this is not your typical hospital sitcom. or is it?

I'm just in love with the O.R. at Moore Regional. The surgeons are great, the surgical nurses even better...and there's always too much going on at any given time so everyone's always on their feet and chatty.

Today I observed a laproscopic Roux en Y gastric bypass surgery. Actually, it's all I did today, because I was called to the O.R. at 8am, and the surgery was behind schedule (inevitably) so the patient wasn't transported until 10:45am, which means the pt and the room wasn't ready for the surgeon until at least 11:15am. With the whole procedure lasting 3 1/2 hours (this one was a little complicated because of the anatomy of this particular pt and the fact that she had a few hernias they had to resolve during surgery), I didn't get scrubbed out until 2:45. I promptly headed to lunch at this point, since i hadn't eaten or drunk anything since 7am, which left me with 45 minutes of floor time with my rotating R.D.

Anyway, the surgery itself was fabulous. The surgeon was such a character and talked the whole time (until he asked the nurse to put some music on, at which point he began singing). He talked me through what he was doing and why...and then he drilled me with questions: What is HbA1C? How is DMT2 defined? How is it different from DT1? Did you know Bariatric surgery is now called metabolic surgery? Why is this? Why do some gastric bypass surgeries reverse diabetes? What was the premise behind the Atkins diet? what does this imply about the substrates we consume and it's effect on our metabolism? It was a little intimidating at first, but he had such a good sense of humor, it actually felt good to be able to answer questions and be challenged. He started off real easy on me: "How many calories are in a gram of protein? carbohydrate?..fat?" after I answered, he said, "Amaris, you're already ahead of 75% of the medical community." He talked on and on about how there was a lot of ignorance in the medical community regarding nutrition, and how R.D.'s are needed greatly, but that the bariatric population was one that required a different approach than the population at large. "The food pyramid does not work on bariatric patients. It only works for the 1/3 of the population that is NOT obese." You can't tell a bariatric patient to eat 6 servings of CHO's a day, he said. "You weigh, what, 115 pounds? ....and you're about 5'2'', can you imagine being 300 pounds? The problem with Dietitians is that they're not obese [yes, I chuckled when he said that]. People don't just wake up and decide to be 5'3'' and 350 pounds (like the pt he was working on right then on the operating table). Can you agree with me that we need to change the way people eat so that we can change the way people metabolize food?"...I was blown away at how passionate he was about nutrition, or how much he valued R.D.'s (even though he thought we went about some things the wrong way...). Of course, much of what he said I've already heard, but he shared from a different perspective than I could know at this point. He kept challenging me to look critically at the way we counsel bariatric pts, but it was really encouraging to me -- even with my extremely limited knowledge of MNT for bariatric pts, I left that O.R. proud to be an R.D. candidate and more enlightened about the M.D.-R.D. dynamic and philosophy of the role of nutrition in post-op pt recovery and wt maintenance....man, what an INTENSE day! As he was stitching up the pt, he said to me, "There are two things I hope you take away from me today; one, that I'm cool, and two, that bariatric patients are different."