Bladder surgery is very different an automotive repair shops

Today I was greeted with one of the most distinct lacks of understanding that I have ever been met with in the pre operative area.

The lady that had been signed up for a cystectomy sincerely believed that she would get her bladder back within the year. That we would "shine it up" and it would be perfect and ready for her to have it again.
When it was explained that this in fact was not possible. She, understandably, was quite disappointed. I then had to take the time to explain that she would in fact have a bag for life, quite the revelation 30 minutes before being taking back to the operating room.

This in my mind brings to light the repeated phenomenon of what we say and what patients hear.  I am constantly reminded that there is often no correlation with what is said and patient understanding. I have told people that they did not have any type of cancer and they have walked away thinking that they had 6 months to live because the only word they heard was cancer. I have told others that they had horrible disease and that we were unable to operate and they have interpreted that as they were cured.

Ineffective communication, be it in the communicator or communicatee is very frustrating and a daunting hurdle to overcome. So far I have only one possible answer. At the conclusion of each clinic visit, bedside round, or preoperative questioning, I have the people repeat back to me what I said in their own words. This is little more than a reality show without the cameras.

This just in: Cancer might inhibit artistic ability

Today on gravity rounds (my favorite because you start at the highest floor of the hospital where you have patients and spiral down to the lowest floor, thus being closest to the exit when you are done), we were seeing one of our last people a very pleasant gentleman whose primary diagnosis was invasive bladder cancer with the complicating factor of having been treated for prostate cancer in the past. The day before we had taken him to the operating room removed both of the above offending organs and given him an abdominal wall urinary diversion.

He wasn't in his room, but was meandering about (gold star for that. People often don't realize but they have to get up and move after surgery. Oddly enough don't seem to want to with a humungous incision running the length of the abdomen, go figure). As we approached he exclaimed that he had been looking for us because he had something very important to share.

He then went one to tell us that since we had removed his bladder and prostate (approximately 24 hours before), he had discovered that he could now play guitar (having never done so before) and even better he could play lynard skynard's freebird perfectly (apparently a long standing dream of his) while my attending incredulously looked on (everyone knows the smile that starts sincerely but then continues to widen towards disbelief).

There might be a scientific explanation for this, however it is likely summed up by the fact that we prescribe pretty amazing IV medication postoperatively.

And you can't bite the nurses

At least not if they don't want you too.

Several days on morning rounds, a nurse of one of my patients asked me the seemingly innocent question:
"Is Mr. So And So usually appropriate?"

I have been around the hospital way too long to do anything but cut to the chase with inquiries such as these.

"What did he do?"

"I was leaning over to change his IV," says the extremely well endowed nurse, "And he started trying to bite my breast saying something like I want it in my mouth." (She does this while demonstrating his chomping motion) She went on, "The weirdest part is his wife was right there."

I march into the room purposely ready to chastise him for his disturbing behavior and as soon as I get close enough to his bed to be in touching distance he reaches towards me and tries to rub my arm, leg, hand.

After a brief yet stern talk in front of his wife who just sat there with one of the best poker faces I have ever witnessed, he said, "I am in the hospital, I can do whatever I want and blame it on the meds."

I saw it as a waste of time to inform him that he hadn't had any of those type of "meds" in over 3 days.

The Gypsy Hospital Experience

Occasionally people refuse to leave the hospital. Ok more than occasionally. It happens all the time. Our most recent refusal came from a patient's wife saying that she felt uncomfortable taking him home even though he was more than ready to go.
It is times like this you have to evaluate the situation and make a decision as to whether to allow the patient to stay (not preferable due to limited resources) or take a stand and push the discharge. This particular guy was more than fine so we decided to push.
During this effort the wife actually took out a blood pressure cuff and started measuring her own blood pressure claiming that she was being stressed out. She then took the opportunity to call patient relations, who arrived promptly with their customary smile and clipboard.
Simultaneously with their arrival it was discovered that the patient pantry on their floor was completely empty and a call was made to restock. Hours later the pantry would be found to be empty again.
On Patient Relations second visit they noticed several full bags. On closer inspection apparently our patient and his family really enjoy graham crackers, pudding, orange jello, small cups of a variety of juice and Shasta by the duffle bag if you will.
After withdrawing their official complaint, they quickly agreed to head home.

There is a less than 5% chance of robot attack during your procedure

Patient: I am not sure I want that robotic surgery.
Me: Why not?
Patient: My next-door neighbor had it and the robot went crazy during surgery and attacked him. He was tangled up in it for hours.
Me: Sir, that is not possible.
Patient: How do you know? You don't know what that robot is thinking.