typical outpatient center has a waiting room for family, a dressing room, and a preoperative area where a nurse takes a brief history, an intravenous line is started, and you have a consultation with the anesthesiologist. (He may call you at home the night before and answer your questions and remind you not to eat anything after midnight). You are then taken to the operating room, your procedure is done, and then you go to a recovery area where you remain at least an hour or until you are stable enough to go home. A nurse will usually help you into the vehicle and give care instructions to your family or friends who are driving.
All in all, the outpatient surgical center is often more convenient for patients because there are not as many patients in the admitting area as in a hospital, and you probably receive more individual attention, purely on the basis of numbers; fewer patients allow the nurses to spend more time with you both before and after surgery. Also, because the acuity and seriousness of the procedures are often much less than in a hospital, the atmosphere is usually more relaxed and thereby more comfortable.
If you are in need of minor surgery such as hernia repair, breast biopsy, removal of small skin problems, or minor orthopedic or podiatric (foot surgery) procedures, you may want to consider an outpatient surgical center.
Chapter 8
THE EMERGENCY ROOM
If you have a touch of plague or meet up with a missile,
Or if your two-year-old has swallowed his brand new plastic whistle,
There is a place that's waiting for your rendezvous with doom...
It's your friendly, local, understaffed... Emergency Room.
The physicians are all dedicated to serve and save humanity
With nurses who are unafraid of squalor and profanity.
And if you have a mother-in-law who's getting on your nerves,
Give her a dose of poison and then call up the reserves.
As long as you can show the world you cared to send for aid,
No one will even ask you why the old bag swallowed Raid.
Just tell the friendly E.R. Doc, old mum was suicidal,
Give him one hundred bucks and he won't call it homicidal!
As recently as twenty years ago anyone with an M.D. degree could apply for and usually get a job working in an emergency room. It was generally a low-paying, thankless job that few physicians wanted, and it was often manned by licensed physicians who were in the residency training and needed the extra money. Now, most of these physicians were adequate, but there was also a whole host of physicians and “new M.D.” graduates who worked in the Emergency Room to augment their income and sometimes these physicians were not well enough trained to manage the more severe problems that presented themselves at the E.R. doors.
Today we are in a new century and emergency rooms have kept pace with all other areas of medicine. For the most part, physicians, working there, are highly trained specialists who have taken an accredited three or four year residency in emergency medicine where most of the programs have trauma center experience. When you arrive at a major emergency room, you can be assured that the staff can expertly handle all types of medical problems, including pediatric emergencies, heart attacks, trauma, lacerations, and gunshot wounds as well as colds, asthma, flu, back aches, and broken bones. It's a whole different world today, and the quality of care has taken a giant step forward.
All major emergency rooms are required to have an on-call panel of specialists who can take over in their specialty after the patient has been seen, evaluated and at least temporarily stabilized by the E.R. physician. These usually include primary care physicians, pediatricians, general and vascular surgeons, cardiologists and cardiac surgeons, neurologists and neurosurgeons, psychiatrists, ear, nose and throat specialists, eye doctors, and orthopedists. These physicians usually have to be available to arrive at the hospital within thirty minutes of being called. Frequently, the emergency patient may be uninsured or minimally insured, and the physicians who take “all comers” are usually donating a significant amount of their time and service “gratis” to the indigent and needy, and should be commended for this.
It is important for the public to realize that the emergency room is not a clinic to be used because it is convenient. If patients have minor problems, they should contact their own physicians during the day rather than crowd an already overused system in the middle of the night with common colds and minor problems, that could wait till morning and be seen to by a family physician or general practitioner.
Frequently, when the place is very busy, the nurse in the waiting room will use a triage selection system to bring the sickest patients in first. This sometimes leaves those bypassed very angry and complaining because they often do not see the urgency of the patient who is taken before them. Obviously, a patient with a heart attack in progress or a stroke needs to be seen immediately as a life-saving measure; similarly, patients who are bleeding or having difficulty breathing, as with severe asthma, must be attended to as soon as possible. So the E.R. physician pleads for understanding and patience from the public.
The emergency room is also the “dumping ground” for the obstreperous, obnoxious, and sometimes dangerous patient who has overdosed on illegal or legal drugs and the alcoholic with one of the many complicating problems of acute alcoholism. These patients are often very difficult to manage and try the most patient, considerate nurses and doctors.
Another use for some emergency rooms is as a minor surgery site. Many physicians, especially those who work in the hospital all day, find it more convenient to meet their patients in the emergency room for giving injections, taking blood, doing spinal taps, removing small skin lesions or checking on problems with surgical wounds. Frequently, I will ask a patient with a problem to meet me in the emergency room so I can evaluate the condition and have the option to run more tests, admit the patient, or send the patient home.
So, if you need to visit your local emergency room, be aware that these doctors and nurses are highly trained and able to help you, but they also have a job which can at times be stressful, difficult and tiring, and they need your understanding too!
Chapter 9
THE PREOPERATIVE WORKUP
I've fallen in love with Betty, the gorgeous preop nurse,
I keep on having surgeries, so we can just converse.
I've had three hundred blood tests and forty EKGs,
And had 600 xrays from my tonsils to my knees.
I think that Betty knows me now, but how shall I explain
The reason I keep coming back, perhaps she'll think I'm vain.
I think I'll have a heart transplant, and then I'll have a chance.
If I give her my own heart, she'll know it's true romance.
Surgery is obviously a stress on the human system. Not only the emotional anxiety of going through a procedure or worrying about whether you have some severe problem that's correctable, but also the physical impact. This type of stress, from the anesthesia to the actual surgery itself can be anticipated by your doctor, and to evaluate the situation he will perform certain tests in the days before you go for your surgery.
The first preoperative workup is
