May 28, 2025 • 45 mins
Ever wonder what’s really happening in the operating room once you're asleep on the table?
In this jaw-dropping episode of Plastic Surgery Uncensored, Dr. Rady Rahban is joined by Paula, a seasoned nurse practitioner who has worked in more than 40 operating rooms—mostly in the heart of Beverly Hills. Together, they pull back the surgical curtain to expose shocking truths about what actually happens during surgery… and it’s not always what patients think. From surgeons leaving the room during closures, to techs performing tasks they legally shouldn’t, and anesthesiologists cutting corners to keep peace—this episode dives into the dark side of convenience and efficiency in the world of cosmetic surgery.
Whether you're considering surgery or know someone who is, this episode is a must-listen. It's not about fear—it’s about empowerment.
🔍 Topics Covered:
– Who is really closing your incisions?
– Why speed doesn’t always mean skill
– The terrifying truth about reused sutures and missing safety protocols
– Anesthesia nightmares and compromised patient safety
– How to actually vet your surgeon and surgical facility
Available now on all your favorite platforms.
✍️ Don’t forget to leave a review and share this with someone you care about. It could change the outcome of their surgery.
In this jaw-dropping episode of Plastic Surgery Uncensored, Dr. Rady Rahban is joined by Paula, a seasoned nurse practitioner who has worked in more than 40 operating rooms—mostly in the heart of Beverly Hills. Together, they pull back the surgical curtain to expose shocking truths about what actually happens during surgery… and it’s not always what patients think. From surgeons leaving the room during closures, to techs performing tasks they legally shouldn’t, and anesthesiologists cutting corners to keep peace—this episode dives into the dark side of convenience and efficiency in the world of cosmetic surgery.
Whether you're considering surgery or know someone who is, this episode is a must-listen. It's not about fear—it’s about empowerment.
🔍 Topics Covered:
– Who is really closing your incisions?
– Why speed doesn’t always mean skill
– The terrifying truth about reused sutures and missing safety protocols
– Anesthesia nightmares and compromised patient safety
– How to actually vet your surgeon and surgical facility
Available now on all your favorite platforms.
✍️ Don’t forget to leave a review and share this with someone you care about. It could change the outcome of their surgery.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Welcome to another episode of Plastic Surgery and Censored. I'm
your host, Doctor Roddy Rabon, and I'm always excited about
our episodes because I think they're all super interesting and formative, educational,
and hopefully entertaining. But this particular episode slash episodes, meaning
I'm not even sure we may even do a two
part of this, I'm actually the most excited about because
(00:29):
what we're going to be talking about is operating room
or o R nightmares. But not from my perspective, which
many would say is biased or limited, but rather from
the perspective of a very well respected nurse now nurse
practitioner who is one of our newest additions to the
Rabond family here at our office, and her experience and
(00:52):
her exposure with her friends and her group and her
community of nurses, and what they've seen happen in the
operating room, which is basically what we've been talking about
in many of our episodes, which basically is what we
read about in the media when things go sideways. But
I just found it so fascinating and so interesting hearing
(01:13):
good firsthand from her own perspective, So you're definitely going
to want to listen very closely to this entire episode,
and maybe we do a follow up episode as we
kind of traverse sort of the landscape of operating room environments.
Speaker 2 (01:28):
Remember, the key here is kind of like a mechanic.
Speaker 1 (01:31):
When you go into an operating room, you're out, you're asleep,
you have no idea what's happening, and you assume, as
you should, that your physician and the environment around you
is safe, and it's it's actively engaged in keeping you safe.
But the truth is, like a mechanic, when you go
(01:51):
and you get your car back, unless you're an expert,
you have no idea what happened while you dropped your
car off. And so I think it's going to be
very eye opening.
Speaker 2 (02:00):
I hope it's going to be.
Speaker 1 (02:03):
Educational that you know, you really really when I say
do your.
Speaker 2 (02:07):
Homework, I'm not just talking about the basics.
Speaker 1 (02:09):
Oh, I went to a board certified plastic surgeon in
Beverly Hills, Like, okay, well that should do it right. No, Essentially,
all the stories we're about to share with you are
board certified plastic surgeons in Beverly Hills. So you're going
to want to dig deeper. You're going to want to
really get to know your clinician, and there's an essence
about each doctor and the way they run their environment
(02:32):
that will echo through because at the end of the day,
at the end of the day, the captain of the
ship is the surgeon, and so where all of these
issues come from when you're in the oar is the
surgeon is the one who is dictating and orchestrating, and
in my humble opinion, is ultimately the one to blame
because when a patient agrees to go under anesthesia, they're
trusting that surgeon.
Speaker 2 (02:53):
And then the surgeon decides.
Speaker 1 (02:55):
Who the our nurse is, who the tech is, who
the antesesiologist, what equipment is used, what materials are there,
what happens pre op, what happens postop. It's really the
surgeon's show. And so they like to play dumb and say, oh,
I didn't know, oh this that the other, But the
reality is that you're the point guard. You're the point guard,
(03:15):
and if something goes sideways, you're the one to blame.
Speaker 2 (03:18):
At any rate, that was a very long introduction.
Speaker 1 (03:20):
We want to welcome Paula to our show. Paula is
our new nurse practitioner to our practice. She helps run
our oars and our clinic and all that good stuff
and welcome to the show. Paula was like, I don't
know if I want to call on the show, and
I said, you have to come, because the information that
(03:41):
Paula has, or better yet, the experience that Paula has,
I could never share with you. I could make examples
of it, but it would just be theoretical. Whereas Paula
now six years have been in the OAR environment right
and has probablyated through you want to say, forty different
(04:03):
surgeons operating rooms, probably around forty and it's exclusively been
essentially in Beverly Hills, and Beverly Hills is no different
than any other place except in that it in the
patient's views, it should have the highest standard. So if
these issues are occurring here in Beverly Hills, you can
just assume one hundred percent they occur everywhere else, because
(04:27):
you know, sometimes we watch the media and we hear
about these like holy shit experiences. Oh you know, any
soesiologist puts his penis in a patient's mouth, crazy things,
and you're like, oh, well, that's in Mississippi. That wouldn't
happen in like somewhere like Beverly Hills. Well, no, it
will so welcome, thank you for coming. I think it's
(04:50):
as everyone who comes on the show, there's always a
little sacrifice they have to make. So if patients come
in here and they talk about their journey, they're sort
of exposing themselves.
Speaker 2 (04:59):
And as a ner who's.
Speaker 1 (05:00):
Reputable and sort of has your own sort of privacy,
if you will, coming and having this conversation exposes you.
But the goal is that you feel by sharing your stories.
What we're going to be doing today is educating people
so they can protect themselves so that in case your
(05:21):
mom or my sister or someone goes out, they're a
little bit more savvy. Of course, you're still asleep, and
you never can be one hundred percent sure, but certainly
having more information is better than having less information.
Speaker 2 (05:33):
So we're going to dive right in, and we're going
to start with a thing that.
Speaker 1 (05:36):
I have mentioned many a time, which is number one issue.
Is you pick doctor Raban as your surgeon, and the
assumption that's made is that you go to sleep, you
have a procedure done, a breast dog, a tummy tuck,
a three sixty LiPo, a facelift, whatever, and doctor Rabond.
Naturally is your surgeon doing the surgery? Who who the
(06:00):
hell else would be doing your surgery? But as I
have mentioned many a time, there are people that come
into the OAR to help the quote unquote for those
of you listening, I'm doing quotes to help the surgeon,
but in my opinion, are actually doing surgery and are
not helping. A tech helps a surgeon, hands them instruments,
(06:22):
a nurse helps a surgeon by retracting or exposing, but
no one should be operating on the patient. So I've
made it a comment. Many times I tell every patient
a simple example, simple, very simple, is that when it
comes to closing, I close everything and they're always like okay, yeah, sure,
(06:43):
whereas I.
Speaker 2 (06:45):
Am, ninety nine percent.
Speaker 1 (06:47):
Of other surgeons have someone the tech, another surgeon, a
junior whoever closing some if not all of it. So
tell me your experience about this other person. Hell, so
let's start with simple and work our way up to
are you fucking kidding me?
Speaker 3 (07:05):
I mean, many times patients go to sleep and they think,
like you said, doctor Vond's doing the closing. But there's
been many times when I see patients go to sleep
and like doctor Vaughn will be closing half of the
patient and then you know, a different surgeon and a
you could be you know, like a fellow or a junior,
like you said, closing the other half. So you know
you are going to a specific surgeon and a different
(07:26):
surgeons doing half of your case. So that's been that,
but it's also been kind of like, okay, they're another surgeon.
Speaker 1 (07:31):
Yeah, so that was so that example, that's a great start,
is sort of the least egregious, right because technically they're surgeons.
