Bloodless surgery refers to to desire to avoid transfused blood or blood related products. If you talk to most surgeons, I think most believe they have the skills to provide bloodless surgery to all of their patients, most of the time. If their patient bleeds and they require a blood transfusion, more than likely the bleeding was caused by a non surgical complication induced by the hospitalist's desire to prevent a life threatening venous thromboembolism with anticoagulants. .
I'm not a surgeon. But I have seen my fair share of operative reports showing 10 cubic centimeters of blood loss after an eight hour surgical marathon. In these situations I am left without an explanation for the six gram/deciliter drop in hemoglobin concentration. It is a hospitalist mystery that I see day in and day out. It seems like a job the Society of Hospital Medicine should tackle
Ten cubic centimeters isn't much, but there is always room for improvement. I've discovered the latest and greatest in bloodless surgery. The skills of these future surgeons are like no other. Where are we going to get our next generation of surgeons? You may think I'm crazy, but I can see the writing on the wall. They are not surgeons by trade. They are cutters. That's right. Cutters. Cutters are those psychiatric folks who use cutting of their wrists and ankles as
- A way of releasing whatever tensions they have
- Gaining attention
- Seeking help
- Feeling alive.
That sounds like a surgeon to me. These cutters have no idea how skilled they are. To be able to cut themselves hundreds of times, day after day, year after year with the skill of a surgeon, avoiding the intricate network of nerves and arteries that supply blood to the hands and feet, and to be able to do all this without the grueling surgical residency, these are surgeon savants. These are the people I want operating on me.
Happy: I saw this patient once that had dozens of superficial cuts on both their hands and ankles.
ED Doc: Oh, you mean those scratches? We see that all the time. Those are cutters.
Happy: They must be really good at cutting to have that many marks and have no major complication. They look so clean. I can't imagine they're actually trying to commit suicide.
Happy's Partner: I wonder what that operative report would look. Total estimated blood loss of 4 RBCs.
4 RBCs. It doesn't get anymore bloodless than that. If you want bloodless surgery, we should stop trying to train surgeons that come from our medical schools filled with high anxiety high achievers looking to impress people who do nothing but try to impress each other all day long and start looking in the psychiatric wards for our laid back cutters with skills. Now that I think about it, picking our next generation of surgeons from the psychiatric population of cutters makes perfect sense. You'd have to be a little psychotic, in the midst of visual hallucinations, to try and convince the hospitalist that the six gram drop in hemoglobin wasn't related to the six hour operation with a documented 10cc of blood loss. Psychosis is the only explanation.
By the way, How do you hide $100 from a surgeon?
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