Agree that the ancef thing is no big deal. I've been at hospitals where it's been routine to give ancef with a pcn allergy, and I've seen some anesthesiologist balk at giving it. My preference is to give it if the pcn allergy is just a rash or hives. If anesthesia doesn't like it, then I go with clinda. Like others have pointed out, most of these pcn allergies are bullshit.
I think there's gonna have to be a change in culture at some point, but shit talking in the OR is just so entrenched. When I think about it, I do say a whole bunch of stuff that would be taken out of context. I've certainly gotten into the habit of calling some of my patients idiots, but I honestly think I'd be a worse surgeon if I had to think about everything I said when I operated.
I operated on three drug addicts in a row last week coincidentally. When the third one was asleep, the nurse asked me why all my patients were drug addicts, and I joked that I prescribe a lot of narcotics. Out of line? I don't think so, but I'm sure someone would take offense. Anyway, all three did incredibly stupid things to injure themselves and I'm sure I called all three idiots at some point during their surgeries. I'd call myself an idiot if I had done the same thing. One (morbidly obese) guy jumped off a 20 foot cliff "just because" and broke is foot. One guy thought that "nothing to eat or drink after midnight" meant that sneaking orange juice in the morning was ok and ended up aspirating during the case, turning a 30 minute surgery into a nightmare. Yeah, I definitely called him a moron when anesthesia told me he just vomited a whole bunch of orange juice around an LMA, and his sats started to crash.
One girl fell off a roof, was given a knee immobilizer for a non-operative fracture, then walked around for 3 weeks without it on because no one told her how to use it. And she comes to see me three weeks out with a patella that's horribly misaligned and half healed. Oh, and she's from another state and has no insurance. She just started rehab in my state 2 days ago. So I spent three hours fixing her in the OR, muttering to myself over and over about how fucked she was going to be. Reduced the fracture over and over and over and said out loud that the reduction looks like shit. Tried every technique I'd ever been taught trying to fit all those broken pieces together. Sweated my ass off wearing heavy lead. Called her an idiot over and over for waiting so long, not following directions, and making my life so difficult. Finally got the pieces somewhat in line and said that I was going to accept it even though it wasn't perfect. "The enemy of good is better," I said. Wondered out loud about how the hell was I going to manage her pain because she's in rehab for prescription drug abuse and her rehab center wouldn't let me prescribe her opiates. I remember distinctly saying out loud, "Everything about this case is fucked up." And I'm sure I'd be roasted over the coals if anyone had recorded me. But the thing is, I was 100% focused on fixing this girl as best as I knew how. Me bitching about her was just me venting in an incredibly stressful situation. She's my responsibility and how well she does from this rests solely on my shoulders. I don't think I'd be as focused if I couldn't be myself. Not a big deal for simple routine cases, but then again, I'm not cursing the patient unless things are really going south.
