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 most of their patients, most of the time. Bleeding complications, if they occur, must result from the VTE prophylaxis. There is no other explanation. I'm not a surgeon. But I have seen my fair share of operative reports showing 10 cubic centimeters of blood loss after an 18 hour surgical marathon. In these situations I am left without an explanation for the 16 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 is 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 and start looking in the psychiatric wards for our cutters with skills. Now that I think about it, picking our next generation of surgeons from the psychiatric population of cutters makes perfect sense. This surgery someecard helps to explain.