Real Surgeon and Anesthesiologist React to Dr. Glaucomflecken

Welcome back to the Dr. Rich channel. Thank you for viewing all of our videos! We’ve had such an overwhelming response from our reactions to Glaucomflecken — and you get what you ask for! Here’s another Glaucomflecken reaction! 

Don’t have time to read this post? Watch the video here instead!

Doctor Rich:

Today we have — in the studio — real live anesthesiologist Jessica Compean! [to Dr. Compean, laughing] You can say, “Hey!”

Dr. Compean [laughing]:

Oh, hi!

Doctor Rich [clicking the play button for the video]:

And away we go…

[Glaucomflecken video begins. The Therapist, Anesthesiologist, and Surgeon (all played by Dr. Flannery) are seated in the counseling room]

Therapist:

Okay. Anesthesia?

Doctor Rich [pointing to Dr. Compean, laughing]:

That’s you…

Therapist:

Surgery? 

General Surgeon:

Yeah?

Doctor Rich [laughing, pointing at himself]:

That’s me…

Therapist:

Do you know why you’re both here today? 

General Surgeon:

I don’t know, but I’m sure it’s his fault! 

Doctor Rich [whispering, pointing at Dr. Compean]:

That’s probably true…

[The Anesthesiologist scowls at the General Surgeon from behind a surgical drape, with only the top portion of his face visible]

General Surgeon [to Anesthesia]:

Do NOT drape-glare me!

Therapist:

You’re here because the two of you refuse to get along. 

General Surgeon:

Oh, come on. We’re fine!

Therapist:

Surgery — yesterday, you took Anesthesia’s chair and replaced it with a stool. 

General Surgeon:

So?

Therapist [emphatically]:

 A comfortable chair is vital to preventing anesthesia-related burnout!

Dr. Compean [nodding in agreement]:

So true!

Doctor Rich:

Is that… Is that accurate? 

Dr. Compean:

Yes!

Doctor Rich:

Although I will say that (at least for robotic surgery) we’re a little bit bougie about our chairs as well! We love to sit, we’ve got a little armrest… been trying to get a coffee holder for awhile…

Dr. Compean:

No, no, that’s very nice!

Doctor Rich [laughing]:

But they’re not good with that…

Anesthesia:

Was VERY uncomfortable!

 Therapist:

And Anesthesia — in retaliation, you stole and hid the surgeon’s compression stockings!

Anesthesia:

Well, he deserved it!

Therapist:

Anesthesia, you KNOW a surgeon’s unhealthy obsession with operating results in physical breakdown at a very early age!

Doctor Rich [to Dr. Compean]:

Is that true? 

Dr. Compean [laughing]:

Yes. 

Doctor Rich:

Do people wear compression stockings? 

Dr. Compean [laughing]:

Noooo!

Doctor Rich:

I don’t wear compression stockings! 

Dr. Compean [laughing in agreement]:

They’re so uncomfortable!

Doctor Rich:

Although I don’t stand either — because I’m a robotic surgeon, so I get to sit down. So do you? 

Dr. Compean:

I don’t stand either. I sit down.

Doctor Rich:

Right, right. But you get to watch/surf the internet — I have to like… actually do stuff!

Dr. Compean [jokingly]:

Don’t give away all of our secrets!

Doctor Rich:

I know, right? 

Therapist:

The two of you need to end this. It’s time to take down that drape!

Anesthesia:

What?! No! [pleadingly] It’s really stupid over there!

General Surgeon:

Says the person who can’t control blood pressure!

Anesthesia:

Well maybe you should stop losing so much blood! 

Doctor Rich:

Does that ever happen?

Dr. Compean [holding up a towel like a surgical drape]:

This is the blood brain/barrier.

[pointing to herself] The brains… 

[pointing to Doctor Rich] …and the blood!

Doctor Rich [sarcastically]:

That’s… that’s a good one… haha… [sad music plays, the video fades to grayscale and an animated tear falls down Doctor Rich’s cheek]

So that never happens, right? You never have issues where you can’t control blood pressure and it’s never your fault. It’s never blood loss with a surgeon?

Anesthesia:

Of course not. No.

General Surgeon:

Never had more than 50 ccs of blood loss!

Doctor Rich:

That’s actually true…

Anesthesia:

What’s in the Cell Saver? Tomato juice?

General Surgeon [defiantly]:

Yeah. Maybe!

Anesthesia:

You’re not allowed to bring food in the operating room — I’ve tried!

General Surgeon:

Well, I wouldn’t lose blood if you’d control the blood pressure… No you, 

Doctor Rich [laughing]:

You guys are always bringing snacks in?

Dr. Compean [clearing her throat jokingly]:

I’m not… Ahem… admitting to anything…

Doctor Rich:

All right — you cannot confirm nor deny. 

Dr. Compean:

Nope!