Albeit I personally think the surgeon, the main surgeon, has
an obligation to share with the patient. Hey, by the way,
I have my fellow, which is a surgeon in training
(07:53):
or a junior doctor in the room helping me. That's
not illegal, that's actually legal. But the illegal hard my
paring opinion, is the non transparency of it. But even there,
and you could say, well, you know, it's my part
of my team.
Speaker 2 (08:05):
So that's number one.
Speaker 3 (08:07):
Yeah, there's been many times I think you're one of
like the only two doctors have have worked with in
Beverly Hills that close the whole time. Only you're doing it.
Everyone else has a tech doing it. A tech has
you know, probably you know, the surgeon will do like
all the deep layers and then the tech will close
the rest. The surgeon will usually scrub out they want
to be in the room for it, and then the
text doing it mostly and that goes from the face
(08:30):
to the body anything like that, and it's just it's
not right because again the patient thinks that the surgeon's
doing everything and here's this tech that they've never met before.
Who I think tech goals like six months or something
like that, closing the majority of the surgery.
Speaker 1 (08:42):
So let's let's let's unpack that. Number one. In my
humble opinion, one of the most, if not the most
important layers of closure is the goddamn last layer, which
is the layer you see right. So deep layers are
important because they hold everything together. The last layer is
the layer that leads to the ultimate most of the
(09:03):
ultimate scar. So plastic surgery is about the scar. Like
I don't want to get a tummy tech because of
the scar. I don't want to get a breastlift because
of the scar. I don't want to hit a facelift
because of the scar. So in the most critical part
of the surgery, you have a wait, a tech. And
as you said it, a tech is first of all,
that's it's illegal. A tech, a junior surgeon not illegal,
(09:27):
A tech illegal. They have no right touching a patient
or operating on them. They're operating when they're closing. And
as you said, a tech can go to school for
like six months. The purpose of a tech is to
hand you instruments. Hey, it's like the caddy to a golfer.
They're there to hand you the nine iron. They're not
(09:48):
there to swing the golf club or putt for you.
And so you're absolutely right. So the tech is closing.
And moreover, at least sometimes when I tell patients like
the doctor will close half and then the tech will close.
Speaker 2 (10:03):
The other half.
Speaker 1 (10:04):
But let's be honest, the doctor's usually what.
Speaker 4 (10:07):
The scrub out, scrubbed out, the lu lunge.
Speaker 1 (10:10):
Answer some emails whatever, they're not even in the goddamn room.
And you would say ninety what percent of times that
you've been in the oar and now you've been in
forty oh ars probably watched let's say, in that forty
oh wars, you've seen forty fifty surgeons or better yet,
thirty surgeons in Beverly Hills all very prominent. Paul is
(10:33):
a very desirable nurse, so she's only in the best
of the best. Oars. What percentage of the times have
you actually seen the tech or a tech or someone
close it?
Speaker 3 (10:44):
Callably ninety eight percent of the time. I can think
of one of the surgeon other than you who closes
the whole thing, right, So.
Speaker 1 (10:49):
You're and it's just to me, it's just batty. I
know that I do it, and it's like normal for me.
And yes, I don't get me wrong, I don't enjoy
doing it. I mean, why would it. So let's back
up here, why why would that happen? Because closing is
a pain in the ass, right, Patients don't understand that
closing is the time consuming part making your dissection, removing
(11:10):
the flap, Doing all that is a third of the time.
The other two thirds of every surgery in plastic surgery
is closing layer one, layer two, layer three, blah blah blah.
Speaker 2 (11:23):
So when you do.
Speaker 1 (11:23):
Tummy tucks and breast reductions, god, it's hours of closure.
I just had my trigger finger injected. I don't enjoy closing,
but that's what I got paid to do. That's the job.
So the reason why they don't want to do it
is just simply because they're lazy.
Speaker 2 (11:40):
They just don't want to do it.
Speaker 1 (11:42):
So that's that. Then we get to the next level,
which is like your brain is going to explode, so
listen very carefully. Thus far, all we've talked about is closing.
So technically it's the easy part of the surgery. It's
very important, but it's not like you know, you need it.
(12:02):
You know, it's very basic. You just got to follow
the instructions. What else have you seen?
Speaker 4 (12:08):
This one?
Speaker 3 (12:09):
I was like shocked at, But there has been points
in multiple surgeons o RS. And wasn't just one surgeon
where the tech is boving. Maybe you can elaborate on
boving a little bit. So the tech is boving, they're
cutting off flaps, they're using the blade, and they're usually
on half of the body, like when we're doing big
body lifts, and then the surgeons on the other half,
(12:31):
so they're both working at the same time. And that
was when I was just like my mind exploded and
I just could not get behind that. And then then
they do these like huge three sixty body lifts, arm lifts,
all this stuff in like three hours and the patient's like, oh,
that was so fast and amazing, which is just so
misleading and it's so horrible because the surgeon's not even
the one doing half of your surgery, right.
Speaker 1 (12:50):
And so what you're saying essentially is the tech is operating,
because at that point there's no arguing. You know, the
surgeon will argue, well, you know he's not really operating,
he's closing. Well, closing is fucking operating. But you can't
deny the fact that you're both simultaneously boving is using
the cottery, which is cutting with electricity so it doesn't bleed,
(13:13):
it cauterizes the blood vessels. So you know, when we
do when we cut things in surgery, we use an
electrical device that sort of cuts and coagulates at the
same time that's operating. Using a blade to cut off
things is operating. If that's not operating, then what am
I doing? And the idea is, again, why would someone
(13:33):
do that? It accelerates the process we're in and out quicker.
This is exactly what I tell people when they come
for what body contouring? So Hidar Dubon High, nice to
meet you. I've lost one hundred pounds. Oh wow, congratulations
I have a shit ton of loose skin. Where is
it my neck, my arms, my thighs, my abdomen, my breasts.
Speaker 2 (13:54):
H Okay, what do you suggest?
Speaker 1 (13:57):
What I suggest is three surgeries, separate surgeries. Yes, surgery one,
we do X surgery, two we do Y surgery, three
we do Z. Oh wow, I have to do three surgeries.
Why can't you do it all at once? Because I'm
the only one there, Like, I can't do five surgeries
in one time. Oh well. I went to this other
(14:18):
three doctors and they said they can do my arms,
my legs, and my abdomen at the same time. And
I always tell them the only way that's gonna happen
is if multiple people are working you simultaneously. There's no
other way. And they're like, what do you what do
you mean what other people? I'm like, yeah, the tech,
the junior, the fellow, whoever. It's like, I call it
(14:41):
Formula one. You have you seen the pit stop at
Formula one? Do you know why they can do it
under three seconds? Like eight people there, like two per tire,
so there's like nine to ten people in a single
pit stop. Well shit, yeah, And I think that's crazy
that and it's you said, it's not one curtain. It's
(15:01):
not like oh that one guy, oh that crazy guy
over there.
Speaker 2 (15:06):
I get what. I want everyone to listen to.
Speaker 1 (15:08):
Everything we're telling you today is not one isolated thing
you see on Extra, oh that one dancing doctor on TikTok.
These are this is fucking everybody, okay. And so you
know here you are like, you're like, whoa, what is this?
Speaker 2 (15:24):
So that I that to me is just mind boggling, right.
Speaker 1 (15:31):
The next level which you shared with me and I actually,
you know, for you to share things with me and
for me to be like what that takes it another
whole level which just grows to tell you that. That's
why I was so grateful that you're like, okay, yeah, sure,
I'll come and shed some light on my experiences. Is
this notion that one surgeon is in two separate rooms.
Speaker 2 (15:53):
So let me explain everything to you.
Speaker 1 (15:55):
Guys. When I operate on a patient, I am in
a room with a patient from the minute they go
under anesthesia to the minute they come out of the
Room's that's the patient I'm operating on them. What you're
telling me is that you experience a scenario or I
don't know if it's scenarios in which a surgeon was
in two rooms with separate patients going back and forth.
Speaker 3 (16:19):
Yeah, so it was one surgeon in particular, and he'd
had two operating rooms in his office, and he would
bring both patients in at once, and there's two different
anesthesiologist that would put both of the patients to sleep, and.
Speaker 4 (16:31):
He would have like his fellow in one room. Like
it'd be.
Speaker 3 (16:34):
It was mostly all fast cases, like breast augmentations, So
he would have his fellow, you know, create the pocket,
do everything in both rooms, and then he would just
pop in.
Speaker 4 (16:45):
He wasn't even stir or anything. He would just like, look, okay,
that looks good.
Speaker 3 (16:48):
Call me when the sizor is in, which is the
thing that you put in before the final implant.
Speaker 4 (16:52):
Then he'd pop into the next room. Okay, that looks good.
