(Voice 1): So one of the things about anesthesia that makes me feel very anxious is that perhaps things I would be able to hear things or feel things that I didn’t expect and I wouldn’t be able to obviously let anyone know. And being able to be in someone else’s care and for me not to be in control is quite hard for me to think about. And in fact, when I think about it just causes immense amount of worry. So I just feel very anxious from that.

(Voice 2): I was told from a previous surgery that it was difficult for the physicians to wake me up. So I’m concerned in an upcoming procedure, I’m concerned about that and I’m hoping that it’ll be easier this time, but I am anxious about it.

INTRO

Maleeha: On today’s episode, Dionne and I pulled together a list of our top tips to share with you all that will make your experience so much smoother and overall much more positive.

Dionne: These concerns are pretty legitimate. I really feel for a lot of our patients when they come in day of surgery.

Maleeha: I do too. I mean, I have some patients who are more worried about the anesthesia than the actual surgical part.

Dionne: Absolutely. First off, you should know everyone that these fears are normal. So you’re not alone. You don’t have to apologize for being nervous or scared or even teary eyed. And we get a lot of teary eyed people. It’s completely normal. I think a lot of the anxiety in our life really in general is fear of the unknown, don’t you think, Maleeha?

Maleeha: Yes, I think it’s fear of the unknown and I think it’s also not feeling like we have any control over our circumstance or what’s about to happen. I just think that lack of control, especially for us, you’re handing it over to somebody else, can be very strong.

Dionne: Absolutely. I find it helpful to talk to my patients, like talk them through the process, almost like a dress reversal. When you know what to expect and you have the chance to discuss your concerns, it kind of calms fears down a little bit, I think.

Maleeha: Yeah. And however crazy your concerns or your fears are and people feel self-conscious sharing them, but it actually really helps both of us. And I think as a patient, just the act of verbalizing them and feeling like your doctor has hurt you is an invaluable experience. But it also helps me do a better job as well because I have tools in my toolbox that I can use and pull out just to make things better for you based on what you’re thinking and how you’re feeling, especially if you had, like, a prior bad experience, particularly nausea and vomiting is a really common one we see a lot. But there are things I can do to tweak to make it better.

Dionne: I can totally speak to nausea, vomiting, and just to kind of speak to your point, Maleeha. I personally get nauseous after surgery, so I make it a point when I have patients to really alter my anesthetic and give patients, like I throw the kitchen sink at them, honestly, to make sure that they don’t wake up nauseous. I give them, like, multi-drugs for nausea so that they’re not waking up both in pain and then, like, gagging, because, I mean, let’s face it, it’s already stressful enough to be writhing, but then to throw up, it just makes the experience so miserable. So if I can take away for you..

Maleeha: Where you? I got to ask Dionne, were you a good patient, or were you like, give me this medicine, give me this medicine! I know what you’re doing.

Dionne: Okay, so I’m a little bit dramatic. Nausea sucks. Okay. And I understand. Okay, so I let him know in the beginning. Look, hit me with everything. With the scop patch, the decadron. Do it all!

Maleeha: You made a list of John. All right, I just had to ask that. So takeaway number one, guys. Share your concerns, however small, with your anesthesiologist and your surgeon, and ask them to walk you through the process so that you know what to expect.

Dionne: And on that vein, if you have serious issues, like a difficult airway or just a bad experience with the anesthesia, you can often request to talk to us or be seen by someone in advance. All right.

Maleeha: that’s a good point.

Dionne: Yeah. But moving on, anticipate that you will meet many different people, and they will serve different roles on your care team. So from the minute you arrive at the hospital or surgical center, you will encounter administration, a pre op nurse, operating room nurse, PA doctor, tech, recovery room nurse, so on and so on and so on and so on. And we’re going to ask a lot of the same questions over and over and over again. You know what, guys? This is by design. This is for your safety. It’s not because we don’t communicate. It’s not because we’re not paying attention. It’s not because we didn’t read your chart. I promise you. We promise.

Maleeha: We hope. Because I know sometimes it does feel like people are not paying attention. Yeah. But I’m hoping that feeling can be disconcerting as a patient. But the truth is, we’re not perfect. Sometimes things get missed and they get overlooked by one person, but that’s less likely to happen when multiple people are checking the same information. And I know we learned this in residency together. If you guys are familiar with something called the Swiss cheese model, it’s used in risk analysis and risk management for a lot of industries, including health care. You can Google it and study it deep down, but I remember vaguely, the takeaway was that there’s this idea that the more layers of security we have, the less likely there is to be an accident. Sometimes the holes like a Swiss cheese can line up and an accident can happen, and that’s what we want to avoid.

