I have seen much in my forty-eight years of medical practice, and in the additional two years I spent in combat as a medic in Vietnam. Every situation, every experience was worthwhile and helped to forge me into a good PA. I recognize this in my other colleagues in medicine, nursing, radiology, phlebotomy, respiratory therapy, housekeeping, and, forgive me, others in our medical institutions. Every one of these specialties contributes to the welfare of our patients and deserves our utmost vigilance in observing each other for the good, the bad, and the ugly.
I vividly remember running a code in a large hospital, and the first-year residents lined up, anxious or eager to perform chest compressions. All wore their white coats, had on gloves, and began performing compressions under strict observation from the other team members and me. One of the residents left for the men’s room after his turn and remained there for at least five minutes. That is quite a long time for a young man without a prostate problem. He exited with the same gloves on and went back in line. I immediately told the nurse who was documenting the code, who swiftly removed him from the line, then reamed him out and educated him. Awareness and observance were both factors in preventing infection.
I spent my career in surgery and emergency medicine, and the last 2 years in urgent care. All these positions require vigilance. As the first assistant in surgery, I focused on my patient, the anatomy, and the patient’s response to, or lack thereof, the procedure. I also observed the anesthesiologist, the ECG, the scrub tech, and the circulating nurse, who shared the same responsibilities as me, including positioning, Bair blanket, and electrical devices. I have seen ECG changes and O2 sats that the person at the head of the table missed. I immediately spoke out. I have seen the anesthesia personnel either fall asleep from old age, a late-night call, or medication. I awakened them. I have seen breaks in technique by others at the table, such as a new resident who was a second assistant, as well as from the Scrub tech or Scrub nurse. I commented immediately and told them to change their gloves or gowns, just as nurses have told me to do when they saw a break in sterile technique. I have always observed that implants are used with care during the procedure, such as sterile implants in orthopedics or general surgery (e.g., mesh) or in plastic surgery (e.g., breast implants). Caring for infection is part of our job, but more importantly, preventing contamination. I imagine I sound like a real pain in the gluteus maximus, but I was never out to win an award for letting errors go unnoticed.
I have observed physicians, surgeons, PAs, NPs, and nurses walk into a room in bloody lab coats, without gloves, and without hand disinfection before or after leaving the patient. I have seen physicians and residents’ ties lying against surgical wounds. I have observed patients developing decubitus ulcers because they were not protected pre-op or were not turned every two hours because of the shortages in the nursing department. Many of these errors occur because administrators, DONs, supervisors, and head nurses were more concerned with following a mandated script than with ensuring the tools and personnel necessary were available. Our Systems need Urgent Care. A soldier is sent out to battle with the appropriate equipment and resources to continue the fight unless an overwhelming enemy has engaged them in combat for so long that their ammo has run out. And still, helicopters dropped supplies and ammo and tried to the best of their ability to send in Dustoff helicopters for the wounded. Why do we expect any less from our hospitals and senior leaders?
Lastly, I have been a patient twice in the last two months, once for an umbilical hernia with bowel obstruction, which was relieved by a resident in the second hospital, and I was asked to delay surgery for 24 hours. Fortunately, since I have only been in my state for 5 years, my daughter is the president of a Parent Association at a very elite private school, and her physician friends referred me to the best hernia surgeon in the state. On CT, I had bilateral inguinal hernias the size of a baseball, a large umbilical hernia, and three ventral hernias with a diastasis rectus. I also had a panniculus from an eighty-pound weight loss and had erythematous lesions and fungal infections. She said that this panniculitis would interfere with my wound healing and jeopardize it, and received authorization for a panniculectomy. She had a cardiac anesthesiologist for me as I have HCM and A-Fib, performed a three-hour procedure with mesh and a repair of the muscles, and I left the OR with a thirty-inch horizontal incision. I stayed in the hospital for six days and was discharged in good condition. All was well except for a seroma on my suprapubic area, which descended downward, and after observing it for a few weeks, I noticed some erythema. My surgeon saw me immediately and said, “You are being admitted to the hospital immediately through the ER for surgery later this evening and evacuation of an abscess and a half gallon of antibiotic for a wash-out. I was placed on super high-powered antibiotics and seen by ID. I am home now with a drain and binder, and I spent Christmas week in the hospital.
It was interesting to observe nursing and postoperative care from a patient’s perspective.
Hospitals are not the place to sleep, as between surgeon visits, nursing care, vital signs by nursing assistants, and 3 AM visits from the phlebotomy department, you learn to rest in between. I received excellent care from my surgical team and had no pain. I asked the nurses to hold my Miralax order, as the antibiotics are already easing bowel motility. I was supplied with everything I required, and the food was at least two-star and edible.
So, what is the wrap-up? We are a profession that has been chosen to relieve anxiety, pain, discomfort, and mental anguish for our patients. We may have a bit more time than others on the team. We should therefore be especially vigilant as sleuths, observing the emotional, physical, and wounds or diseases, as well as the medications that are ordered or that we may have ordered. By following proper techniques and precautions, we can help this patient leave the facility quickly as they heal. Still, if we choose not to be observant or aware, we can be co-conspirators in a poor outcome, a sick patient, and a medical or surgical catastrophe. This is why we seek appropriate malpractice insurance: we never know when we will be named, and even if we are not guilty, we will need the proper insurance to represent us in the legal process and preserve our reputation. And please remember a nursing rule:” The five Rights. The right patient, the right drug, the right time, the right dose, and the right route. Have a happy, uneventful, healthy, and prosperous 2026 from me and CM&F.
