Picture of Ian Ross, MD

Ian Ross, MD

Another Day in the Trenches

It is late afternoon. I have finished my elective ORs. I have to pee; my bowels churn. I am a little hungry. Two consults in the ED await. Nothing urgent. But there was/is the constant threat of a stroke or something bad coming in. Business as usual, and I find out, at the last minute, that there is a Department of Surgery meeting in an hour. Uggh.

It is a Zoom meeting (actually Microsoft Teams). Better, right? Not exactly. I am going to have to go to my car in the parking lot, get my laptop, find an empty conference room, plug in and get going. It is still early, but the meeting can go long and who knows what will happen with the ED. So, I am going to have to go the cafeteria, and get a very early dinner.

Now in the old days, there were not so many meetings. And you had to show up in person. And they would provide dinner. And the medical staff office would figure out a way to remind you about a meeting sufficiently in advance. Now the medical staff office is virtual, and reminders are sent through the hospital email system. That system is so full of messages, that I rarely check it … if I responded to all the messages, I would not have time to get anything else done. Oh, and the medical staff office is also virtual, staffed by people living as far away as Montana and Idaho (really!) who have never set foot in the hospital proper.  They have never met their co-workers and “physicians” in person.

There is something there, something that you can get from a Zoom meeting, for sure. But let’s face it, it is never the same as actually being physically present. We all learned this during COVID. Telemedicine is great when it is all you have got, and serves a good purpose, still, in many situations. But should it replace all in person meetings?

I have missed the last two meetings, mostly because I did not know about them. I really must make this one work.

Decisions, decisions. I run to the car and get my computer, find a spot for “the meeting” and set up. I rush to the ED and see the easier of the two consults, one of those “nothing” traumatic subarachnoid hemorrhages (little old lady with a fall and a black eye and low-dose apixiban, but not even a loss of consciousness) that used to get sent home in old days because they are so small that they were not visible on the scans. Today, with such good imaging they get picked up, given factor concentrates and placed in the ICU by trauma docs looking to increase their daily census of “critically-ill” patients. It turns out to be exactly this type of scenario, so I bang this one off, run to the cafeteria to get some food and sit down in front of the laptop. I am only 5 minutes late. The meeting has not started yet. After a few acknowledgments, I turn off the camera and microphone and slurp down my early dinner. It is only 5:35 PM. I eat when I can. I learn about updates to EPIC (our newest EMR), progress with OR turnover (it is honestly worse that it has ever been) and other wondrous efficiencies that our merger with a bigger hospital system has brought. I am more interested in infection control, and pick up that there have been zero infected prosthetic joints over the last year (which makes me very happy as I am slated to get a new hip joint soon). This is the general information part of the meeting. We have been going 30 minutes and are not even half through. At least I got some other work done, on my phone, at the same time.

Suddenly my phone goes off with an alert that a CT angiogram (CTA) was just completed. I get on the app that lets me look at the CTA. The neurologist calls me at the same time, and we agree that it looks like a large vessel occlusion, one that I should go after, for a mechanical thrombectomy. It is now after hours, so the interventional radiology (IR) team has gone home. It will take about 30 minutes for them to get to the hospital, and another 15-20 minutes to get started.

I leave the meeting, sort of; I am still muted with the camera off. I just leave well enough alone, rush to the ED, which is not far away and see the patient. I get my assessment and the “paperwork” done in no time flat. Acute stroke management is one thing in the hospital that does work well. Patient is now on autopilot. I am on the clock, but I know how things play out and I have about 20 more minutes till they will be ready for me to stick the groin.

Back to the laptop. The executive session where we do the peer review is now just starting. I switch on the camera and mic, state that I am going to have to “leave early” for an emergency, and ask that my cases for final peer review assignation get moved up in order, which happens. Luckily, they are straightforward, and I had been able to refamiliarize myself with them during the early part of the meeting when I was eating and they were going over a lot of drivel. So, I blow through those neurosurgery case reviews, formally sign out, and am in the IR cath lab before the patient gets there.

Thrombectomy goes well, I get to the ED to see the other, more complex, consult that was waiting for me and then see another quickie consult. I get home by 10 PM. Elective cases, done. Check. Consults and emergency case, done. Check. Surgery meeting, done. Check. And I even got some dinner.

European advertisements, both for television and print, tend to be much racier than those that we get on this side of the pond. There exist compilations of the best ads of the year which I have enjoyed looking at over the years. One, a German ad aimed at television advertisers and their reliance on ratings, recently popped back into my mind. It showed a couple in early stages of making love, on a chesterfield in front of the glow of a television, totally into each other, oblivious to whatever was on the TV. The caption read, “Just who do you think is getting screwed?”

Perhaps I should be ecstatic that I got to provide all this clinical care, do some other administrative chores, and still “attend” the surgery meeting? I did what I had to do. I did not lie to anyone. But this technology does allow for us to multitask in ways that were not intended, and I am often not sure that somebody is not getting screwed by such behaviors.