Speaker 3 (16:55):
And so he has two patients going on at once,
and then he would get sterile and just put the
final in plan in and you just go from room
to room to room. So within like a whole day,
from like a six am to three pm day, he
could do like forty breast dogs, which is just like
crazy because he has both rooms going did.
Speaker 1 (17:12):
You guys hear that is that insane? Does anyone is
anyone freaking out like I'm freaking out? Like that's just
you're sure you're highly efficient. It's wow, what a great
system you have in place. That's illegal, you're taking care
of a person. Yes, it's inconvenient. The whole purpose of
surgery is inconvenience. I could come up with a hundred
(17:37):
ways to do my surgeries faster. I am a really,
really efficient dude. My wife makes fun of me, like
I'm figuring out when I have to do errands on
a Sunday, I'm mapping out the root so that God
forbid I have to double back between a place. That's
how efficient I am. But when it comes to the
o R, I'm not looking for efficiency. I'm looking for
(17:59):
the most inefficient and safest, highest level way to do it.
And that's my ass sitting in there from beginning to end.
Of course, I have two rs, we.
Speaker 2 (18:06):
Have two oars.
Speaker 1 (18:07):
We could literally bring two patients in as I'm as
as even what you described as nuts, but if I
wanted to, as one of my patients is almost done, right,
Josh is going to start closing. Josh is my tech
who's salivating to close, because Josh is accustomed to closing
at his other locations and his other OAR experiences exactly
(18:29):
like Paula, he was closing. So I leave Josh alone.
He closes My tummy tuck. Now I have my second
OAR patient is being intubated, which is even less egregious
than the concernario where two patients are asleep simultaneously and
as this one wakes up, that one I get started.
That's highly efficient. Still wrong because the patient's being closed
by Josh, but that's at least a little even better
(18:51):
than two of them at the same time under two
anesthetics being operated on by essentially a fellow, so that
they're just that was that was a Oh my god,
I can't believe it.
Speaker 2 (19:02):
So then we move to another level.
Speaker 1 (19:04):
So again you assume you're in Beverly Hills and there
are no corners being cut. Right when you go to
an operating room, you have no idea how much stuff
is going on, how much equipment is in place, what
all the safety measures are. Yes, when everything goes great,
it's like symphony. Oh my god, you went in boom
(19:24):
in your office. You had major surgery. I mean, what
are we talking about we used to do that in
the hospital. So when you do it and it goes well,
it's beautiful. But if and when it doesn't go well,
it's a shit show, a true shit show, because you're
not in a hospital. You don't have one hundred staff members,
(19:44):
you don't have an ICU, you don't have all of
that stuff there. And that's the time where outpatient surgery
centers become very vulnerable. When it comes to efficiency, they
crush the hospital. When it comes to cleanliness, they crush
the hospital. But when it comes to catastrophes, they get crushed.
(20:06):
And so we'll talk about safety equipment. So let's chat
about some of the things you see not there. By
the way, all of this is required. This isn't an
option or like, hey, doctor Bond, you're just a really
tightly laced guy.
Speaker 2 (20:21):
So you have all no no.
Speaker 1 (20:22):
If you have a surgery center and it's accredited, these
are required to have accreditation. So what are some of
the stuff you've seen not there?
Speaker 3 (20:32):
I mean, there's a certain thing a nurse does when
she comes in in the morning. So there's been a
lot of centers that I come in and I go
do all my checks of everything, and I'm you know,
when it's a new sunder, you can't seem to find
things or something, so to ask, oh, where's your crash card?
I just want to make sure everything works so you
have all the medications. God forbid we have to use it.
And there's been so many centers that just don't have
a crash car or a working crash cart. And I'm
just like, so, what are you how are you operating?
(20:55):
Like that's something you need to operate, God forbid you
ever have.
Speaker 4 (20:58):
To use it, but you need it there. That's a
huge one.
Speaker 1 (21:01):
So let's stop with that for a second. And by
the way, the question is like, oh, you know how
many times Paula's walks out of a job where she's
been asked? You know that now she's with us and
she's in a stable home. But what Paula did as
a nurse is what ninety nine percent of nurses do.
Ninety nine percent of OAR nurses rotate. They rotate, They
(21:23):
rotate through different centers. On Tuesdays, doctor so and so
needs me. On Wednesday's, doctor so and so needs me,
And they may rotate through two or three or five
facilities at a time.
Speaker 2 (21:32):
But very few nurses are doctor Rabond's nurse.
Speaker 1 (21:37):
The reason is it just you just have to have
enough cases to sustain that nurse five days a week. Otherwise,
the nurse needs a job five days a week. She
can't be in the oar one or two days, and
then what am I going to do the rest of
the time. So you show up to facilities that you
are asked to come to and so on, and sometimes
it's like whoa, what the hell?
Speaker 2 (21:58):
What kind of place is this?
Speaker 1 (21:59):
It's only then that you realize it's like that, and
then you know Paulo will walk out like I can
I can't stay here. This is this is I'm because
remember she gets exposed, right even though it's a center
and they haven't they have creditations and there's a non
medical director, et cetera.
Speaker 2 (22:17):
So can you just imagine what a.
Speaker 1 (22:20):
Place that puts a nurse who's coming in to just
do her job, puts them into this position where they
got to come to a facility and just be like,
you guys are just this is wrong.
Speaker 4 (22:29):
Right?
Speaker 1 (22:30):
How many times have you been like I can't be
a part.
Speaker 2 (22:32):
Of this thing?
Speaker 3 (22:32):
A lot time I walked out A lot and I
feel bad because then they don't have a nurse, and
the surgery will ultimately hopefully they has been counseled. They
don't operate without a nurse. But it's just it's my
license at the end of the day. It's also just
not right to put patients through.
Speaker 1 (22:44):
That, right, And so in her world, Paula is doing
what I do in my world, which is we draw
the line. We we have integrity. Our job is to
do the job correctly. So if a patient in my
end comes and hasn't done their medical clearance, what do
you know? You cancel the case? What do you mean
you're going to cancel the case? There's thousands of dollars
on the line. Can't help you.
Speaker 2 (23:06):
I mean, she's just not ready to do surgery.
Speaker 1 (23:09):
So Paula has been put in that position multiple times.
So back to what I'm talking about. What do you
mean you don't have a crash card Like you may
have nothing in your facility, nothing, but you have oxygen
and you have a goddamn crash card Like that's the minimum.
Speaker 2 (23:31):
You have to have.
Speaker 1 (23:32):
And what a crash cart is is basically a cart
that has everything in it that you would need in
the case of a catastrophic complication like cardiac arrest, pulmonary arrest, anything,
a stroke, anything that would be like life ending. You
don't go scrambling around the operating room. Imagine a new nurse,
(23:55):
Oh my god, where's your jentraline? Blah blah blah. You
just go to the cart which is labeled and marked
and every drug is there, and you just open the
cart and you administer the life saving treatments that need
to be to be administered, Like that's the bare minimum.
And to imagine that you're flying an airplane with you know,
(24:18):
zero radar is insane to me.
Speaker 2 (24:21):
What else have you seen this? Not in the operating room?
Speaker 3 (24:23):
Basic things like I went in one time when we
were about to start the case and I went into
the operating room to make sure all the things I
needed for the patient were in there, and they didn't
have an STD machine, which is essentially just kind of
compression that we put on your legs help prevent blood cloths.
And this patient was getting like lif with three sixty
three sixty body lift breadth, like a long case. And
I asked the surgeon and I'm like, hey, where is
(24:45):
your STD machine? And he's like, oh, we don't use
that here, and I was like, so, I'm like, what
do you mean when to use that here?
Speaker 4 (24:50):
So what do you do for blood cop prevention like anything?
Speaker 3 (24:53):
I was like, oh no, no, we're fine, We're fine, And
he's just trying to brush it off. And the tech
there told me she's like, oh yeah, like it broke
a couple of months, wanted to get a new one.
And I was like, what do you mean, don't want
to get a new one? Like you have to have
that on every patient surgery. So I was like, I'm
not doing the case out of a machine, like that's
just this patient's going to get a blood clock, Like
what do you mean? So it's just things like that
where they just try to cut corners and like turn
(25:15):
a blind eye to things. But when things go wrong,
like they go really wrong, really wrong, So.
Speaker 1 (25:18):
What is it? So again, these are we're not talking about.
In my operating room, I like to spend money on things.
Oh wow, you have ethicon sutures. Wow, those are expensive sutures. No,
in my facility, we use the cheapot sutures. We still
have the sutures, right, we don't have we don't have
good Diva chocolate. We have hershees, okay, but these things
(25:39):
are not optional. And when you are put to sleep,
one of the many risks exposed to you is a
blood clot in your lower extremities in your legs, in
which you then shoot that blood clot to your lungs
and you get a pulmonary emblast and you drop dead.
