can practically see the drool at the corners of your mouth as you
contemplate putting in your very first chest tube! I can hear the
email you're writing in your head: "Dear Mom, today I was able to hone
my surgical skills while saving a life...my job is oh so rewarding!"
So don't look at me like I'm the enemy. Stop fingering that scalpel in
your pocket. (Oh gosh, I hope that's a scalpel!)
But dude, take a step BACK! Do not get mad at me because I won't
witness your consent. The person you want to stab with a chest tube is
not some big 20-year-old kid. It's a 70-year-old lady. She's pretty
healthy looking, even with a pneumothorax. But she doesn't speak
English very well and even I can understand that she's scared about
being in pain. She keeps asking, "Operation room we do it? I go a
little sleep?" You telling me she'll be fine with 5mg of morphine and
some local anesthesia at the site is not going to cut it.
Don't be mad at me for grabbing one of our ED attendings (who happens
to speak the same language as the object of your chest-tube lust).
Come on, he agrees with me: this old gal had no CLUE what was coming
down the pike! You do know you can't get informed consent using hand
gestures and some made-up foreign vocabulary! Ending every word with "-
ski" does not mean that you're speaking Russian, not even if your
patient is nodding and smiling politely.
Look: a little conscious sedation and we'll all get what we want, and
then you can stab away to your little heart's content. See? I knew
you'd come around.