It has been a while! Today I’ll be sharing a personal experience. For the first time since becoming a surgeon, I had to undergo surgery myself. Nothing crazy. I had appendicitis and underwent a smooth laparoscopic appendectomy. I want to share my experience and thoughts on how we care for our own patients.
I was in clinic on a Thursday. Around noon I felt mid abdominal discomfort that I attributed to being hungry. I ate. Pain did not improve. Over the course of the next few hours, I felt more discomfort and slight nausea. Around 5PM I went to the hospital to see a consult. As I was seeing the patient and obtaining consent for a procedure the following day, I felt worse and the pain had migrated to my right lower quadrant. I placed the consent in the chart, wrote my consult note, put in the orders and let the hospitalist know that I had the patient set up for a leg angiogram the following day.
I went downstairs and decided to sit down for a little. Noticed that I was slumping, walking much more slowly and carefully than I normally do. Started pushing on my right lower quadrant and elicited pain. I knew I had appendicitis, but still wanted to see if it got better. The hospital I was at has a very busy emergency room, so I decided to go back to my office and ultrasound myself – yes, ultrasound myself to see if I could make my own diagnosis. On the drive to the office every time I hit a bump it would hurt. Again, in my mind confirming the diagnosis. Got to the office, used the curved probe but could not conclusively locate my appendix – I am a vascular surgeon, so not proficient on testing for appendicitis.
Called my wife, she insisted I go to the ER, I just wanted to go home. I drove home. I laid down, watched Boba Fett with my 8-year-old son and felt good if I didn’t move. I work in a large hospital system that has about 5 ERs. I looked on my phone to find one with fewer patients (thanks iPhone Epic), and chose a hospital near my home. Once I got there I went to registration, there were no people in the waiting room. I did not share that I was a surgeon with the staff. They gave me my armband and sat down.
About 15 minutes later (around 10:30 PM) I was brought into the triage room, which ended up being my room for the remainder of the stay. The nurses came in full ER style – one nurse wearing a cool pair of cowboy boots who was asking me about symptoms, past medical/surgical history, last meal, allergies, and whether I felt safe at home. The other nurse, a traveler, quickly put in an IV in my left antecubital vein and drew labs.
A little while later the ER physician came in with a scribe and asked about symptoms. I told him I thought I had appendicitis and gave my history. Afterwards I shared that I am a vascular surgeon in our health system. He said he would examine me, see what the labs showed and set me up for a CT scan, which was the main reason I was there for. His examination was thorough and quick – full ER style. He offered me pain medication and I declined.
The CT tech came in and told me all about was I was going to experience. I told her I was somewhat familiar with the process (having taken hundreds of patients into CT scanners from the trauma bay in my residency training years), but that I personally had not had a scan. She was very professional, and we had a nice chat about vascular and interventional radiology, since she was thinking of pursuing training to become an interventional tech.
She wheeled me into the CT room. Was careful with getting me on the table. Looking up to the ceiling they had the usual scene to allay patients’ fears – a landscape with trees, clear blue skies (which are not typical for Seattle in January), and a bright sun. Got hooked up to the contrast injector and she explained who I would feel. After the injection I would feel warm throughout my entire body and potentially like I had wet myself. The former was the main sensation. As a general surgeon I knew the scan would be important. At my age, the top diagnosis was still appendicitis, but I had thoughts and even fears that maybe it was something else. In my mind it could also be right sided diverticulitis, perhaps a colon mass, who knows. My vascular surgeon self was not happy about getting exposed to more radiation. Maybe I should have worn my radiation badge.
In any case, I was already there and happy that I was going to get diagnosed. The tech explained the CT as going through the doughnut and having the CT slice me like a loaf of broad… I laughed since I tell the same thing to my patients. We went back to the room. The nurse came in to do my covid swab. I hate that test!
I waited for about an hour until the ER physician came in with my diagnosis – early acute appendicitis. Given my symptoms, signs and CT findings, he’s calling it. Unfortunately, the facility I went to has no general surgery. They send patients to the big hospital in downtown Seattle. I asked to be transferred to the hospital 9 miles (circa 15 KMs) north from my home in Seattle in the city of Edmonds. He said they don’t typically do that, but he would ask. This was my preference because I only recently started covering the two downtown hospitals. I know pretty much all the OR staff at Edmonds, so I felt more comfortable going there. I had seen them in action since they had helped me with a lot of tough vascular cases and they were always nice to me. The ER doc started me on antibiotics, I asked to get a fluid bolus since I was dehydrated.
The ER doc came back, told me that the on call surgeon had accepted the transfer, but since they had no beds (current pandemic overflow of patients and understaffing), they would schedule my surgery first thing in the morning. I had the option of staying in the ER until I had to go to preop vs going home. I went home, slept for two hours and went to the Edmonds hospital.
At 5:30 AM I was in registration. Left my wallet, keys and pager in the safe and waited for the nurse. She did not recognize me at first. We walked to preop and got taken to a room. The nurses did eventually recognize me and were nice and accommodating. As a surgeon I have cursory knowledge of what happens to patients in the hospital, but clearly not everything that goes into the process of registration to OR.
