Not the worst case, nor the worst patient, not really, although I struggle to clearly remember any as bad. Chipper and self involved, manipulative and saccharine, a young, trained singer, the story is she is an opera singer, who insisted on getting a block and sedation to avoid an intubation. Not in itself an unreasonable preference, but we have laryngeal masks, that could have been managed. And taking out hardware is not a reliable surgery, it either goes very well and quickly, or very badly and takes a long time.
We were also waiting for her, late, and with insurance issues, and the pre-op crew were trying to get her ready quickly - which they do very well. They asked her to open the door when she was changed. Seemed to be taking a while, they gave her extra time before knocking, only to find her sitting there reading scripture.*
When I greet her by name, and ask her what she goes by, she tells me her rather dramatic and unusual middle name (think - Winterella.†) In a bright, overfriendly voice. Ugh, I think. She chatters on the whole time.
The ROH ¬ does not, as expected, go well. Non-union, no bone in the middle -just connective matrix, so taking out the plate would leave her with an unstable bone. Surgeon goes to her head to tell her this, and that he'll have to put on a new plate. She begins sobbing, uncontrolled in any way, loud. I'm getting the necessary implants and tools, drill, c-arm, and the resident anesthesiologist tells me the patient wants a song played. I do know keeping her calm is important, but it's down the list a bit at this moment.
Thankfully, the program I have running for music does allow a song/album choice, and after a minute or two, I find the song. A hymn ‡, on an album from BYU. Anesthesia resident asks me to turn it up, amid other things I'm doing so they can fix the bone, I turn it up. And then I get asked to start it over. I ignore this, as I am doing more critical tasks.
Patient starts singing along. Loudly. Off key. To the sappiest sort of hymn you hopefully cannot imagine. I'm in hell. At least the whining, sobbing stop while she's singing. Surgeon has broken scrub to talk with her family to get consent, since she's been difficult to convince. She does agree, but under sedation, this is not considered consent. Then she cries for the surgeon. The resident surgeon rolls his eyes at me, and puts on his deepest most reassuring voice, and she latches on to him for male comfort. I continue to keep everything afloat as different items are needed, surgeon returns, she sings loudly and sobs intermittently, nearly squirms off the table, so I get an extra safety strap on her.
This goes on for hours. She is tough, despite all the whining. Give her that.
Her singing is of the pretty, pop star variety. Trained, strong, but warbles all over melody without every actually settling on one.
The sort of voice one says "She's so clear. I can understand all the words!" As though that were some kind of artistic virtue. As my 75 year old patient told me this week about the sort of music she likes.
If I want to hear the words, I'll listen to speech. I'll
read the damn lyric sheet, if I care that much.
Singing isn't about clear verbal communication, most lyrics are silly, and I can't stand clear, merely,
pretty voices. I prefer the rugged
beauty of souls who have suffered and endured. Aretha Franklin has a beautiful voice. Bob Dylan has a beautiful voice. Nina Simone had a beautiful voice. Nothing to do with pretty, or understanding the words. Fuck understanding the words. Music is beyond words, if you think you understand by articulation, the soul is lost. I detest musical pablum. Who understands the words in Opera?
She again delayed us by keeping the surgeon talking to her as we got the next case ready. As far as we could do, needed surgeon, had to drag him away from talking with her, telling her the same information over and over. And over.
When I have
needed treatment, I make sure to say, 'do what you usually do. You know best what works well.' And I'm so aware of my own role as my own advocate, and not at all obedient. But I don't want to unnecessarily upset routine, since that sets me up for random distraction problems. Like you don't tell your waiter how to put down the plates.
I sometimes have to sit on my hands not to help in restaurants, but I know it's important not to interfere. Not to make too many special requests. Not because I'm wrong, but because it may not work. Let the people who are good at their jobs get on with it, once the decision is made.
Yes, I did work a very long, difficult day. Not quite 12 hours.
*Book Of Mormon related.
¬Removal of Hardware. Usually for pain, pushing through the skin. Most hardware will stay in permanently. At least, that's the intention.
‡LDS liturgical music is mild, bland, and child-friendly. Dull.
†The real name is actually more phony sounding, reality always beats fiction for unbelievability.