And why that happened in the operating room is because
(26:01):
you are laying there just stagnant, just laying their lifelessly,
and the blood in your legs accumulate, they collect because
we've given you medications that dilate your venus system, and
they sit there like a lake and there's no movement
in them, and then they clot. Then you get up,
you go home, and you move around, like when we
(26:24):
talk about people sitting on an airplane for twelve hours
and then they get out on the airport, and then
as you move around, that clot that's in your leg dislodges,
shoots up into your lungs and boom, you just drop dead,
right palmin ambulis. So in order to reduce, not eliminate,
reduce that risk, we put on these compression compression devices.
Speaker 2 (26:48):
Thank you. I had a like Alzheimer's meat stroke.
Speaker 1 (26:52):
And the idea is that they mimic your walking, so
while you're laying there lifelessly, they're acting as if your
calves are working and they're circulating the blood so that
there's no stagnation. Not only do you need them, you
need to put them on before the patient goes to sleep.
Speaker 2 (27:09):
I'm a stickler.
Speaker 1 (27:10):
I come in the room back in the day when
I would be in other facilities and I'd come in
and the patient's asleep, and then I come up to
the notes, I'm like, hey, why the hell are these.
Speaker 2 (27:19):
Leg squeezers not on.
Speaker 1 (27:20):
They're like, oh, okay, yeah, I was gonna put it
on a second. I'm like, wait, wait, wait, you're gonna
put it on in a second. Do you put the
bun before you put the patty? What does that mean?
Speaker 2 (27:28):
There's an order to this. They need to be on.
Speaker 1 (27:30):
Not only they need to be on before they go
to sleep, because once the anesthesiology gives them the drug
starts the dilation. You put it on after for all
you know, you're shooting the clot off. So that's how
important this is. And again it's not an option. You
don't have an option to have these things. These are required,
and to think that you've been in facilities. Again, I'll
(27:52):
keep underscoring this throughout this episode. Reputable surgeon, Beverly Hills,
not some shoddy ass place, some strip mall in Miami. Okay,
then we're going to go to the idea of you'd
come into the or and you'd see that they're reusing stuff.
So this is an interesting concept because there's this fine
(28:15):
line that we say in everything we do today. It's
about carbon footprint, right, so carbon interesting, we're talking about
carbon footprint here.
Speaker 2 (28:23):
It's the idea of wastefulness.
Speaker 1 (28:25):
One of the things I experience, and I've watched for
twenty years is a total total amount of waste we
have in our medical system. If you've ever been in
a hospital, they literally open something on the back table.
They don't use it, they just opened like a doctor
has a preference card.
Speaker 2 (28:41):
So, oh, we're doing a total hip today.
Speaker 1 (28:43):
Great. So the nurse before the oar start the case starts,
opens up fifteen things, sets them on the back table,
so we're ready. The surgeon comes in and they're like, nah,
I don't want to do that today, or I want
to do this or whatever, and all that stuff gets
thrown in the trash. So, in my opinion, that's waste
because I've done many mission trips in Guatemala and El Salvador,
and we have operated on children and saved their lives
(29:06):
with so called stuff that's expired or used, right, because
at the end of the day, we don't have anything else.
So there is this fine line between reusing things or
resterilizing things. So if you open up a package of
laps which are just towels, for example, and you don't
use them, and they've never been touched and you are
able to resterilize them, I think it's arguable. I think
(29:29):
that's in my opinion, saving the world. But you're not
going to use a suture, a suture that's gone through
a person's body, been contaminated, used half of it, and
then resterilized that. So I think you've seen some things
being reused or repurposed that frankly, is not in the
purpose of saving.
Speaker 2 (29:49):
The planet or the landfills.
Speaker 1 (29:51):
It's just old fashioned cheap you're trying to cut corners
and tell me what some of the things you've seen.
Speaker 3 (29:58):
Sutras is a big one I'm accustomed to. You know,
we don't there's a suture left, you don't finish it,
you put it in the sharps container, you dispose of it.
So there's been a lot of centers I've been at
where the texts were usually there full time. Will be like, oh,
where did you put this suture? And I'm like, oh,
I just put it in the sharps Like, oh no, no,
like we keep that. I'm like, what do you mean
to keep a suture like that was just inside of
someone else's body? You're going to use that on a
(30:18):
different patient. And they'd be like, yeah, the surgeon wants
to do that because the sutures are like thirty dollars
each and I'm like, what do you mean you want
to reuse the suture. So things like that, I've seen
a lot of using different like sterilizers like for breast
and plants and things like that there one time use. Also,
I've seen a lot of that being reused because they
tend to, you know, be expensive and whatnot, insurgeons want
(30:40):
to reuse them.
Speaker 4 (30:41):
So a lot of a lot of surgeons do that.
I've seen that a lot too.
Speaker 1 (30:46):
So for example, one of the things I remember early
on in my career, I think I was out a
year or two. I went to as kind of like
what you're doing. I went to a lot of centers, right,
I was a hired gun. Wherever there was a case,
I would go because I needed to be busy and
I need to work, and I didn't give a shit
how much money I made. I remember showing up in
this one guy's facility just like you didn't know where
I was going. Really, to be honest with you, and
(31:07):
to be honest with you, I didn't hadn't done.
Speaker 2 (31:10):
I wasn't in a place that I am now.
Speaker 1 (31:11):
I couldn't call the shots, so I show up. It
was it was an obgyn who was doing cosmetic surgery.
Again back in the dadn't really fully understand cosmetic surgeon,
plastic surgeon, board certified, non board certified.
Speaker 2 (31:24):
He wasn't doing the case. I was doing the case,
but it was his center, and I remember starting the case.
First thing we.
Speaker 1 (31:32):
Noticed is that they didn't have backup oxygen. No backup oxygen.
The what does that effing mean?
Speaker 2 (31:38):
How do you jump out of an airplane without a
backup parachute? Like, what do you?
Speaker 1 (31:41):
So the antepesiologist was freaking out about that, and then
the next thing was they were like we started the case,
they used a backup, a small canister, and then the
BOV wouldn't work. And I'm just like, guys, I'm in
the I have a bleeder here, I need a bovy
And they kept reusing the BOV pad And a BOV
(32:02):
pad is about contact. The gel has a stick on
your thigh so they can conduct, and it wasn't working
because they reused this BOV kind of like, it's three
dollars you're charging me, who's charging the patient thousands of dollars? Thousand?
Speaker 2 (32:18):
You know what you want to save save?
Speaker 1 (32:20):
Tell the patient, Hey, we're gonna reuse our suture, and
instead of charging you three thousand dollars for the oar,
we're gonna give you a discounted rate.
Speaker 2 (32:27):
It's five hundred dollars. Are you okay we're using suture?
Speaker 1 (32:30):
Hell yeah, If you give me twenty five hundred dollars off,
that's between you and the patient. You cannot charge them
Rich Carlton prices and then make it a Motel six
like what the so we had that then I was like,
I need a suture. I need this suture. We don't
have that suture. I need this other future. We don't
have that one either. Why don't you use this instead?
What do you mean use this instead? I need oil.
(32:51):
We don't have oil. Why don't you use coolant? So
I ended up scrubbing out, losing my mind. I was screaming,
blow murder. They had to come in, like I was like,
and I was like a year out from training, so
I was in no position to the lady.
Speaker 2 (33:07):
The wife was running the center. She had to come
and calm me down. I was like, this is I'm
calling them? I was, and they were like, okay, let.
Speaker 1 (33:14):
Us catch you. It was just and they had to
go next door and get all this stuff. It was insane,
needless to say. I never went back there and and.
Speaker 2 (33:20):
All that other stuff.
Speaker 1 (33:22):
But at the end of the day, at the end
of the day, this is common practice. Common practice is
let's cut corners, let's save money, and and let's not
tell the patient. And that's how we make a dollar,
that's how we we make sure our profit margins are higher.
Speaker 2 (33:38):
There's so much.
Speaker 1 (33:41):
Valuable information here that no one knows besides people that
are in the business. No one understands these things. Because
you have no advocate. You go to sleep, you have
not a clue what is being done to you, and
you make a very very large assumption that someone is
watching out for you. And while I would say, let's
(34:03):
pray that most of the time that's happening, right, even
five percent or ten percent, your experience is insane, right
because it's saying, Wow, I've been to a lot of centers,
and I would say that ninety percent of them are
doing something mickey mouse, that's just wrong. The last thing
we're going to talk about is some anesthesia nightmares. So
(34:26):
remember the nurse, with all due respect on the totem pole,
is is low on the totem pole relative to the
anesthesiologists and relative to the surgeon. In other words, it
isn't and again with all due respect, just for analogy purposes,
if if a child is calling out their parents, we
got a problem here. We got a problem. If hey mom, Mom,
(34:49):
you're driving erratically? Why you mom?