I was given my chlorhexidine wipes to clean my entire body. Yes, I was standing naked in the room using the wipes. Put my gown and hospital socks on and the nurse came back in when I opened the door. She went through the process of noting allergies, past medical/surgical history, medications, whether I had any falls and felt safe at home. The process is quite tedious, but necessary. Another nurse came in to place my IV. She wanted to use my hand, I asked her to use my cephalic vein at the wrist instead (you could drive a truck through it), she gladly put it there.
They got done with the process quickly, since I rarely take medications, and other than the weight I put on during the pandemic, I don’t have major medical issues. I also have not fallen recently and feel safe at home. The only person that attacks me is my three-year-old son when I get back home and he runs towards me to give me a hug. It’s not really an attack, but he’s a strong little guy.
I was wheeled to the OR. At the elevator I saw one of the scrub techs going in with two cups of coffee in her hand. She had a shocked face when she saw me. Asked her for a cup of coffee and the transporter said “absolutely not!” I was kidding, but congratulated my transporter for making sure my case wouldn’t get cancelled. I got wheeled in the PACU where they place the first cases of the day. I was behind a curtain but seen by enough people and some came back to say hello and chat for a little bit. I welcomed it, since it is always nice to catch up. I was given some preop meds for pain. I signed the consents, even filled out the one for the surgeon. The surgeon came in, we talked for a few minutes. He gave me the rundown, which I appreciated. Although I trained in general surgery and did a bunch of laparoscopic appendectomies, I don’t do them in my current practice.
The anesthesiologist came in. He’s a young guy that I’ve worked with a lot. He told me which meds he would use and looked at my airway (grade 1) and told me the risks. At each point, all of my doctors asked me if I needed to hear everything they normally tell patients, I said yes and they gladly went through it. I felt it was important to receive all the information and not assume I know everything. For example, the surgeon performs a nerve block on the abdominal wall as part of the operation. I was impressed, because if I were to do this operation, that is not something I would do.
The nurse started rolling me back, took a quick pit stop to empty my bladder. The resident introduced himself, did not realize that he would be operating on one of his attendings. He even asked if he could scrub in, I said of course. I’m a huge believer and supporter of resident education, so I knew there was great value in having him in the room. I got taken back to the OR, the anesthesiologist was not expecting me this soon. He wanted to roll me back himself and give me some midazolam to help calp my nerves. Honestly, I did not feel nervous at all. I know this hospital. I know the people. I know they play by the rules and they ALWAYS perform at a very high and professional level.
I joked with the scrub tech that we’re finally in the OR together since we had only done one case before. I got on the OR table and thanks to the amnestic medications used, I have NO recollection of what happened after that! I remember waking up in the same room where I had my initial preop done. The PACU nurse was signing me out to the recovery nurse. I told them I felt nauseated, but my pain was OK, so got some nausea meds. I felt sleepy, so I took a nap. About an hour later they woke me up. I asked for some crackers, soda, and cheese. Ate without any issues. Called my parents to let them know how everything went. My wife had been getting updates throughout my stay. I was able to void so the nurse came in and took out my IV. Got dressed and was taken to my wife’s car outside on a wheelchair. Had a nice chat with the nurse who took me there. We drove home and I went straight to bed to relax and eat snacks. I’m writing this on the morning of postop day 1. So far, so good. I am having some shoulder and incisional pain, as expected. Taking my non opioid medications is helping a ton.
As you can imagine, getting sick did not happen in a void. On Thursday evening I did see a patient that needed an angiogram the following day in Edmonds. I had a scheduled case in the morning at the downtown hospital for an AV fistula creation, and two new consults from nephrologists at two hospitals. I have five postop patients at the two downtown hospitals, not to mention a full clinic on Tuesday and Thursday, call on Wednesday and on call the following weekend.
Before I went to the ER I told my partners there was a chance I would not be able to go to work if I indeed had appendicitis. When I got the diagnosis in the ER, I contacted the resident that was covering our service overnight that I was not coming in the next day and that one of my partners was going to do the case. In preop, I contacted my manager, program coordinator, scheduler, the hospitalist, my partners (3), the nephrologist, and the IR tech lead. They were all very understanding and wished me a speedy recovery. I’m still struggling on when I should go back. My dad reminded me that after his appendectomy on a Saturday, he went back to the OR on Monday. I don’t know if I’m that brave. I already asked to have Monday and Tuesday off. As always, the struggle of the surgeon. That said, I am going to make sure I really feel well enough to go back.
Overall, it was an eye-opening experience. Getting sick is no fun. Thankfully I had a straightforward diagnosis with a straightforward surgical solution. Well, straightforward in the 21st century; my great-grandfather died of perforated appendicitis in Guatemala in the 1930s. Many of our patients have more complex problems. However, it was great to live through the experience of becoming the patient. Certainly, makes me more appreciative of ALL the work that goes on behind the scenes that I am not privy to as the attending surgeon.
To me, all the patients magically appear in preop and if there’s a delay, we feel frustrated. Now I know that there are so many steps that occur before they make it to the table. A delay probably means that the patient showed up late, has a complex medical history and takes 15 different medications, has several allergies that must be either listed or confirmed, does not feel safe at home, has had falls (common in my vascular patients), the electronic medical record is acting up, and many other possibilities that are out of our control.
After becoming the patient, I am even more thankful for having so many great people in healthcare. At every point in my care, I was treated with respect, compassion, and sincere concern. I felt safe and well taken care of.
Thank you for reading this long post, please let me know if you have any comments or questions!