Dionne: Exactly. But I’m glad you brought that up. I mean, you definitely took me back to residency.

Maleeha: Yeah. Morning rounds.

Dionne: One of our didactics.

Maleeha: Yeah, because we always do these things called root cause analysis. We call them sentinel events, and we want to make sure that they don’t happen again and this happens. So just like you want to get an access to a bank account, there’s all these different passwords and identifications that we use. It’s the same idea. We have multiple people asking and just checking out along the way.

Dionne: Absolutely, I think that’s like the perfect analogy. That the password, and then they give you a security code that they text you and then no one remembers. Right, exactly. It’s the same thing. So perfect analogy. And you know what Maleeha? It happens. Wrong site surgery. Surgery performed on the wrong patient body part, wrong side of the body. It’s rare, but it’s distressing. And when it happens, it is all over the news. It gets a lot of attention. And hospitals are doing a really good job of instituting checklists and surgical timeouts to make sure the entire team is on the same page before starting. And I think that really started around when we were in residency. Don’t you agree?

Maleeha: I agree. Because we learned this it was called the “Checklist Manifesto.” And we had a lot of lectures on this because anytime this happens, a surgery on the right side that should have been on the left or in the wrong patient, that’s a big deal for the hospital. And so we call it a sentinel event, and we do this elaborate root cause analysis like I was mentioning earlier. And that’s how the checklist really got put into place. Right?

Dionne: Yeah, exactly. And now that we’re attending, we’ve never started a case, a surgical case, or even when we do our own procedures without doing a time out.

Maleeha: Absolutely. Keep in mind guys. And keep in mind that in the operating room, we reposition patients a lot. Sometimes they’re on their stomach, they’re on their side just to get the right exposure. And that can be confusing to figure out what’s right and what’s left.

Dionne: Absolutely.

Maleeha: Which brings me to the takeaway number two. Prepare to repeat yourself. Make sure your site when I say site, I mean where you’re having your surgery is marked with a pen by the surgeon, particularly if it’s a right side versus a left side surgery prior to heading back to the operating room. And be patient. And don’t worry if people keep confirming your name, date of birth, allergies, and your procedure.

Dionne: Absolutely. And you know what else they should do? Well, this is take away number three, know who’s in the operating room.

Maleeha: Good one!

Dionne: Oh yeah. Ideally everyone should introduce themselves when they meet you prior to heading back into the operating room. And depending on where you’re having your surgery, there could be a medical student, a resident, a fellow nurse, PA surgeon. It could be a whole party, guys. But it’s good for you to be aware and ask who will be there and what role they’re going to have in your operation.

Maleeha: Yes. We’re not saying you have to memorize people’s names or write them down even, but it’s helpful just to know who will be taking care of you and like Dionne said, what role they have to play because you have the ability to make requests. I’m not going to say they’re always going to be honored. It’s very much dependent on the particular situation. But I have had patients request all female providers in the room or no students observing. There can be sensitive issues at play here, so sometimes people can make accommodations. That’s another reason why to know it’s good to know who’s in the room.

Dionne: Absolutely. So the next takeaway number four is have a cheat sheet. Okay. Have a cheat sheet. And that cheat sheet should have your past medical history, allergies, and your real reactions to those allergies, medications, including supplements and drug use, recreational.

Maleeha: Especially with marijuana.

Dionne: Exactly, especially with marijuana. Yes.

Maleeha: That’s coming up a lot. People are taking all their edibles and they’re laced with THC and CBD and I see them everywhere and I mean, this is a whole other episode we can do on medications and allergies and recreational drugs topic. Yeah. Okay, so we’ll move forward.

Dionne: Sometimes your doctor’s office forgets to fax or email your information and it can be really helpful to have that information on hand. Remember earlier how we said you’ll be asked the same question over and over again with the cheat sheet, you don’t have to worry about forgetting or leaving anything out because you have enough already to think about. You’re about to have major surgery. So when you have this on hand, you can just hand this over to your anesthesiologist and all the people that are going to be taking care of you and it will go a long way.