Doctor Rich:

So what IS in the Cell Saver? Is it tomato juice? 

Dr. Compean:

Absolutely not. 

Doctor Rich:

Okay. So the Cell Saver is a technology that’s particularly helpful in circumstances where there’s an anticipation of a higher blood loss — or in patients who can’t (or won’t) accept blood products. So it’s a technology where blood is actually collected. Instead of going into a regular suction canister during the surgery, it goes into a unit repository that is collected during the surgery. It’s then centrifuged down so that the viable red cell mass can then be transfused BACK to the patient at the end of the surgery. Now this is all in theory, since I’ve never lost more than 50 ccs of blood!

Dr. Compean [sarcastically]:

Yeah, of course not…

Doctor Rich [laughing]:

But other surgeons find this helpful?

Dr. Compean:

VERY helpful. 

Doctor Rich:

Okay. Yeah. So my practical application for that would be two circumstances (at least for GYN, Uro/GYN surgery) would be a very large — we’re talking about greater than 10, 15, 20 centimeter — myectomy. So the removal of a fibroid for the uterus. 

Now, the reason that this might be a higher blood loss surgery is because there are four pedicles that supply blood to the uterus — and those all have to be maintained and left intact while you’re surgically removing the fibroid. So there’s just ongoing blood loss that whole time! And sometimes for these larger fibroids, you can look up and all of a sudden there is like 500… a thousand ccs of blood loss!

So typically — and correct me if I’m wrong — the perfusionist is able to give back about half of the blood that’s lost during the surgery.

Dr. Compean:

Correct. 

Doctor Rich:

And that’s your own blood! So you’re not getting a transfusion from… a rando!

There are several important keys about that — one of which (probably the most important) is called a transfusion reaction, right? 

Dr. Compean [laughing]:

Oh, don’t make me start that…

Doctor Rich [joking]:

“I Did’Nt cOme pRepAred FoR tHis! I didn’t know I’d be ‘edu-macating’ people!”

So probably the most common — and perhaps severe — side effect would be a transfusion reaction. This is when there are antibodies that the patient has, that actually see donor blood as foreign — and creates inflammation… and can actually even lead to death. All that being said — NOT to tomato juice.

Anesthesia:

You’re not allowed to bring food in the operating room — I’ve tried!

General Surgeon:

Well, I wouldn’t lose blood if you’d control the blood pressure!

Anesthesia:

No… You wouldn’t lose blood if you’d stop cutting through all the arteries and veins!

Therapist [firmly]:

That’s ENOUGH! I didn’t want to have to do this… but you’ve left me no choice!

General Surgeon [nervously]:

What do you mean?

Therapist:

I have to put on the hat.

General Surgeon [begging]:

Oh no, no, no, no. Come on — we’ll be good!

[The Therapist puts on a colorful nurse’s cap and looks at the doctors sternly]

General Surgeon [gasping]:

Charge Nurse!

Therapist [as Charge Nurse]:

Now, if you don’t play nice — there WILL be consequences!

General Surgeon [wincing]:

Like what? 

Therapist:

Maybe I’ll turn off the wifi…

[Dr. Compean gasps in horror]

Doctor Rich [in disbelief]:

Oh, dude!

Dr. Compean:

Oh my God, no! 

Doctor Rich [laughing]:

You might retire!

Dr. Compean [laughing]:

Yes!

Doctor Rich:

If there was no wifi?

Dr. Compean [joking, but with a grain of truth]:

We’d be MISERABLE. Can you imagine? A four-hour surgery with no wifi? What is this — a third-world country? 

Doctor Rich [making a slashing motion to indicate it never happens]:

There are no four-hour surgeries… 

Therapist [to Surgeon]:

Maybe I’ll set the OR room temperature to 70 degrees…

Doctor Rich [getting up from his chair and walking out of view]:

I’m leaving!

General Surgeon [horrified]:

That’s so balmy!

Dr. Compean:

We’d love it. Let’s do it!

Doctor Rich:

Actually the only reason that the OR is kept at, like, frigid temperatures in the sixties is for operator comfort. The surgeons and all the staff — except for anesthesia and nursing. We’re all draped in layers of stuff (sometimes lead), and it gets very hot. So there’s no actual patient benefit to a frigid temperature. And you can actually check that out and more OR facts in this video here

Therapist:

And you’re both going to be forced to attend internal medicine, grand rounds!

[Doctor Rich and Dr. Compean look at each other in horror]

Doctor Rich:

Nooooo!

General Surgery:

You wouldn’t!

Therapist:

Try me! 

Doctor Rich:

Is there anything worse than internal medicine grand rounds? 

Dr. Compean:

Absolutely not.

Doctor Rich:

I can’t… I’d need at least eleven cups of coffee to survive that…

[music from the game “Candy Crush” plays. Therapist looks disapprovingly at Anesthesia, who is on his laptop playing]

Doctor Rich [laughing]:

Is this Candy Crush? I’ve never played it…

Therapist [without the hat]:

You like to crush candies another time?

