generalGeneral Electric makes all kinds of electrical things. General Motors makes all kinds of cars and trucks. General Mills makes all kinds of breakfast cereals. General stores sell, well, everything. General . . .
1. affecting or concerning all or most people, places, or things; widespread.
2. considering or including the main features or elements of something, and disregarding exceptions; overall.
Uh oh, it looks like Doc had a stroke. Why the hell is he talking about light bulbs, Cadillacs, and Cheerios?
You know, as usual I had a point before you interrupted. Now if I might finish, I could perhaps get to that damned point. "General" is a wastebasket term, and just about anything can fall under the umbrella of "general", just as with general surgery.
Ooooh . . . gotcha.
Yeah, maybe next time you won't be so hasty to jump to conclusions about my mental health, which is, as usual, stellar.
Anyway, the best thing about general surgery, the thing that keeps it interesting, the thing that makes me continue despite the 2 AM appendectomies (it's always 2 AM), is the sheer variety of patients for whom I get consulted. On any given day I could get a call for a pancreatic mass, a perianal abscess (though I would prefer not), an enlarged lymph node, appendicitis (it's always appendicitis), and anything in between. And when I'm on trauma call, you can add splenic rupture, compartment syndrome, subarachnoid haemorrhage, and anything in between.
It's that "anything in between" that has the capacity to throw me . . . sometimes. I'm not a cavalier surgeon. I know what my limitations are, and when a patient tests (or surpasses) those limits, I call for help. Arrogant surgeons (the prototypical ones on "Gray's Anatomy" with the god complex) think they can do anything to anyone and get away with it. When they do that, the patients are the ones who suffer, receiving substandard care from doctors who have no business treating them. Sometimes these calls can be one of those zebras we hear about, something I'm not equipped to handle on my own and really tests my limits.
Recently Dr. Lee (not his real name™) did test my limits, though not in the way I just described. Make sense? No? Don't worry, just like with the Buicks and Count Chocula, it will.
Dr. Lee is an emergency doc that woke me from a deep slumber just after 1 AM, and the call didn't surprise me one bit. My phone had been ringing off the hook all day up until midnight when it finally shut the hell up for all of 60 minutes or so. I figured it would be another appendicitis patient who urgently needed me to save his life but decided to wait until the middle of the night to do so just like all the rest. Grumble grumble fucking grumble.
"So I have this guy here . . ." Dr. Lee started.
Yeah, you always have a guy. It's 1 AM, so just get the hell on with it.
"He was in a car accident and has a laceration on his forehead . . ."
Well isn't that dandy, at least it isn't appendicitis. I can suture a forehead. But wait, so can Dr. Lee. So why the hell is he calling me? What else more serious is going on that I can treat? Is the laceration deep enough to require a multi-layered repair under anaesthesia? Does he also have a fractured skull? A lacerated liver? A haemothorax? Bladder laceration? These are all the thoughts that screamed through my head in approximately 0.192 seconds as I awakened fully and listened intently.
". . . The accident was a week ago . . ."
I started listening somewhat less intently and began grinding my teeth slowly, waiting for the punchline.
". . . and he had stitches put in his forehead, and he needs to have them removed."
He stopped. I anxiously waited for him to tell me why he was really calling me, because if this was really why he was calling me at 1 o'clock in the goddamned morning, the patient isn't the one who would need a trauma surgeon right about now. I figured it was obviously just a joke, though I noted to myself that I didn't really know Dr. Lee well enough for him to be trolling me like this in the middle of the night. All those thoughts had lumbered through my skull in the next 0.294 seconds, until he said,
"So, uh, I was wondering if you could take them out."
I was glad I had the mental fortitude and forethought to mute my phone before letting loose the string of expletives that would have made Quentin Tarantino and Samuel L. Jackson blush. I finished cursing, composed myself, unmuted my phone, and asked him slowly and carefully if I had seen the patient a week prior and stitched him up.
"No, it was done at another hospital."
Mute. Expletives. Unmute.
"Is the wound infected?" I asked him, hoping at least there was something to justify this. Anything.
"No, it's healed just fine. The stitches just need to come out."
Mute. Expletives. Unmute.
I don't think my voice was nearly as composed as I intended it to be just then as I said in a quavering voice, "Then why are you calling me at 1 AM instead of either A) telling him to see, at a reasonable hour, whoever put them in, or B) taking...the...sutures...out...yourself?"
There was a slight pause before he said (with a baffling amount of confidence that what he was saying made perfect sense), "Because you're listed as being on call for surgery."
At this point I made no effort to conceal my true emotions as I explained to Dr. Lee in no uncertain terms that he, as a fully trained emergency physician, was fully capable of 1) evaluating a wound and 2) removing sutures, especially sutures that were not mine. I also explained that he was fully capable (maybe) of using his brain to determine if calling me at 1 AM to remove someone else's sutures made any logical sense whatsoever. I was not entirely convinced that Dr. Lee believed me as he told me he would just send the patient home to follow up with the surgeon he saw initially.
I grumbled (probably . . . I don't remember my exact response), hung up, cursed some more, wondered at what carnival Dr. Lee won his medical degree playing fucking Skee Ball or something, and went back to sleep, visions of giant teddy bears and MD degrees hanging from the ring toss game dancing through my head. General surgeons are trained and expected to do pretty much anything at any time (within reason, of course), but that conversation strained even my admittedly ample limits.
The patient that actually needed me and was actively dying came in about 3 hours later, but that's a story for another post.