Tuesday, November 12, 2013

Dr. Orthochick: Pre-op

Patient A.G. is involved in a motor vehicle accident on December 27, 2011. She requires emergency neurosurgery and is admitted to the hospital. On December 28th, 2011, A.G. begins experiencing knee and ankle pain and orthopedic surgery is subsequently consulted for further evaluation. Dr. Orthochick diagnoses the patient with a left tibial plateau fracture and pilon fracture, both of which will require surgery.

Orthochick asks the trauma attending, Dr. Sicu, when the patient will be cleared for surgery. Dr. Sicu says to wait until the weekend. Orthochick tells her attending, Dr. Germaphobe the news. Dr. Germaphobe says he is going away over the weekend and to call his partner, Dr. Innocuous to do the surgery. Orthochick calls Dr. Innocuous to see if he's available, he's not. Orthochick reports back to Dr. Germaphobe, who says he will do the surgery the following Thursday. Orthochick tells Dr. Sicu.

Dr. Sicu discharges the patient to the rehab part of the hospital.

2 days before the surgery, Orthochick goes over to the rehab part to start getting things in order. The nurse tells her that A.G. has been having more headaches and that the rehab attending, Dr. Physiatry doesn't want her to have surgery. Orthochick speaks to Dr. Physiatry, who says that it's fine with him if it's fine with neurosurgery. Orthochick calls Dr. Brain of neurosurgery, who says it's fine but to not put A.G. on any anticoagulation afterwards. Orthochick realizes that this means that A.G. is at a high risk of developing a blood clot because she won't be able to walk for 6 weeks after the surgery and subsequently consults Dr. Filter of interventional radiology for placement of an IVC filter. While documenting this in the patient's chart, Orthochick sees a note from Dr. Monday of plastic surgery, who was consulted for A.G.'s facial fractures. Orthochick thinks it would be a good idea for A.G. to have both procedures done at the same time and calls Dr. Monday to see when he's available on Thursday. He says he's available after 15:30. Orthochick then calls Dr. Germaphobe's office to see what he has doing on Thursday. She discovers he has Thursday free after 13:00 and schedules A.G.'s surgery for Thursday starting at 13:00 with Dr. Germaphobe and Dr. Monday will scrub in after he's done, which will be around 15:30.

Dr. Physiatry calls Orthochick to let her know that A.G. won't be able to come back to the rehab facility until she's off IV pain meds. Orthochick figures this will be a 2-day stay and gives Discharge Planning a heads-up.

Orthochick explains all this to the patient, who is in agreement.

On Thursday, the day of surgery, Dr. Physiatry discharges A.G. from rehab, and she goes over to the main hospital. She is met by Dr. Filter, who puts an IVC filter in her. She then goes to the pre-op area. She's brought to the OR at 13:00. Dr. Germaphobe finishes around 16:00, Dr. Monday finishes around 17:30. A.G. is brought to her room around 19:00, in stable condition. Orthochick has been in scoliosis clinic all afternoon as scheduled, so Dr. Engineer is the resident in the surgery. Dr. Engineer then goes on vacation, leaving Orthochick to round on his patients, including A.G. A.G. is sent back to rehab on postoperative day 4.

I swear, sometimes it's the surgery that's the easy part.

P.S. Only a few hours left to get The Devil Wears Scrubs for only 99 cents! It's Dr. Orthochick-approved!


  1. For whom is the price .99? Followed the link and got told it would be $1.99. shortly to rise to $2.99. Not upset as even $2.99 is cheap. Just wondering.

  2. Just another day at the office... or medicine floor.

  3. I totally agree with that "Sometimes it's the surgery that's the easy part."

  4. combo cases are always like this. torture, and sure to fu the schedule.

  5. I would just like to say...Dr. Orthochick is obviously awesome for setting all of that up!