Push, don’t PUSH!

Push, Don’t push

Okay, I’m a gynecologist.  I’m supposed to get people to push, right?  Well, that works in the obstetrical land.  Push the baby out.  Push yourself down here on the bed so I can examine you.  Lots of pushing in the OB world.  

But in the surgical world pushing is bad.  For an abdominal surgery, we want a nice soft abdomen.  No pushing involved.  Pushing makes it hard to see.  Pushing makes it hard to poke your needle into tissue and then tie off a vessel to stop the bleeding.  Pushing makes the bowel get in the way.  

Why do I have so much pushing in my abdominal surgeries?  All of my cases are done with spinal anesthesia by my nurse.  He learned how to do anesthesia from others, but was not formally trained.  He does not know how to intubate.  Spinal anesthesia works great when it works.  But sometimes the medicine doesn’t work here, even with a perfect stick.  Sometimes then you have to give ketamine, AKA God’s gift to the developing world.  

Needless to say, I often times don’t have a soft abdomen to operate on.  But you know what?  I do the case anyways.  Because that’s what we do here, we push on even when it’s hard.  Visiting doctors don’t like it.  I don’t like it either, but I’m just used to it.  If a case gets too difficult with the patient pushing, I make the nurses call Olen just in case the ketamine gets a little too deep, so he can secure an airway.  So I try not to complain to much during surgery about pushing, because then I just have to worry about the patient’s airway (as Olen is often home with the kids lately).  

We recently had a visiting CRNA for our Smile Train.  She mentioned that we need a training program here and I absolutely agree!  I think we should start one RIGHT NOW!  All I need is a dozen or so CRNAs or Anesthesiologists to come for one month (or less) per year.  You’ll help us set up our curriculum, and voilà….We’ll be on the right track!  

We certainly have the surgical volume!