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I recently found myself outside of my usual hospital role – trading my scrubs for a hospital gown and taking my Type 1 diabetes on a trip to the operating room. It’s always an enlightening place for a health care provider to occupy, perhaps even more so for a recovery room nurse.
I have a bird’s-eye view of what works and what doesn’t, before and after the knife.
I chose a specialist from another city as my surgeon; therefore, I didn’t know a soul at the hospital I was going to – except the surgeon. I felt like I needed to pull my pants up, stand a little taller and let people know the best ways to care for me pre-, intra- and post-operatively – not in a pushy kind of way, more disease-oriented info and anesthesia preferences for when I was out to lunch on medications.
It all began with a phone call (that I requested) from the anesthesia group the day before surgery.
Surgery ‘My Way’
I started by giving the anesthesiologist a low-down on my health; informing him that my diagnoses haven’t seized the remarkably healthy body they reside in. I also let him know that I’m a recovery room nurse so he knew where I was coming from.
I proceeded to ask my questions.
Me: “Can I eat or drink if my blood sugar gets low in the middle of the night (clear liquids up to four hours pre-op)?”
Doc: “No, you need to be NPO after midnight.”
Me: “Ok, well where I work we do four hours. Could you honor that time frame so I don’t get my surgery cancelled after driving all this way in case of a low blood sugar?”
Doc: “No” – and then proceeded to digress about why I can’t eat or drink because of general anesthesia.
Me: “Hmm. Ok, well I’m hoping for a spinal.”
Doc: “That wasn’t my plan — we don’t ‘do that’.”
He can’t see it, but I just put my game face on.
Really, it’s not necessary to provoke anger in a patient, especially when she clearly knows what she’s talking about – right? Seriously, this isn’t HIS PLAN – it’s MY SURGERY, how about ‘OUR PLAN’.
Me: “Well that’s funny, I’ve had one before with no problems – why can’t you do one?”
(I was thinking is this guy serious? I know all anesthesia providers are trained to give patients spinal anesthesia and it’s perfect for my surgery.)
Doc: “That’s not what we USUALLY do – but let me ask you some questions.”
Me: “O.K.” (I was thinking — there may be some hope here.)
Doc: “So, you have Type 1 diabetes — do you take insulin?” (Ok – at this point I was ready to throw the towel in, did he just ask me that?)
Me: “Yes, I take insulin.”
Doc: “What’s your plan in the morning, are you taking your pump off?” (Did he miss the Type 1 diabetes lecture in med school or what – I’m seriously unimpressed.)
Me: “I have Type 1 diabetes and I don’t make any insulin. If I remove my insulin pump you’ll have a bigger problem on your hands – ketosis.”
Doc: “Look, maybe I should have one of my partners take your case.”
Me: “That sounds like a great idea.” (How did I get so lucky I wondered; I didn’t even have to request another doctor, he did it for me.)
The Tides Turn
As soon as I got off the phone I called a friend from work – who also happens to be an anesthesiologist. Armed with new supporting evidence of why I needed and should have a spinal I was ready for – round two.
As luck would have it, the next anesthesiologist to call had an amazing personality and flexible plans for my case. I could indeed drink clear liquids if my blood sugar got low; he simply preferred that I don’t ‘set an alarm’ to get up and drink prophylactically. He also was agreeable to a spinal and having a conversation about it’s risks and benefits.
He was the right guy for me, exactly what I needed before I pulled the plug on surgery altogether.
Day Of Surgery
I thanked my anesthesiologist up and down when I met him; pointing out his characteristics that I appreciated (this is so important to do – many providers only hear complaints). He was agreeable to incorporating all of my ideas into my surgical plan that day. We agreed on a temporary basal rate for the O.R. and he was amenable to using my continuous glucose monitor to keep an eye on my blood sugars throughout the surgery. With the spinal in, surgery proceeded ‘my way’.
Part Of The Plan
‘Our plan’ went off without a hitch. I was so grateful for the care I received; in the end I was most relieved that I had complete trust in my surgeon because the wild card was anesthesia. There’s no question - patients always need to be a part of their plan; this includes being let it on the silent reasoning that may be taking place inside the providers’ head.
A listening ear, a simple explanation and a willingness to practice ‘outside of the box’ all serve as welcome attributes when you’re on the sharp end of the knife.