The Joplin Globe, Joplin, MO

September 27, 2010

Linda Cannon, Book review: An inside look at surgery — quite literally

By Linda Cannon
Special to The Globe

JOPLIN, Mo. — “Operating Room Confidential”

By Paul Whang

Inspired by Anthony Bourdain’s “Kitchen Confidential,” anesthesiologist Paul Whang has written his own informative and entertaining (if not for the squeamish or those with delicate sensibilities) book about anesthesia, surgery and the goings-on in hospitals titled “Operating Room Confidential.”

As an example of the “squeamish” part, consider the following passage:

“During open abdominal surgery, where a large cut exposes the gut, if there is inadequate muscle paralysis, muscles will tighten and push the writhing, squirming coils of pink guts through the cut and over the body, like coiled toothpaste squeezed from a tube. It’s a very freaky but totally involuntary reflex.”

There are many more (and more graphic) passages about the human body in the book, so consider yourself warned if you tend toward queasiness.

As to the sensibilities, there are several passages about sexual matters, including behavior of staff and some of the peculiarities of the human body and its responses to various stimuli. So, if you don’t care for that sort of thing, you might want to take a pass or at least be prepared to skip over those sections.

Given those caveats, this is a really interesting book for anyone interested in what goes on in hospitals, particularly operating rooms. Some of the information will be familiar to medical television junkies, like the possibility of explosions during electrocautery in the belly (hey, methane is flammable, you know!), and perhaps the dreaded “awareness during surgery.”

If you don’t know about that last one, let me say that it is rare, but can be quite devastating. In those cases, generally the anesthetist has fallen down on the job. If you haven’t heard of it, it occurs when the paralytic drugs are fully in effect (preventing the patient from alerting anyone to the situation) but the anesthetic ones aren’t fully in effect. The patient winds up fully conscious and feeling all the cutting and pulling and everything else but is unable to move or speak. Yikes!

Fortunately (for both doctors who wish not to be sued and patients who don’t want to have memories like that), it is generally caught at some point and the patient is administered amnesic drugs that prevent them from remembering the event. I would imagine that there have been some whopping lawsuits when the event went unnoticed by the operating room team!

The first chapter covers what goes on in the operating room before and during surgery, including who’s there to do what and what happens if they finish up and discover a sponge or other object or implement missing. Ooops!

There is a chapter titled “Off-label Truths about Doctors” in which Whang uses the Myers-Briggs test to outline the usual personality types that go into the various medical and surgical specialties. If you are a student of the Myers-Briggs types (introvert/extrovert, sensing/intuition, thinking/feeling, judgment/perception), you might find the section useful for dealing with your own doctor. If not, it makes for entertaining reading anyway.

Aside from satisfying idle curiosity, the book also gives a lot of good information for anyone facing surgery. Reminders to bring lists of all medications (including herbal remedies and over-the-counter drugs), and as complete a medical history as you can manage are useful.

Speaking of medical histories, here’s an anecdote from the book that illustrates the author’s sense of humor: “When English is not the first language, a good interpreter is sometimes needed, though I’ve found relatives of patients are not always helpful. ‘Now Mr. Lima, do you have any chest pain?’ I ask. The daughter interrupts. ‘His English is not that good. I’ll speak to you for him, okay?’ ‘Sure, go ahead and ask him.’ ‘DAD, DO YOU HAVE ANY CHEST PAIN?’ she screams at him in English. ‘No, I’ve got none,’ he responds in English. She looks at me earnestly. ‘He says he’s got no pain.’”

Other interesting information includes what can be done preoperatively to reduce postoperative pain and what level of pain is to be expected from various surgeries. The last section is in Q&A format and answers the questions most often asked about surgery and anesthesia. All in all, it’s informative for those planning surgery and interesting for medical junkies. I feel fortunate to fall in the latter category! To your health.

Linda Cannon is the circulation supervisor/collection development librarian at Joplin Public Library.