Things to ask the surgeon before you're under

I've had a few procedures that I've been out for, but the only operation I've ever had was when I had my wisdom teeth yanked. That was back in the day when you went into the hospital to have your wisdom teeth out. I believe the reason was that insurance covered a hospital stay (and full anesthesia in an OR), but didn't cover the dentist's office. I don't even know whether dental insurance existed back then. I was 18.

Anyway, I don't have a lot of first person experience to draw on here. Most of my surgical experience is second hand, hanging around the family waiting room, waiting to hear from whoever was operating on my husband.

Over the years, Jim underwent three major surgeries, and as far as I know not one of his surgeons abandoned the OR while my husband was under their care. That's as far as I know. Two of the three surgeons became pretty friendly with Jim, and the other guy seemed great, so I pretty much trust that they were there throughout. I did get to talk to all of them afterwards, and never had an inkling that any of them went AWOL.

But every once in a while, there's a story about a surgeon going taking off. One I remember was a drug-addicted spine surgeon who took off midway through surgery to deposit his paycheck in the bank. (This doctor, David Arndt, was just all-round bad news, and ended up losing his license and in Federal prison.)

Then there was the hoopla a few years back when it was revealed that some orthopedic surgeons at Mass General Hospital were performing multiple surgeries simultaneously, waltzing back and forth between ORs. Teaching hospitals often schedule surgeries with a slight overlap, in which Dr. Big leaves it to a resident to close a patient up while they move on to their next. But what was uncovered at MGH was surgeries scheduled to overlap for a number of hours. 

Anyay, there's now another scandal: a surgeon who left the OR at Boston Medical Center prior to performing an emergency ankle operation. Dr. Tony Tannoury grabbed something to eat, went to eat it in his parked car, and conked out, missing the procedure entirely. Fortunately, the chief resident was able to take care of things. 

But Tannoury has received a reprimand and a $5K fine for his lapse in judgement. 

In a recent ruling, the state board [Massachusetts Board of Registration in Medicine] concluded that Tannoury, who was the attending surgeon for orthopedic trauma emergencies that night and had escorted the patient with the resident into the operating room, had “engaged in conduct that undermines the public confidence in the integrity of the medical profession.” (Source: Boston Globe)

Tannoury will also be required "to complete five continuing education credits in “professionalism” and review regulations for supervising residents."

Fortunately, the outcome of the Tannoury-less procedure was successful. The patient was fully informed about what happened, and all charges were waived. 

I can't imagine the pressure that surgeons are under, and how exhausting their work is. But let's use a little common sense here.

If you're too tired to perform an operation, shouldn't you, like, tell someone? Surely, there are policies and procedures that address situations like this. 

I can understand wanting to grab a quick snack before operating - I sure wouldn't want my surgeon's energy drooping while I were under their knife - but if you're feeling at all groggy, for god's sake, don't go sit in your car to eat it. That's a recipe for nodding off. Eat in the hospital caf, and if your head hits the table while you're eating, there's someone around to shake your shoulder, wake you up, and get you on your way to the OR. 

Still, although I'm not sure I'd want it to happen to me, Tannoury's infraction seems forgivable. Stupid, yes. Careless, sure. But forgivable. 

Meanwhile, in the aftermath of the simul-surgery brouhaha - which Tannoury, although not at MGH, was lightly caught up in - the rules have changed. 

In 2019, the state medical board tightened regulations for surgeons who leave operating rooms before operations end, including when they are managing overlapping procedures...

The revised regulations, which medical experts described as among the most-far reaching in the country, require doctors to provide more information to patients beforehand about who will be participating in an operation. They also require hospitals to document each time a lead surgeon enters and leaves the operating room.

Surgeons used to carry pagers. Not sure whether cell phones have replaced this old technology, but maybe there needs to be a checkstep in which, when the chief surgeon is gone for a bit too long for a bio break or snack attack or whatever, the second-in-charge buzzes them. Maybe all Dr. Tannoury needed was a little bit of a jolt.

Me? I'm unlikely to get out of life without having an operation of some sort. I always have questions for doctors. I'll just add a question or two for the surgeon about whether they're planning on being around for the entirety of my operation, and in whose good and steady hands they'll be leaving me if they need to check out for a bit. 

As long as they're not taking off to deposit their paycheck, I'm cool with grabbing a bite or a bio break. I just want to know what the plan is. Even if I'll be under and clueless about what's going on in the conscious world.