Friday, January 12, 2018

Happy Talk

My next newspaper column. Chillin' at the end of a nice vacay in Hawaii.

Taking a mental health break from Donald J. Trump, VSG:
"Thangzz doc yer th greatiss .... No, rilly man... yer the... zzzzz ..." "Wha? Operation's over? No way. You're kidding, right? Oh yeah, lookit that. Wow. The operation's over? No way. You're kidding, right? Over? You're kidding, right? Is the operation over? You're kidding. Right? Oh yeah..." "I robbed a bank, y'know. Had to kill a guy. Put the money in a Swiss bank. The account number is...."  
I've been asked frequently: "Did I say anything when I was out?" Readers of my blog wondered the same. Evidently, it's a pretty common concern: do people reveal stuff or otherwise embarrass themselves when under the effects of anesthesia drugs? Relax, people: the answer is "no." Mostly.  
Sodium pentothal, formerly used extensively in the operating room but now largely replaced, has been referred to as “truth serum.” Whereas it's still true that under the influence of para-surgical drugs people can get a little disinhibited, it's not the case that they'll get all revelatory. I haven't learned any secrets from my patients. When asked, however, I've been known to say, "Well, you did mention a Swiss bank account." Only once did that result in a worried look. 
Most surgical patients get a little something to relax them before they get wheeled into the OR. It's not unlike a couple of my perfect martinis. So yeah, tongues loosen a little. Giggles sometimes; rarely, tears. "Wow, this feels great..." Stories get told. Amusingly, when the story is interrupted mid-sentence by the arrival in their brain of the knock-out punch, I've seen people wake up later and begin exactly where they left off, unaware of the passage of time. And yet, I've never heard anyone say anything they'd be sorry about. Except telling me how wonderful I am (for my regular column-haters, there’s no drug that potent.)  
When possible, I enjoyed operating on awake patients. We’d talk, usually light-heartedly. Given some sort of anti-anxiety drug, the conversations can be loose, chatty, funny. People will say the same thing over and over, ask the same questions repeatedly. My goal is to keep them comfortable; if they want to ramble on, it's fine with me. Most often they doze, wake up, talk a little, doze some more. It's pleasant, not confessional. 
Because such talk is commonplace, even when particularly entertaining it went out the other side of my mind as quick as it enters; my head -- and, I'd aver, those of everyone else in the OR -- is a sieve that way. Talk like that is texture, not substance.  
The flip side of this is a theoretical utility. Studies of suggestibility under anesthesia are equivocal. Still, I liked to give some positive thoughts to my patients as they went off to sleep and when they emerged: "We'll take good care of you. You'll be comfortable when you wake up." And, after it's over, "Everything went great. You'll be happy we did this. Comfortable, no nausea." I have no idea if it had an effect or not. 
I always made it a point to talk to my patients when they were awake in the recovery room, not only telling them how it went but -- unless it wasn't true -- telling them I expect things to be fine, give them some positive vibes. With practically no exceptions, no matter how engaged and appropriate they were in those conversations, people never remembered what was said, or even that I'd been there. Or that they'd asked me the same thing five times in a row. But I always did it.  
If it were possible, I'd love to see a study of people wherein, within a standard time of awakening, they'd hear suggestions. Some would hear words saying they'd be comfortable, be up and out of bed soon; others would hear something neutral, unrelated to pain. The floor nurses wouldn't know who heard what. Pain medication use would be recorded, along with nausea, time before getting out of bed. I'd like to think the former group would outperform. (The studies I'm aware of played recorded messages during surgery.)
The problem with any sort of surgical studies is that even when operations are "the same," they really aren't. Different surgeons, different operating times, incision size; different people getting the procedure, for differing reasons. It's really hard to standardize. Still, it'd be interesting. Valid or not, I liked doing it. 
[Image source]


  1. I had my semi famous L4-L5 splattered. My wife at the time said she'd get one of those heated straps that go around your waist. Within 20 minutes I was in the worst constant pain I've ever been in. I could have chewed the bedpost in 1/2.

    I lived 41 miles away from the hospital. Every bump felt like an extra pain level I never knew existed. We got there and checked me in. They gave me 2 injections of morphine. It was like they did nothing. The nurse who now has an attitude(it's an area where people look for drugs at the hospital) She insists I sign the paperwork. I ask for the Dr. 3 times before 'Princess snotty tude' went to get the Doc, but not before she said "Do you want me to get the Dr.? In a way that said "If you won't go away, the Dr. will." I'd already asked 2 for the Doc. So I was a little perturbed that the third time triggered a snotty attitude.

    So Doc Cartman walks in (His real last name). Doc looks at me and says "We ain't done anything for you have we." I said "You've really tried though and I thank you, but you can't send me home like this, I'll be right back 1/2 way home. (Understand, I have been there twice in the last two weeks, this visit is #3). He says "I'll be right back".

    So Doc draws the meds himself(does everything himself) at within' no time I was asking my wife (Look at her shoes baby. I love your pink shoes. Oh look! Pink pants too! (by this time they are howling) Then I say "Hon, look at her face, she's beautiful!, can we take her home? I wanna keep her." Then I stare at her shoes and say "I really like your shoes" Then Doc says "It appears we've reached our goal" Then I said "Will you help us meet our goal?" to the nurse in pink. By this time the tears were coming down and we were drawing a crowd because they were laughing so hard. The last thing I said was directed towards nurse Pink. "Knock knock" she says "who's there?"(at this point they are all dying) I said "Pink pants" she barely got it out "Pink pants who?" To which I said "Pink Shoes" At that moment in time it was the funniest knock knock joke of all time.

    I only remembered being madly in love with nurse pinks shoes and Doc Cartman saying "We haven't done much for you."...The rest was told to me by my wife and Doc Cartman when we went back a week later. That story stuck to me for 1/2 a decade.

    Doc Cartman said it'd be 3-5 weeks before my MRI. So he gave me morphine patches and more Vicodin than I have ever seen in one place.(120 10/500...It was 1997) It took 2 1/2 weeks because there was a cancellation. I got my MRI and a fairly quick appointment with my PA. The disc jelly was 'hugging my nerve". It was just over 3 months before I had surgery. I've been disabled ever since. I have no reflexes in my right leg and it's still painful but I manage well despite it all. Going from a good job to SSI and not playing baseball put me into a deep depression. I was contemplating suicide so my family didn't have that burden anymore. It sucked, it still sucks, but I am doing OK. The adjustment was tough. I was the picture of health. I worked hard as a hod carrier. Even lil old ladies who got a hug snuck a little biceps feel. I never really noticed that asspect other than 3-4 girls copping a sneaky feel. But when my back thing happened, I got lots of hugs after I was diagnosed. That's when I noticed it because they all were coppin' a

    So there's my morphine story.

  2. Let's see if in the paper you get the usual talk about your experiences as a Dr. routine. It's always the trolls who promise they would like you more if you did that instead of politics.

    Translation: We wish you'd shut up, you're a major enemy of the Nazi uprising by making too much sense and being very persuasive. Stop encouraging people to comment.


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