Speaker 2 (34:51):
You should have signaled like, whoa waitit.
Speaker 1 (34:53):
You're the parent, Like you're the one who should be
setting the example, calling the shots, setting the bar. So
one of the things is sometime often the anesthesiologist is
doing whatever, more times than not, the surgeon is cutting
corners and everyone has to toe the line, and everyone
has to be button lipt, and the anesthesiologist gets paid
by the surgeon. Everyone's sort of at the mercy of
(35:14):
the surgeon. But every once in a while, you got
some crazy ass antithesiologists. In my practice since the day
I've been in practice, not the day, but essentially there
soon thereafter. I've used the same tow anthesiologists for twenty
years because I know who they are, I know how
they do it there, and then I can say with
confidence anesthesia is gonna be done right. Most surgeons get
(35:39):
the anesthesiologists de jure. They have a few cases a month,
they don't have enough cases to sustain an ongoing anesthesia relationship.
Their office will call and start scrambling for whoever's available.
The patient doesn't know that, the patient doesn't know the
pilot is flying with a co pilot that just happened
to be walking by and they grabbed him. So tell me,
(36:03):
I think you've seen some anesthesia like and ctesiology just
doing some things and you're like, oh, oh, oh, no, no, no,
what is going on here?
Speaker 3 (36:10):
Uh yeah, there's been a lot of instances, but there's
a lot where a big one is a lot of
patients are scared of anesthesia, sure, and they're scared of
the word general anesthesia, right, and they think that's just
so scary, and they much rather do kind of what's
known as like a toilet like a moderate sedation. And
a lot of times anethesiologist the surgeon will tell the anetheseologists, oh,
(36:32):
this patient wants to do a moderate sedation for like
a seven hour facelift, rhino whatever we're doing on the face,
and patients think that sounds amazing and great. But in
reality with that, they don't have a what's called like
you know this, but yeah, I don't know that. Yeah,
what's a protected airway? So essentially they're not integrated, their
airways not protected. They have all this bleeding, and it's
(36:54):
just the way that I've seen some anises all just
go bad as they kind of just jerry rig it
in order for it to work, so they'll connect oxygen
lines with co two lines, which I'm just watching and
I'm like, I've never seen this in my life. Just
they don't have to call it, you know, like quote
unquote general anesthesia. But it's just at the end of
the day, extremely unsafe. For the patient, especially for long surgeries,
(37:16):
and you know these patients are getting are usually older.
So I've seen a lot of that happening just because
the anesthesiologist wants to keep the surgeon happy.
Speaker 1 (37:25):
Right, So what Paul is referring to is this idea
or notion. One of sometimes the most frightening part of
any surgery is the anesthesia part. And I've had patients
who have like, oh my god, doctor Bonn, I trust
you with my life. It's amazing whatever. I am not
worried about you, but I'm so afraid to have anesthesia,
have three kids?
Speaker 2 (37:45):
Can you make sure I wake up right?
Speaker 1 (37:47):
And so as a result, we've done many episodes on
general anesthesia. I brought doctor Houston on and we talked
about it, and it's kind of like being afraid of
something that historically was dangerous back in the day, but
like we haven't updated our que cards right, general anesthesia
today is so safe again, everything with the assumption is
(38:08):
done correctly. Is like I would personally rather go to
sleep and wake up and be out of the room
and make sure that I was fully under control. But
a lot of patients are afraid and what they want
is to do the surgery, but they don't want to
go to sleep, and so there is another method of anesthesia,
which is that you refer to as twilight or conscious sedation,
(38:30):
which is basically the following difference. The difference is that
you are not intubated.
Speaker 2 (38:37):
So let me explain that.
Speaker 1 (38:39):
In general anesthetic, they take you deep enough where you're
fully out of it. You're not moving, you don't feel anything,
your body's disassociated, and as a result, you can't breathe.
So we put a breathing too connected to the monitor
to the anesthesia machine, which is a ventilator, and we
breathe on your behalf. The reason why that advanced is
(39:00):
so critical is that when you're asleep and you're under anesthesia,
your ability to close off and protect your airway your
trachea to your bronchial to your lungs is compromised. So
if you were to vomit or fluid were in your mouth,
you could your normally you and I are talking here,
(39:21):
if you were to vomit, your body would close off
the path to your lungs. You're not going to vomit
and then it goes into your lungs, you'll immediately die
because you'll get all that shit in your lungs. It
causes ards inflammation and your lungs shut down and you
can't breathe. So in anesthesia, while you're knocked out, we
(39:41):
block and close off your airway. Your airway is protected
because it has a tube and it has a balloon
in it, so if you were to vomit, if you
were to whatever, none of it goes into your lungs,
so you're totally protected. The anesthesiologist is doing all the
work for you. When you are at any type of
anesthesia lesser and you're semi awake, but you don't remember
(40:06):
your airway is not protect there's no tube in there.
You're breathing on your own, or you use something called
an LMA, which only covers your throat, and if you
were to aspirate, if you were to vomit, it would
go into your lungs. And that's kind of what we
were talking about with munjaro and semi glue tides, And
there have been deaths because people vomited and it went
in their lungs and then their lungs shut down, and
then they went to the hospital and then they were
(40:27):
on the ICU and they couldn't be ventilated, and they
dropped dead. I'm not, by any means suggesting that conscious sidation,
which is a massive part of anesthesia, shouldn't be done
at all. If your anesthesiologist is badass, then knock yourself out.
What we're referring to is there are instances where a
(40:48):
patient is not a good candidate for conscious sedation, they
are at risk, they should have general anesthesia. The patient
is afraid, the surgeon doesn't want to lose the case.
The surgeon tells the anthesiologists, and the ant caesiologists buckles,
and instead of standing up against the surgeon and saying no,
(41:10):
I don't think that's safe, we should do it this way,
does it the way they want. And then there are
some anithesiologists that sort of we call the maguyver it
and sort of connect things. I mean, you're not again
in Guatemala. When we're in Guatemala and I've had both,
I'm in Beverly Hills, endless amount of money available to
(41:31):
the patient in Guatemala, zero money. So I've seen all
the spectrum. And when you have no choice and a
kid sick, you do whatever it takes. But you don't
need to do. It's elective surgery, guys. So this idea
that they're mickey mousing or jerry rigging or cutting corners
for anesthesia is something that patients don't understand. And that's
why when I tell patients during their consults, da da
(41:53):
da da da da da and my anesthesiologists happen to
be two people that put my mom, my wife, my sister,
my mother in law, my four nieces to sleep we're
at my wedding. I tell every single patient that because
then they know that I'm not just going to pull
some asshole out of my hat show up that day
and God knows what they're going to do and not do,
and then they're not going to have the balls to
tell the surgeon. Yo yo yo, hey, hey what are
(42:15):
you guys doing? I cannot tell you the times I've
seen aneczologists fall to the surgeon and they know what's
going on is wrong, and they don't pipe up.
Speaker 2 (42:23):
Have you seen that all the time?
Speaker 1 (42:25):
Right?
Speaker 2 (42:25):
You see it happen.
Speaker 1 (42:26):
You see that dynamic where the anethesiologists is concerned because
they are the others copilot. They're the other there're the
other doctor in there, and they should chime up, be
like hey Roddy, Yeah, the patient's not doing well.
Speaker 2 (42:40):
What do you can stop? And they do nothing.
Speaker 4 (42:43):
Happens all the time.
Speaker 3 (42:44):
They just a lot of anthesiologists just want to have
like a good relationship with the surgeons, so they're invited
back to the center again, right, so they'll do whatever it.
Speaker 1 (42:51):
Is right, Because what happens if you, as an anti caesiologist,
are like, hey, what are you doing? Why are you
doing that? That's not right? What happens someone else the
next time? I won't call you because you're annoying. You're
a troublemaker. Oh my god, isn't that like what happens
in every other place where there's a whistle blow or
they fire them. So that's the reason why people don't
(43:12):
do it. So as a result, really, again, like I
said at the beginning, this whole thing, everything we're about
to talk about, and we're going to talk about in
a second episode revolves around surgeons being responsible orchestrating and
setting up the environment so it's safest for the patients.
But we're gonna end this episode and we're gonna have
(43:33):
a part two, a part two of this episode of
what we called Oh r nightmares, operating nightmares, and we're
gonna keep going because I think that this for Me
is one of my best episodes because it's really sharing
the inside story, inside track of what's happening. And it
shouldn't be done to scare you. It should be done
to empower you. And I think that ninety percent of
(43:54):
the times, if you're empowered.
Speaker 2 (43:55):
You can do well. But you should know the details.
Speaker 1 (43:57):
So Paula, will you join us on a second episode? Right?
