Part 2 book “Core clinical competencies in anesthesiology” has contents: Transhiatal esophagectomy, nephrectomy, cut off at the knees, renal transplant, left lower extremity pain, puff the magic dragon, aborted takeoff, revenge of the bluecrab cake, mind, body, and spirit, and other contents. | Part 1 Case 36 Contributions from Stony Brook University under Christopher J. Gallagher Mr. Whipple and the case of the guy who likes to mix a few vikes with his vodka Misako Sakamaki and Brian Durkin The case You are consulted the week before surgery by the surgical oncologist about “another one” coming for surgery for pancreatic cancer. You remember fondly the “last one,” who drove everyone crazy, from the preoperative admission area nurses to the guy who held open the hospital door as he left for home and let it slam him in the rear. He had his big life-saving cancer surgery and was lucky to get out of the hospital alive – and that meant that someone had to keep the staff from killing him. This is the dreaded narcotic user and abuser who will tax your professionalism to the nth degree. You remember those days back in high school, when they showed those black-and-white movies about people who fell ill to the needle? Today, they don’t dress as nice, may actually not use a needle, and may actually get their opioids from the same guy who gives you a flu shot. They live among us, and yes, they are often your patient. The Whipple procedure (did Dr. Whipple succumb to pancreatic cancer? I think he did) is a long, tedious operation performed occasionally at your institution by a surgeon who likes to “keep the patient dry.” “Don’t follow those ‘rules’ you usually follow. Urine output is not that important. I don’t want them to bleed too much.” These are the words of this surgical oncologist, who also doesn’t want you to use local anesthetic in the epidural for the first 24 hours postoperatively. What are you to do for this patient? Can his postoperative pain be effectively managed? Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 184 Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and
