Surgical Precision

RACmonitor Publisher and Monitor Mondays host and Executive Producer Chuck Buck recently went in for surgery – and came away impressed with the quality of his care.

The call was set for 4:30 in the morning.

Having grown up in Hollywood when my dad was acting in television programs (think Quentin Tarantino’s “Once Upon a Time in Hollywood”), I remember fondly seeing him get up even before then, so he’d have time to drive into Culver City by 4:30 and sit around in makeup and wardrobe waiting to be called for a two- or three-minute scene.

Fast forward to San Diego, and my hospital’s surgery scheduling center issued the 4:30 call for me. Remembering how my dad approached these kinds of calls, I was on. Showered, shaved, and wearing my favorite red loafers, I headed out in the darkness of the early morning to the hospital, clutching my steering wheel and heading east along an almost deserted freeway.

Walking into the brightly lit hospital lobby, the very officious greeters exhibited a Four Seasons demeanor. As if they had rehearsed their lines before I entered, they knew my name and greeted me warmly, as though I were a wayward traveler seeking refuge in a luxury hotel. They also knew the reason for my visit and where I should go, the route to take to the elevator, and the waiting room and room number.

Once in the waiting room, which was already occupied by other patients, I presented myself to another receptionist, who also seemed to know my name and the reason for my visit. Here, at this desk, the receptionist affixed a band to my wrist – as if I was being granted a backstage pass at a popular concert. I waited for what seemed like hours, thinking about my dad, as he might have sat in his makeup, fake beard, and cowboy hat, waiting for daylight to break behind the Griffith Observatory.

At long last, I was greeted by a nurse who escorted me to yet another waiting area. This was the pre-op area for all general surgery patients, all of whom were in hospital beds, separated by folding curtains. At this hour, all the curtains were open, to reveal a surprising variety of patient demographics – mostly old, mostly white, and all somber.

One talkative nurse was particularly effusive. She chatted endlessly with me as she moved about my bed, instructing me to remove my garments (including my red velvet loafers) and stow them in oversized Ziploc bags, each with a barcode. Another hospital official came into my crowded room and asked me to remove the money from my wallet. She insisted that I remove every last bill and coin. Perfunctorily, she counted the change – with the dexterity of a racetrack cashier. She totaled the money on a form, which she insisted that I acknowledge and sign. The money would be stowed securely (as I was told) in a hospital safe (which, incidentally, had my barcode).

Then there was more chatter with the talkative “Barbara,” who allowed that she had been in this position for more than 20 years, at a job she relished – and one for which she seemed not to be in it for the money, so to speak. She loved patients and being there to help them and provide comfort, while, I assumed, assuaging fears and trepidation.

Had this pre-op room been a chicken coop, I would have been the most loquacious rooster. I began clucking by asking her about the coders. You see, for me, I was experiencing a hospital stay of which I had only read in the abstract, editing others’ articles about length of stay. For me, though, this was reality. I was experiencing it in real-time, and it was happening to me now – at about 8:30 in the morning.

The coders, Barbara told me, no longer work in the hospital. They work from home.

Taking a bit of pride in demonstrating my knowledge, I inquired about the whereabouts of the clinical documentation integrity professionals (CDISs). She said she seldom sees them, but only on special occasions (to which I rejoined by saying that I had read that the better ones worked on the floor, along the physicians. Not the case here, I was told).

Barbara also explained that a number of caregivers would be coming to my bedside to ask me the same set of questions. To be sure, she said, they all knew the answers, as this was more of a test of my mental capacity. And so they came. And the routine appeared to be well-scripted. They called me by my name. They asked me the reason for my visit, and then they checked my wristband an entered some notation in the bedside electronic health record (EHR).

My urologist-surgeon then appeared: a slightly built Asian-American who seemed to have aged since he and I had first begun discussing this operation nearly a decade before – his hair grey now. He was quite businesslike, sans any affectation of a bedside manner. He reminded me that there were four bladder stones that he was going to remove.

Soon I was wheeled into the surgery center. Once again, there was the last-minute check of my wristband, and more scrutinizing via the bedside EHR. My urologist – the attending physician – called my daughter to explain the procedure. I think he also talked into a microphone to describe the procedure for the record. I remember how television directors would often recite aloud the slate before shooting a scene (concluding by saying “take one.”)

To me there could only be one take.

The anesthesiologist placed what seemed to be some sort of rubber cup over my face, allowing me to chortle that I was still awake (only to be reminded that it I wouldn’t be…for long.)

Then blackness.

When I came to my senses six hours later, my daughter was there, and she explained to me that the surgery had taken six hours – longer than expected, as the stones were harder than anticipated, forcing the surgical team to abandon new technology for older technology (which I joked included a jackhammer and an industrial vacuum cleaner.)

The old technology was okay with me, because, recently I have begun self-describing myself as an old-school gentleman.

So, what are my takeaways?

First, I was thoroughly impressed with the Four Seasons hotel demeanor of the hospital’s greeters and the overall deferential treatment I received. All were courteous, polite, and non-obstructive. My well-being was their top priority, and their demonstrated sincerity was Oscar-worthy.

Second, they were all so very professional, reminding me of all the crew members with whom I have worked in television production. They all knew their respective tasks and seemed to have taken an inordinate amount of pride in performing their work in what appeared to me to be seamless fashion.

Third, I was impressed with their conscientiousness in checking and double-checking my wristband, and asking me to affirm my name and the reason for my visit.

As I write about my first experience as a surgery patient, I am reminded of the less fortunate and America’s underserved populations – wishing that soon, what appeared to be routine treatment for me will be the new normal for so many of them.