Speaker 4 (44:01):
So you're lucky.
Speaker 1 (44:01):
Paulo wasn't even sure about the first episode. All right, guys,
so that's going to be a rap. As always, at
the end of each podcast episode, I have two requests
that I ask you. Number one request is if you
like our show, please go and right right now we're
gonna end this. I know you're driving, or you're on treadmill,
wherever the hell you are, just go and write a
nice review. It makes such a difference. There's so many
(44:22):
people that put this production together, put in energy. We're
here on a Sunday, and then it allows them to
feel good about this entire production.
Speaker 2 (44:29):
So we love that.
Speaker 1 (44:30):
And the second is share this podcast with everyone you love,
because you don't have a clue. Who's about to go
and have surgery next week? And until and then when
you find out it's too late. Hey, you should have
listened to this episode, So share our episode, write a
nice review, and we'll see you next week.
Speaker 2 (44:47):
On Plastic Surgery Uncensored
Welcome to another episode of Plastic Surgery and Censored. I'm
your host, Doctor Roddy Rabon, and I'm always excited about
our episodes because I think they're all super interesting and formative, educational,
and hopefully entertaining. But this particular episode slash episodes, meaning
I'm not even sure we may even do a two
part of this, I'm actually the most excited about because
(00:29):
what we're going to be talking about is operating room
or o R nightmares. But not from my perspective, which
many would say is biased or limited, but rather from
the perspective of a very well respected nurse now nurse
practitioner who is one of our newest additions to the
Rabond family here at our office, and her experience and
(00:52):
her exposure with her friends and her group and her
community of nurses, and what they've seen happen in the
operating room, which is basically what we've been talking about
in many of our episodes, which basically is what we
read about in the media when things go sideways. But
I just found it so fascinating and so interesting hearing
(01:13):
good firsthand from her own perspective, So you're definitely going
to want to listen very closely to this entire episode,
and maybe we do a follow up episode as we
kind of traverse sort of the landscape of operating room environments.
Speaker 2 (01:28):
Remember, the key here is kind of like a mechanic.
Speaker 1 (01:31):
When you go into an operating room, you're out, you're asleep,
you have no idea what's happening, and you assume, as
you should, that your physician and the environment around you
is safe, and it's it's actively engaged in keeping you safe.
But the truth is, like a mechanic, when you go
(01:51):
and you get your car back, unless you're an expert,
you have no idea what happened while you dropped your
car off. And so I think it's going to be
very eye opening.
Speaker 2 (02:00):
I hope it's going to be.
Speaker 1 (02:03):
Educational that you know, you really really when I say
do your.
Speaker 2 (02:07):
Homework, I'm not just talking about the basics.
Speaker 1 (02:09):
Oh, I went to a board certified plastic surgeon in
Beverly Hills, Like, okay, well that should do it right. No, Essentially,
all the stories we're about to share with you are
board certified plastic surgeons in Beverly Hills. So you're going
to want to dig deeper. You're going to want to
really get to know your clinician, and there's an essence
about each doctor and the way they run their environment
(02:32):
that will echo through because at the end of the day,
at the end of the day, the captain of the
ship is the surgeon, and so where all of these
issues come from when you're in the oar is the
surgeon is the one who is dictating and orchestrating, and
in my humble opinion, is ultimately the one to blame
because when a patient agrees to go under anesthesia, they're
trusting that surgeon.
Speaker 2 (02:53):
And then the surgeon decides.
Speaker 1 (02:55):
Who the our nurse is, who the tech is, who
the antesesiologist, what equipment is used, what materials are there,
what happens pre op, what happens postop. It's really the
surgeon's show. And so they like to play dumb and say, oh,
I didn't know, oh this that the other, But the
reality is that you're the point guard. You're the point guard,
(03:15):
and if something goes sideways, you're the one to blame.
Speaker 2 (03:18):
At any rate, that was a very long introduction.
Speaker 1 (03:20):
We want to welcome Paula to our show. Paula is
our new nurse practitioner to our practice. She helps run
our oars and our clinic and all that good stuff
and welcome to the show. Paula was like, I don't
know if I want to call on the show, and
I said, you have to come, because the information that
(03:41):
Paula has, or better yet, the experience that Paula has,
I could never share with you. I could make examples
of it, but it would just be theoretical. Whereas Paula
now six years have been in the OAR environment right
and has probablyated through you want to say, forty different
(04:03):
surgeons operating rooms, probably around forty and it's exclusively been
essentially in Beverly Hills, and Beverly Hills is no different
than any other place except in that it in the
patient's views, it should have the highest standard. So if
these issues are occurring here in Beverly Hills, you can
just assume one hundred percent they occur everywhere else, because
(04:27):
you know, sometimes we watch the media and we hear
about these like holy shit experiences. Oh you know, any
soesiologist puts his penis in a patient's mouth, crazy things,
and you're like, oh, well, that's in Mississippi. That wouldn't
happen in like somewhere like Beverly Hills. Well, no, it
will so welcome, thank you for coming. I think it's
(04:50):
as everyone who comes on the show, there's always a
little sacrifice they have to make. So if patients come
in here and they talk about their journey, they're sort
of exposing themselves.
Speaker 2 (04:59):
And as a ner who's.
Speaker 1 (05:00):
Reputable and sort of has your own sort of privacy,
if you will, coming and having this conversation exposes you.
But the goal is that you feel by sharing your stories.
What we're going to be doing today is educating people
so they can protect themselves so that in case your
(05:21):
mom or my sister or someone goes out, they're a
little bit more savvy. Of course, you're still asleep, and
you never can be one hundred percent sure, but certainly
having more information is better than having less information.
Speaker 2 (05:33):
So we're going to dive right in, and we're going
to start with a thing that.
Speaker 1 (05:36):
I have mentioned many a time, which is number one issue.
Is you pick doctor Raban as your surgeon, and the
assumption that's made is that you go to sleep, you
have a procedure done, a breast dog, a tummy tuck,
a three sixty LiPo, a facelift, whatever, and doctor Rabond.
Naturally is your surgeon doing the surgery? Who who the
(06:00):
hell else would be doing your surgery? But as I
have mentioned many a time, there are people that come
into the OAR to help the quote unquote for those
of you listening, I'm doing quotes to help the surgeon,
but in my opinion, are actually doing surgery and are
not helping. A tech helps a surgeon, hands them instruments,
(06:22):
a nurse helps a surgeon by retracting or exposing, but
no one should be operating on the patient. So I've
made it a comment. Many times I tell every patient
a simple example, simple, very simple, is that when it
comes to closing, I close everything and they're always like okay, yeah, sure,
(06:43):
whereas I.
Speaker 2 (06:45):
Am, ninety nine percent.
Speaker 1 (06:47):
Of other surgeons have someone the tech, another surgeon, a
junior whoever closing some if not all of it. So
tell me your experience about this other person. Hell, so
let's start with simple and work our way up to
are you fucking kidding me?
Speaker 3 (07:05):
I mean, many times patients go to sleep and they think,
like you said, doctor Vond's doing the closing. But there's
been many times when I see patients go to sleep
and like doctor Vaughn will be closing half of the
patient and then you know, a different surgeon and a
you could be you know, like a fellow or a junior,
like you said, closing the other half. So you know
you are going to a specific surgeon and a different
(07:26):
surgeons doing half of your case. So that's been that,
but it's also been kind of like, okay, they're another surgeon.
Speaker 1 (07:31):
Yeah, so that was so that example, that's a great start,
is sort of the least egregious, right because technically they're surgeons.
Albeit I personally think the surgeon, the main surgeon, has
an obligation to share with the patient. Hey, by the way,
I have my fellow, which is a surgeon in training
(07:53):
or a junior doctor in the room helping me. That's
not illegal, that's actually legal. But the illegal hard my
paring opinion, is the non transparency of it. But even there,
and you could say, well, you know, it's my part
of my team.
Speaker 2 (08:05):
So that's number one.
Speaker 3 (08:07):
Yeah, there's been many times I think you're one of
like the only two doctors have have worked with in
Beverly Hills that close the whole time. Only you're doing it.
Everyone else has a tech doing it. A tech has
you know, probably you know, the surgeon will do like
all the deep layers and then the tech will close
the rest. The surgeon will usually scrub out they want
to be in the room for it, and then the
text doing it mostly and that goes from the face
(08:30):
to the body anything like that, and it's just it's
not right because again the patient thinks that the surgeon's
doing everything and here's this tech that they've never met before.
Who I think tech goals like six months or something
like that, closing the majority of the surgery.