Anesthesia:

Sorry…

Therapist:

Now how are things going with Surgery? 

Anesthesia [dismissively]:

Fine. 

Therapist:

Really? Because I see here that there was an incident in the OR yester… ANESTHESIA!

[Anesthesia glares from behind a surgical drape]

Therapist:

For the last time — do NOT bring surgical drapes into this office!

[Anesthesia lowers the drape and looks unhappy]

Now, would you like to tell me what happened? 

Doctor Rich [laughing, asking Dr. Compean about surgical drapes]:

Do you bring them when you go to therapy?

Dr. Compean [holding up a towel so only her eyes are visible]:

Well… It’s the imaginary drape.

Doctor Rich:

The imaginary drape. I bet you could drape-glare even without a drape!

Dr. Compean:

Oh, yeah! I don’t need a drape to glare. 

Therapist:

Now, would you like to tell me what happened? No. I’m good. Well, according to the circulating nurse… Where did you get coffee? 

Anesthesia [sipping from a cup]:

Oh, I don’t know… It’s one of the perks of anesthesia — somehow we just end up with coffee. 

Doctor Rich [laughing]:

Alright, so there’s probably one thing I’m jealous of…

Therapist:

Well, according to the circulating nurse, you wrote, “The General Surgeon is a Mallampati 4” on the whiteboard. 

Anesthesia [dismissively]:

Yeah… so?

Therapist:

It is inappropriate to make fun of people’s difficult airways!

Anesthesia:

Well, he started it!

Doctor Rich:

So what’s a Mallampati 4?

Dr. Compean:

So in anesthesia, we evaluate a patient’s airway — and they’re graded from one through four (one being the easiest and four being the most difficult). 

Doctor Rich [laughing]:

Okay. So I’m, I’m probably four?

Dr. Compean [laughing]:

Let me see — open your mouth. Nah… You’re a one! 

Doctor Rich:

Sounds kind of dirty…”Mallampati?” 

Dr. Compean:

Yeah… It does…

Therapist:

Last week at the end of a ten-hour case — you asked the General Surgeon how his work-life balance was going!

Anesthesia:

I was just trying to make small talk!

Therapist:

Anesthesia — you know surgeons don’t have work-life balance!

Anesthesia:

That’s not my problem!

Therapist:

Mm-hmm… We need to work on your conflict resolution skills. 

Doctor Rich:

So that IS kind of one of the elephants in the room for medicine. There is an alarmingly high rate of physician burnout among internal medicine, doctors, and surgeons. There are high divorce rates… high suicide rates in virtually every specialty — except anesthesia because they’re at the golf course every day at three o’clock!

Anesthesia [laughing]:

We have great work-life balance!

Doctor Rich [laughing in agreement]:

That’s right. So go to anesthesia! 

Anesthesia:

Oh, come on! No, we don’t!

Therapist:

Let’s work through some scenarios. I’ll be the Surgeon. “Anesthesia: the patient’s moving. Can you do your job please?”

[Anesthesia scowls and raises the surgical drape]

Dr. Compean:

There’s the glare!

Doctor Rich [laughing]:

Is that so that you can’t see the rest of your facial expressions? 

Dr. Compean:

Yes! We’re mouthing to you — you just can’t see it!

Doctor Rich:

Yeah… Probably have some expletives going on there…

Therapist:

Let’s try a different approach…

Another Anesthesiologist [to Anesthesia]:

Hey, dude! How’s it going? 

Therapist [indignantly]:

Well, excuse me! We’re in the middle of a session! 

Anesthesia:

Hey, what’s up? 

Other Anesthesiologist:

You wanna take a break? 

Doctor Rich [laughing]:

Every time! Every time I turn around, it’s like, ”Jessica, can you… Oh, it’s Bob now…” You know? Jessica is on a break. 

Dr. Compean [also laughing]:

Always taking breaks! 

[Therapist shakes his head “no way” in angry shock]

Doctor Rich:

No, not during therapy!

Dr. Compean [laughing]:

No, this is not a good time. Come back in ten minutes…

Doctor Rich:

So does that ever happen — where you, like, don’t give somebody a break if they come in or they don’t give you a break?

Dr. Compean:

Yeah! They get mad. You hear about it!

Doctor Rich:

Oh my God!

Dr. Compean:

Oh yeah — it’s the unspoken rule. You have to get a break, you get a break!

Doctor Rich:

Well, Jessica — I want to thank you for coming in to help us out with this anesthesia-themed “Glaucomflecken Reacts” video today. 

Dr. Compean:

It was my pleasure!

Doctor Rich:

If you enjoyed this video, make sure you subscribe — because six out of ten of you have not! And check out these other Glaucomflecken videos here, and this one here, and that one there! 🙂