’ve ever had to work in, way harder and tighter space than all the rectal cases, pancreas, liver transplants, etc. Did a suture and tube gastropexy and closed up around 830-9. Hands down the hardest case I’ve ever done. Feeling this morning like I ran a marathon and did some qweer crossfit routine.
Did not get to cook the salmon that was on the menu last night. The whole week’s menu is now thrown off.
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CU Medallion [63526]
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Eeewwwwww!
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[5]
Posted: Nov 3, 2020, 8:27 AM
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Hope there was no Rona in there!
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Oculus Spirit [94086]
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I read all that and came away with.......
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[6]
Posted: Nov 3, 2020, 8:27 AM
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damm his menu for the week is screwed.
#GoodJob
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110%er [5852]
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Re: In physical pain this morning
emoji_events
[8]
Posted: Nov 3, 2020, 8:27 AM
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did you remember to check the lint filter?
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110%er [6063]
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Re: In physical pain this morning
[4]
Posted: Nov 3, 2020, 8:38 AM
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Dang it! I knew I forgot something
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CU Medallion [71537]
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I feel for you, but on the flip side, I bet
emoji_events
[5]
Posted: Nov 3, 2020, 8:28 AM
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you made what, $200? $250 from that procedure? Some people don't make that much in a week!
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110%er [6063]
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Re: I feel for you, but on the flip side, I bet
[4]
Posted: Nov 3, 2020, 8:31 AM
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Dude even though I get to practice independently here, I’m still paid like a fellow. I didn’t earn dickall. My reward is the sweet satisfaction of a learning opportunity
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CU Medallion [71537]
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LOL wut?
[3]
Posted: Nov 3, 2020, 8:32 AM
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If you'd left a rubber glove in his chest I'm guessing you wouldn't get indemnity for doing the job gratis, no?
I mean, I get it, but it doesn't seem right. Medical career pathing is just bizarre.
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110%er [6063]
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Re: LOL wut?
[3]
Posted: Nov 3, 2020, 8:36 AM
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Just did some quick math, if I did this case next year at a pretty standard rvu conversion factor for private practice, it would be about a $1800 case. My malpractice is covered by the hospital here, but if I’m named in a suit or even if it’s settled, I have to put that on all future license applications.
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CU Medallion [71537]
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I'm assuming that for cases like you just described,
[3]
Posted: Nov 3, 2020, 8:38 AM
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that would generally be your only surgery of the day? Or would you have to scrub up and move to the next one?
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110%er [6063]
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Re: I'm assuming that for cases like you just described,
emoji_events
[9]
Posted: Nov 3, 2020, 8:41 AM
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No, with the way OR block time works you usually will have 3-4 cases a day. Just before this one I did a sleeve on a woman with an LVAD to help her get a heart transplant. Fortunately those were my only two cases of the day, but yeah if something goes off the rails and you have more work to do... go take a leak, have a Diet Coke, and go get back to work. It’s hard to mentally clear the slate after a hard case, even worse when something actually bad happens and a patient gets hurt or isn’t doing well.
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CU Medallion [71537]
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Oof that hurts to even think about.***
[2]
Posted: Nov 3, 2020, 9:08 AM
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All-In [45582]
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Re: In physical pain this morning
emoji_events
[5]
Posted: Nov 3, 2020, 8:46 AM
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That brings back a lot of memories. My dad and I did that to a lot of female hitchhikers growing up in the 80's. Good times. Miss you Dad!
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CU Medallion [53682]
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Sounds like the time I helped my animal science major
emoji_events
[6]
Posted: Nov 3, 2020, 8:46 AM
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roommate pull a stuck calf. We were both shoulder deep in there trying to turn it. Wound up using a strap and a come along. My wrists and shoulders ached for 2 days after. If I’d had any thoughts about changing my major to AS, that cured me.
Mom and calf were find btw.
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Orange Blooded [3458]
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“You should see the other guy”***
emoji_events
[7]
Posted: Nov 3, 2020, 8:55 AM
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CU Medallion [62158]
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Lost 40 pounds and was still BMI 30
[2]
Posted: Nov 3, 2020, 9:01 AM
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####, just ####.
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CU Medallion [72065]
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^^^loves to spend his entire day inside of other dudes' guts***
[3]
Posted: Nov 3, 2020, 9:06 AM
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CU Medallion [69631]
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Hall of Famer [20181]
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TLDR version here for anyone interested:
[3]
Posted: Nov 3, 2020, 10:35 AM
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Didn't have seggs.
Worked.
Has salmon in fridge that needs to be cooked.
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All-TigerNet [14907]
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After all that, maybe you should think about a hiatus.***
[2]
Posted: Nov 3, 2020, 12:38 PM
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All-In [32381]
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"*About* 8 pledgeted ethibond sutures"?
[2]
Posted: Nov 3, 2020, 2:58 PM
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That sentence seems inexact and a bit worrisome.
(Just kidding, I don't shive a git)
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110%er [6063]
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Re: "*About* 8 pledgeted ethibond sutures"?
[1]
Posted: Nov 3, 2020, 3:06 PM
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Eh who’s counting
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