Speaker 1 (08:42):
So let's let's let's unpack that. Number one. In my
humble opinion, one of the most, if not the most
important layers of closure is the goddamn last layer, which
is the layer you see right. So deep layers are
important because they hold everything together. The last layer is
the layer that leads to the ultimate most of the
(09:03):
ultimate scar. So plastic surgery is about the scar. Like
I don't want to get a tummy tech because of
the scar. I don't want to get a breastlift because
of the scar. I don't want to hit a facelift
because of the scar. So in the most critical part
of the surgery, you have a wait, a tech. And
as you said it, a tech is first of all,
that's it's illegal. A tech, a junior surgeon not illegal,
(09:27):
A tech illegal. They have no right touching a patient
or operating on them. They're operating when they're closing. And
as you said, a tech can go to school for
like six months. The purpose of a tech is to
hand you instruments. Hey, it's like the caddy to a golfer.
They're there to hand you the nine iron. They're not
(09:48):
there to swing the golf club or putt for you.
And so you're absolutely right. So the tech is closing.
And moreover, at least sometimes when I tell patients like
the doctor will close half and then the tech will close.
Speaker 2 (10:03):
The other half.
Speaker 1 (10:04):
But let's be honest, the doctor's usually what.
Speaker 4 (10:07):
The scrub out, scrubbed out, the lu lunge.
Speaker 1 (10:10):
Answer some emails whatever, they're not even in the goddamn room.
And you would say ninety what percent of times that
you've been in the oar and now you've been in
forty oh ars probably watched let's say, in that forty
oh wars, you've seen forty fifty surgeons or better yet,
thirty surgeons in Beverly Hills all very prominent. Paul is
(10:33):
a very desirable nurse, so she's only in the best
of the best. Oars. What percentage of the times have
you actually seen the tech or a tech or someone
close it?
Speaker 3 (10:44):
Callably ninety eight percent of the time. I can think
of one of the surgeon other than you who closes
the whole thing, right, So.
Speaker 1 (10:49):
You're and it's just to me, it's just batty. I
know that I do it, and it's like normal for me.
And yes, I don't get me wrong, I don't enjoy
doing it. I mean, why would it. So let's back
up here, why why would that happen? Because closing is
a pain in the ass, right, Patients don't understand that
closing is the time consuming part making your dissection, removing
(11:10):
the flap, Doing all that is a third of the time.
The other two thirds of every surgery in plastic surgery
is closing layer one, layer two, layer three, blah blah blah.
Speaker 2 (11:23):
So when you do.
Speaker 1 (11:23):
Tummy tucks and breast reductions, god, it's hours of closure.
I just had my trigger finger injected. I don't enjoy closing,
but that's what I got paid to do. That's the job.
So the reason why they don't want to do it
is just simply because they're lazy.
Speaker 2 (11:40):
They just don't want to do it.
Speaker 1 (11:42):
So that's that. Then we get to the next level,
which is like your brain is going to explode, so
listen very carefully. Thus far, all we've talked about is closing.
So technically it's the easy part of the surgery. It's
very important, but it's not like you know, you need it.
(12:02):
You know, it's very basic. You just got to follow
the instructions. What else have you seen?
Speaker 4 (12:08):
This one?
Speaker 3 (12:09):
I was like shocked at, But there has been points
in multiple surgeons o RS. And wasn't just one surgeon
where the tech is boving. Maybe you can elaborate on
boving a little bit. So the tech is boving, they're
cutting off flaps, they're using the blade, and they're usually
on half of the body, like when we're doing big
body lifts, and then the surgeons on the other half,
(12:31):
so they're both working at the same time. And that
was when I was just like my mind exploded and
I just could not get behind that. And then then
they do these like huge three sixty body lifts, arm lifts,
all this stuff in like three hours and the patient's like, oh,
that was so fast and amazing, which is just so
misleading and it's so horrible because the surgeon's not even
the one doing half of your surgery, right.
Speaker 1 (12:50):
And so what you're saying essentially is the tech is operating,
because at that point there's no arguing. You know, the
surgeon will argue, well, you know he's not really operating,
he's closing. Well, closing is fucking operating. But you can't
deny the fact that you're both simultaneously boving is using
the cottery, which is cutting with electricity so it doesn't bleed,
(13:13):
it cauterizes the blood vessels. So you know, when we
do when we cut things in surgery, we use an
electrical device that sort of cuts and coagulates at the
same time that's operating. Using a blade to cut off
things is operating. If that's not operating, then what am
I doing? And the idea is, again, why would someone
(13:33):
do that? It accelerates the process we're in and out quicker.
This is exactly what I tell people when they come
for what body contouring? So Hidar Dubon High, nice to
meet you. I've lost one hundred pounds. Oh wow, congratulations
I have a shit ton of loose skin. Where is
it my neck, my arms, my thighs, my abdomen, my breasts.
Speaker 2 (13:54):
H Okay, what do you suggest?
Speaker 1 (13:57):
What I suggest is three surgeries, separate surgeries. Yes, surgery one,
we do X surgery, two we do Y surgery, three
we do Z. Oh wow, I have to do three surgeries.
Why can't you do it all at once? Because I'm
the only one there, Like, I can't do five surgeries
in one time. Oh well. I went to this other
(14:18):
three doctors and they said they can do my arms,
my legs, and my abdomen at the same time. And
I always tell them the only way that's gonna happen
is if multiple people are working you simultaneously. There's no
other way. And they're like, what do you what do
you mean what other people? I'm like, yeah, the tech,
the junior, the fellow, whoever. It's like, I call it
(14:41):
Formula one. You have you seen the pit stop at
Formula one? Do you know why they can do it
under three seconds? Like eight people there, like two per tire,
so there's like nine to ten people in a single
pit stop. Well shit, yeah, And I think that's crazy
that and it's you said, it's not one curtain. It's
(15:01):
not like oh that one guy, oh that crazy guy
over there.
Speaker 2 (15:06):
I get what. I want everyone to listen to.
Speaker 1 (15:08):
Everything we're telling you today is not one isolated thing
you see on Extra, oh that one dancing doctor on TikTok.
These are this is fucking everybody, okay. And so you
know here you are like, you're like, whoa, what is this?
Speaker 2 (15:24):
So that I that to me is just mind boggling, right.
Speaker 1 (15:31):
The next level which you shared with me and I actually,
you know, for you to share things with me and
for me to be like what that takes it another
whole level which just grows to tell you that. That's
why I was so grateful that you're like, okay, yeah, sure,
I'll come and shed some light on my experiences. Is
this notion that one surgeon is in two separate rooms.
Speaker 2 (15:53):
So let me explain everything to you.
Speaker 1 (15:55):
Guys. When I operate on a patient, I am in
a room with a patient from the minute they go
under anesthesia to the minute they come out of the
Room's that's the patient I'm operating on them. What you're
telling me is that you experience a scenario or I
don't know if it's scenarios in which a surgeon was
in two rooms with separate patients going back and forth.
Speaker 3 (16:19):
Yeah, so it was one surgeon in particular, and he'd
had two operating rooms in his office, and he would
bring both patients in at once, and there's two different
anesthesiologist that would put both of the patients to sleep, and.
Speaker 4 (16:31):
He would have like his fellow in one room. Like
it'd be.
Speaker 3 (16:34):
It was mostly all fast cases, like breast augmentations, So
he would have his fellow, you know, create the pocket,
do everything in both rooms, and then he would just
pop in.
Speaker 4 (16:45):
He wasn't even stir or anything. He would just like, look, okay,
that looks good.
Speaker 3 (16:48):
Call me when the sizor is in, which is the
thing that you put in before the final implant.
Speaker 4 (16:52):
Then he'd pop into the next room. Okay, that looks good.
Speaker 3 (16:55):
And so he has two patients going on at once,
and then he would get sterile and just put the
final in plan in and you just go from room
to room to room. So within like a whole day,
from like a six am to three pm day, he
could do like forty breast dogs, which is just like
crazy because he has both rooms going did.
Speaker 1 (17:12):
You guys hear that is that insane? Does anyone is
anyone freaking out like I'm freaking out? Like that's just
you're sure you're highly efficient. It's wow, what a great
system you have in place. That's illegal, you're taking care
of a person. Yes, it's inconvenient. The whole purpose of
surgery is inconvenience. I could come up with a hundred
(17:37):
ways to do my surgeries faster. I am a really,
really efficient dude. My wife makes fun of me, like
I'm figuring out when I have to do errands on
a Sunday, I'm mapping out the root so that God
forbid I have to double back between a place. That's
how efficient I am. But when it comes to the
o R, I'm not looking for efficiency. I'm looking for
(17:59):
the most inefficient and safest, highest level way to do it.
And that's my ass sitting in there from beginning to end.
Of course, I have two rs, we.
Speaker 2 (18:06):
Have two oars.
