Following pre-op instructions might be a good idea

Well, after yesterday’s whinge-fest of a blog post, I’m happy to report I encountered no road-ragers during my commutes today. And I worked with a couple of exceptionally pleasant surgeons, and the OR staff were as nice as always. The patients, however, tested my patience.

“Don’t eat or drink for x hours before surgery” includes fruit smoothies and popcorn, which were the forbidden pre-operative foods of choice, respectively, for two of my patients today. Some days I just want to pull out my hair. Yes, we told you not to eat or drink (miscreants frequently claim they weren’t told this. Bulls**t. It’s like saying you went to Mass but no one told you to kneel.) No, we weren’t kidding. (We don’t tell jokes.) The average American can go without food for a few hours without shriveling to dust. Your belly won’t bloat, nor will flies crawl over your dessicated lips, if you forego the chicken and waffles before your bunionectomy.

It seems that when we want some patients to think (common sense), they are often not up to the task. But if we simply want them to do, rather than think, suddenly everyone’s a Rhodes Scholar, heading to the Internet to consult with some shaman somewhere. Still others seem to believe it’s their duty to disobey anything they are told by an “authority” figure, even if it’s for their own good. People, pre-op instructions are decidedly not the place to work out your issues with authority.

If you’re having surgery, and your surgeon or another person in the know instructs you not to eat or drink for x hours prior — DON’T EAT OR DRINK!! We aren’t kidding. Don’t eat a fruit smoothie because “my blood sugar was low!”. That’s why God made apple juice, which most people can drink safely up to 4 hours before most surgeries. I don’t care about your low blood sugar; that might be uncomfortable (suck it up, you’ll live), but it won’t kill you like lungs full of smoothie just might. And I can only imagine what tiny popcorn particles marinated in stomach acid could do to lung tissue. Stomach acid is made to digest meat; lungs are meat; and small particles are just about the ideal way to ensure that acid gets to every part of the lungs.

The ironic thing is that more-recent evidence has demonstrated the benefits of drinking carbohydrate-containing liquids, like sports drinks, up to shortly before surgery. We are starting to advocate this step for more types of surgeries. But I’d say the single greatest obstacle to doing so more widely is our well-founded fear that we can’t trust patients not to abuse the license, because so many people can’t or won’t follow simple instructions.

End of rant. Thank you for your attention.

Michael Sebastian @mikeseb