Doughnut

Not for the first time, a case was delayed by a patient who didn't believe the instructions not to eat or drink before surgery. And when we meet these people, we are usually not terribly surprized. Not the brightest bulbs, the sharpest knives, the most complete decks.

Long ago, parents brought their young son to fix his hernia, and stopped on the way to get him a hamburger, because "He was hungry!" Yeah, well, now you can reschedule and try again. Felt terrible for the kid. Today, a young man stopped for a donut, and we really couldn't put him off, until whenever we could get him on the schedule again. Fractures are best fixed sooner rather than later. So, we took him at the end of our day. His name was a literary reference to an unsympathetic character, which amused me to no end. Even as I headed into overtime.

Why is this an issue? Food in the stomach plus anesthesia means food in the lungs. Likewise coffee, orange juice, milk, gum, none of it worth the risk, for a surgery that can wait for another day. In a trauma, something really urgent or life threatening, we don't delay, and there are precautions to minimize the risk, pressing down on the trachea to close the esophagus during induction and intubation, a technique also used for those with regular reflux. But even that does not eliminate the risk, and the consequences can be life threatening, aspiration pneumonia for instance. So, there are guidelines that the anesthesia department adheres to.

And patients are given instructions, both in writing and on the phone, and often in person in the clinic. Not like we keep it a secret. Donut Guy today apparently kept complaining to the pre-op nurses about how hungry he was. If he'd skipped the donut, he'd have had lunch by then.

Proof, if any is necessary, that no one can make anyone else do anything. Even if it is clearly in their best interests, and there are painful consequences.

We have to take up Moby's food and water at ten this evening. He's getting his teeth cleaned tomorrow, and we will follow instructions for him. He is not going to like us much. But this is our duty, to do right by him.