Maleeha: Yea. And also the act of writing things down for yourself or a loved one makes us feel more organized and prepared, which makes the experience smoother. I mean, at least it makes me more organized. I just think of it like when I’m going to the airport and I have everything already laid out, like my tickets, my boarding pass, my passport, everything’s just lined up. It just makes it so that I’m not rooting around my bag. So I think same idea. You know, I practice here in Phoenix and we get a lot of snowbirds, so I have a lot of elderly patients from usually the Midwest, like Illinois, or Wisconsin. And I had a gentleman from Wisconsin who happened to have a pacemaker, but the office, his cardiologist, a pacemaker, by the way, is a device that we implant that regulates the heartbeat. And he came all the way from Wisconsin and his cardiologist was in Wisconsin. And I didn’t have the notes faxed to me so I could look at the pacemaker, some information I needed to know. So I was asking this guy like, oh, trying to ask questions. And you know what he did? He had the presence of mind to whip out his iPad and was like, you know what? I have e-chart, like I have…let me just log in and I just saw my cardiologist. I just had all these labs done. I have them right here. Let me show them to you. And it was such a huge save because it had everything in one spot. I got to see everything. Nothing was delayed. And I think that was a great tip in my head. I filed that away.

Dionne: Yeah, absolutely. I love each art just as a patient, but also as a physician. I’ve had similar scenarios where patients just bust out their e-chart and I can see relevant information very quickly because we start really early and sometimes we can’t get to the doctor’s office or the hospital.

Maleeha: For me, there’s a time difference. Exactly. When I’m operating, some places not open yet because of the time gap.

Dionne: Exactly. A bonus tip to that is…bonus have a reliable family member or friend who knows you to accompany you. They can ask questions on your behalf and record important information. So I’d like to add that little sprinkle to the email.

Maleeha: That’s a good one. And reliable. Not like the fun family member.

Dionne: Not just your ride.

Maleeha: Yeah, not just your ride. Okay, that’s important. But it would be great if your ride was also like with it and able to take notes because the reality is the person will often be around after surgery in the recovery area. And that can be helpful. They can sit with you. They can listen to the discharge instructions from the surgeon and the nurse. And you’re not going to remember those things when you’re groggy and still recovering from anesthesia. Which leads me to my next takeaway. Takeaway number five, fill your meds out in advance. Like I said, often the surgeon will prescribe medications for you to take after the surgery when you’re discharged, to go home, get those filled as quickly as possible, especially the pain medications that have to be approved by the pharmacy in person with a paper prescription. You know, a lot of them are sent electronically. Narcotics cannot be filled electronically. And so while you’re in the surgery, your reliable, reliable keyword partner can or friend can take that script to the CVS or I’m really plugging CVS, but like any pharmacies, Walgreens, Costco, whatever, wherever you’re getting a good copay guys, get it filled and have it ready because what happens is these surgeries end. It’s late in the evening, it’s a Friday. You get home, and then you’re trying to sort out where the pain medicine is and the pharmacy is closed. It can be a real disaster. And playing catch up with pain, it’s hard to win that battle.

Dionne: Yes, absolutely. It’s a miserable weekend. It’s just going to be miserable. I mean, you and I do a ton of orthopedic cases, and those will be some of the most painful cases. So painful that we do a procedure called a nerve block, where we literally block the nerve. We numb the nerve, we numb the arm, the leg, or whatever they operated on. So for at least that first night or first day after surgery, the area that was operated on is nice and numb. The thing is, once that block wears off oh, yeah. And it wears off okay. And so you really need that Rx to be filled out so that you can start those medications right away.

Dionne: So that wraps up some of our main tips and takeaways to recap. Number one, share your concerns with the anesthesiologist, and if you have a serious medical issue, ask to be seen in advance.

Maleeha: Number two, prepare to repeat yourself with your name, date of birth, your allergies. Your procedure is part of the process to prevent a wrong site surgery.

Dionne: Number three, know who’s in the operating room with you and what role they will play in your care so that you’re comfortable.

Maleeha: Number four, keep your latest medical history with you and bring someone who you trust to accompany you.

Dionne: And last, but definitely not least, fill your prescription early on at the pharmacy so that you have them when you need them. I’m sure there are more we can list, so if you have any that you found helpful that we didn’t mention, we would love to hear them.

Maleeha: Absolutely. We could probably do a whole another episode, some more are coming to me as we speak. Guys, thank you so much for joining us today. For more IV drip, check out our other upcoming episodes. You can find us at theivydrip.co. Please spread the word and don’t forget to subscribe to our podcasts. And now for the random tip of the day.

Dionne: So this is for the ladies. Okay.

Maleeha: Sounds like a lady’s song. Hey, Mr. DJ.

Dionne: No, but seriously, don’t get your lashes done before surgery. We tape those down. Okay? And we tape it down because we’re trying to protect your eyes, and we would hate to ruin those lashes. Okay. We know the investment you put in there to get those lashes done. And we don’t want to mess them up. So just don’t get them done before surgery.

Maleeha: Yeah, just don’t…do that right after surgery.

Dionne: Yeah, exactly. To celebrate, if you have a good tip, we would love to hear from you. Email us at info@theivdrip co.