Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When the patient treats the doctor

Wes Fisher, MD
Physician
November 10, 2014
Share
Tweet
Share

Another day, another pacemaker, at least so it seemed at first.

The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories.  He laid there, smiling, knowing he’d made the right decision after years of struggling with his arrhythmia in other ways.  His heart was showing signs of slight weakening and his arrhythmias remained too fast despite a multitude of therapies, so he had agreed to proceed with placement of a biventricular pacemaker with later ablation of his AV node some weeks later after his surgical wound was well-healed.

The nurses and technicians in the room were wonderful, reassuring the patient as they moved him to the narrow procedural table.  More wires were connected to monitors and a blood pressure cuff placed. The instrument table laid ready, and the patient’s choice of soft rock could be heard faintly in the background.  The pre-sedation note was completed and checklists reviewed.

Meanwhile, I donned by lead, bouffant hair net, headlamp, and face mask, then scrubbed for the procedure.  Shortly thereafter I turned to open the procedure room door with my backside and was quickly greeted to a hearty “time out!”  The patient’s identity and procedure confirmed, I could see the patient smiling:

“We lawyers like to hear those things,” he said.

“Nurse, make sure you give him a ton of sedation — he’ll need it, okay?” I joked.  We laughed together at the thought.

“1 of Versed and 25 mcg of Fentanyl,” the nurse shouted to the control room.

“1 and 25,” the control room answered.

He and I had struggled together with his arrhythmia for years, finally agreeing that this option at this stage in his arrhythmia’s progression would be best.

I made my way to his side and once again prepped his chest with chlorhexidine prep sticks, letting each dry before the next was applied.   The surgical sight was then draped to provide an island of an orange plastic film surrounded by a sea of blue paper covering.  Other drapes were secured and a pocket for instruments was made.

“Everybody have lead?” I asked.  The x-ray system was enabled, then the pacemaker system analyzer cable, a Site-Rite ultrasound probe and Bovie pen made ready.   All was set to begin.

“Mr. Jones [not his real name], I’m going to start to numb your skin with the local anesthestic.  This will sting,” I said.

“Okay …” as he braced himself for inpact.  Then:

ADVERTISEMENT

“Come-on, doc, you can do better than that!” as if to mock me, jokingly.

“Yes, I can, ” I countered, then proceeded to administer more anesthetic to the area.  As the area became more anesthetized, his shoulder seemed to relax.  No doubt the Versed helped a bit, too.

I continued, locating the appropriate spot, then performing the incision.  He was unaware.  The pocket was created first, then I found the vein and placed the first lead without a problem.  Badda bing, badda boom.  Now for the next.

Then, out of the blue:

“Doc, I heard you’re having a knee replacement … ”

“Just a partial, I hope …”

“Hey, I just want to tell you.  It’s the best thing I ever did. Listen, it’s not as bad as you think, but there’s quite a bit you have to be ready for. Don’t forget to preload the Miralax — that iron supplement before the procedure to slow you down and then the narcotics afterward to stop you up: It’s a Machiavellian ploy by those orthopedic surgeons to assure your discomfort.”

I chuckled as I thought about this.

“And whatever you do, take the pain medication before physical therapy.  I had a physical therapist threaten to fire me when I failed to take the pain medication 45 minutes before therapy.  And get rid of all those rugs.  It really helps to plan your trips when you get up.  Think about what you need and what you might need to limit your trips.  I’m telling you, this saved my life.  You know I’m writing a book about stuff like this … I’m waiting on the proof. Don’t come back too soon.  Have you completed your FMLA forms yet?”

“What?”

“FMLA.  Look it up.  Loads of fun.  Anyhow, be nice to your wife — you’re gonna need her.  Trust me on this …”

And on and on it went: Patient treating doctor, until his pacemaker was done.  Then, finally, I had a chance to reciprocate:

“I’m closing.”

“Thanks, doc, and good luck.  You’re going to do fine.”

Wes Fisher is a cardiologist who blogs at Dr. Wes.

Prev

5 ways to ease the integration of NPs and PAs

November 10, 2014 Kevin 19
…
Next

Cognitive behavioral therapy: Why parents should be involved

November 10, 2014 Kevin 6
…

Tagged as: Cardiology, Hospital-Based Medicine, Orthopedics

Post navigation

< Previous Post
5 ways to ease the integration of NPs and PAs
Next Post >
Cognitive behavioral therapy: Why parents should be involved

ADVERTISEMENT

More by Wes Fisher, MD

  • How to help physicians end maintenance of certification nationwide

    Wes Fisher, MD
  • When patients tweet their own heart attacks

    Wes Fisher, MD
  • So you failed maintenance of certification. What now?

    Wes Fisher, MD

More in Physician

  • The weight of genetic testing in a family

    Rebecca Thompson, MD
  • A surgeon’s view on RVUs and moral injury

    Rene Loyola, MD
  • Reclaiming moral ambition in health care

    Mick Connors, MD
  • When language barriers become a medical emergency

    Monzur Morshed, MD and Kaysan Morshed
  • The burden of the eldest daughter

    Jessie Mahoney, MD
  • A doctor’s letter from a federal prison

    L. Joseph Parker, MD
  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • The hypocrisy of insurance referral mandates

      Ryan Nadelson, MD | Physician
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
    • How functional medicine helps where conventional care falls short [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
  • Recent Posts

    • The weight of genetic testing in a family

      Rebecca Thompson, MD | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Meeting transgender patients with compassion and equity in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why your health is a portfolio to manage

      Larry Kaskel, MD | Conditions
    • Reclaiming moral ambition in health care

      Mick Connors, MD | Physician
    • Pain control failures in fertility clinics

      Maire Daugharty, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • The hypocrisy of insurance referral mandates

      Ryan Nadelson, MD | Physician
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
    • How functional medicine helps where conventional care falls short [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
  • Recent Posts

    • The weight of genetic testing in a family

      Rebecca Thompson, MD | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Meeting transgender patients with compassion and equity in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why your health is a portfolio to manage

      Larry Kaskel, MD | Conditions
    • Reclaiming moral ambition in health care

      Mick Connors, MD | Physician
    • Pain control failures in fertility clinics

      Maire Daugharty, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

When the patient treats the doctor
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...