Speaker 1 (18:07):
We could literally bring two patients in as I'm as
as even what you described as nuts, but if I
wanted to, as one of my patients is almost done, right,
Josh is going to start closing. Josh is my tech
who's salivating to close, because Josh is accustomed to closing
at his other locations and his other OAR experiences exactly
(18:29):
like Paula, he was closing. So I leave Josh alone.
He closes My tummy tuck. Now I have my second
OAR patient is being intubated, which is even less egregious
than the concernario where two patients are asleep simultaneously and
as this one wakes up, that one I get started.
That's highly efficient. Still wrong because the patient's being closed
by Josh, but that's at least a little even better
(18:51):
than two of them at the same time under two
anesthetics being operated on by essentially a fellow, so that
they're just that was that was a Oh my god,
I can't believe it.
Speaker 2 (19:02):
So then we move to another level.
Speaker 1 (19:04):
So again you assume you're in Beverly Hills and there
are no corners being cut. Right when you go to
an operating room, you have no idea how much stuff
is going on, how much equipment is in place, what
all the safety measures are. Yes, when everything goes great,
it's like symphony. Oh my god, you went in boom
(19:24):
in your office. You had major surgery. I mean, what
are we talking about we used to do that in
the hospital. So when you do it and it goes well,
it's beautiful. But if and when it doesn't go well,
it's a shit show, a true shit show, because you're
not in a hospital. You don't have one hundred staff members,
(19:44):
you don't have an ICU, you don't have all of
that stuff there. And that's the time where outpatient surgery
centers become very vulnerable. When it comes to efficiency, they
crush the hospital. When it comes to cleanliness, they crush
the hospital. But when it comes to catastrophes, they get crushed.
(20:06):
And so we'll talk about safety equipment. So let's chat
about some of the things you see not there. By
the way, all of this is required. This isn't an
option or like, hey, doctor Bond, you're just a really
tightly laced guy.
Speaker 2 (20:21):
So you have all no no.
Speaker 1 (20:22):
If you have a surgery center and it's accredited, these
are required to have accreditation. So what are some of
the stuff you've seen not there?
Speaker 3 (20:32):
I mean, there's a certain thing a nurse does when
she comes in in the morning. So there's been a
lot of centers that I come in and I go
do all my checks of everything, and I'm you know,
when it's a new sunder, you can't seem to find
things or something, so to ask, oh, where's your crash card?
I just want to make sure everything works so you
have all the medications. God forbid we have to use it.
And there's been so many centers that just don't have
a crash car or a working crash cart. And I'm
just like, so, what are you how are you operating?
(20:55):
Like that's something you need to operate, God forbid you
ever have.
Speaker 4 (20:58):
To use it, but you need it there. That's a
huge one.
Speaker 1 (21:01):
So let's stop with that for a second. And by
the way, the question is like, oh, you know how
many times Paula's walks out of a job where she's
been asked? You know that now she's with us and
she's in a stable home. But what Paula did as
a nurse is what ninety nine percent of nurses do.
Ninety nine percent of OAR nurses rotate. They rotate, They
(21:23):
rotate through different centers. On Tuesdays, doctor so and so
needs me. On Wednesday's, doctor so and so needs me,
And they may rotate through two or three or five
facilities at a time.
Speaker 2 (21:32):
But very few nurses are doctor Rabond's nurse.
Speaker 1 (21:37):
The reason is it just you just have to have
enough cases to sustain that nurse five days a week. Otherwise,
the nurse needs a job five days a week. She
can't be in the oar one or two days, and
then what am I going to do the rest of
the time. So you show up to facilities that you
are asked to come to and so on, and sometimes
it's like whoa, what the hell?
Speaker 2 (21:58):
What kind of place is this?
Speaker 1 (21:59):
It's only then that you realize it's like that, and
then you know Paulo will walk out like I can
I can't stay here. This is this is I'm because
remember she gets exposed, right even though it's a center
and they haven't they have creditations and there's a non
medical director, et cetera.
Speaker 2 (22:17):
So can you just imagine what a.
Speaker 1 (22:20):
Place that puts a nurse who's coming in to just
do her job, puts them into this position where they
got to come to a facility and just be like,
you guys are just this is wrong.
Speaker 4 (22:29):
Right?
Speaker 1 (22:30):
How many times have you been like I can't be
a part.
Speaker 2 (22:32):
Of this thing?
Speaker 3 (22:32):
A lot time I walked out A lot and I
feel bad because then they don't have a nurse, and
the surgery will ultimately hopefully they has been counseled. They
don't operate without a nurse. But it's just it's my
license at the end of the day. It's also just
not right to put patients through.
Speaker 1 (22:44):
That, right, And so in her world, Paula is doing
what I do in my world, which is we draw
the line. We we have integrity. Our job is to
do the job correctly. So if a patient in my
end comes and hasn't done their medical clearance, what do
you know? You cancel the case? What do you mean
you're going to cancel the case? There's thousands of dollars
on the line. Can't help you.
Speaker 2 (23:06):
I mean, she's just not ready to do surgery.
Speaker 1 (23:09):
So Paula has been put in that position multiple times.
So back to what I'm talking about. What do you
mean you don't have a crash card Like you may
have nothing in your facility, nothing, but you have oxygen
and you have a goddamn crash card Like that's the minimum.
Speaker 2 (23:31):
You have to have.
Speaker 1 (23:32):
And what a crash cart is is basically a cart
that has everything in it that you would need in
the case of a catastrophic complication like cardiac arrest, pulmonary arrest, anything,
a stroke, anything that would be like life ending. You
don't go scrambling around the operating room. Imagine a new nurse,
(23:55):
Oh my god, where's your jentraline? Blah blah blah. You
just go to the cart which is labeled and marked
and every drug is there, and you just open the
cart and you administer the life saving treatments that need
to be to be administered, Like that's the bare minimum.
And to imagine that you're flying an airplane with you know,
(24:18):
zero radar is insane to me.
Speaker 2 (24:21):
What else have you seen this? Not in the operating room?
Speaker 3 (24:23):
Basic things like I went in one time when we
were about to start the case and I went into
the operating room to make sure all the things I
needed for the patient were in there, and they didn't
have an STD machine, which is essentially just kind of
compression that we put on your legs help prevent blood cloths.
And this patient was getting like lif with three sixty
three sixty body lift breadth, like a long case. And
I asked the surgeon and I'm like, hey, where is
(24:45):
your STD machine? And he's like, oh, we don't use
that here, and I was like, so, I'm like, what
do you mean when to use that here?
Speaker 4 (24:50):
So what do you do for blood cop prevention like anything?
Speaker 3 (24:53):
I was like, oh no, no, we're fine, We're fine, And
he's just trying to brush it off. And the tech
there told me she's like, oh yeah, like it broke
a couple of months, wanted to get a new one.
And I was like, what do you mean, don't want
to get a new one? Like you have to have
that on every patient surgery. So I was like, I'm
not doing the case out of a machine, like that's
just this patient's going to get a blood clock, Like
what do you mean? So it's just things like that
where they just try to cut corners and like turn
(25:15):
a blind eye to things. But when things go wrong,
like they go really wrong, really wrong, So.
Speaker 1 (25:18):
What is it? So again, these are we're not talking about.
In my operating room, I like to spend money on things.
Oh wow, you have ethicon sutures. Wow, those are expensive sutures. No,
in my facility, we use the cheapot sutures. We still
have the sutures, right, we don't have we don't have
good Diva chocolate. We have hershees, okay, but these things
(25:39):
are not optional. And when you are put to sleep,
one of the many risks exposed to you is a
blood clot in your lower extremities in your legs, in
which you then shoot that blood clot to your lungs
and you get a pulmonary emblast and you drop dead.
And why that happened in the operating room is because
(26:01):
you are laying there just stagnant, just laying their lifelessly,
and the blood in your legs accumulate, they collect because
we've given you medications that dilate your venus system, and
they sit there like a lake and there's no movement
in them, and then they clot. Then you get up,
you go home, and you move around, like when we
(26:24):
talk about people sitting on an airplane for twelve hours
and then they get out on the airport, and then
as you move around, that clot that's in your leg dislodges,
shoots up into your lungs and boom, you just drop dead,
right palmin ambulis. So in order to reduce, not eliminate,
reduce that risk, we put on these compression compression devices.
Speaker 2 (26:48):
Thank you. I had a like Alzheimer's meat stroke.
Speaker 1 (26:52):
And the idea is that they mimic your walking, so
while you're laying there lifelessly, they're acting as if your
calves are working and they're circulating the blood so that
there's no stagnation. Not only do you need them, you
need to put them on before the patient goes to sleep.
Speaker 2 (27:09):
I'm a stickler.
Speaker 1 (27:10):
I come in the room back in the day when
I would be in other facilities and I'd come in
and the patient's asleep, and then I come up to
the notes, I'm like, hey, why the hell are these.
Speaker 2 (27:19):
Leg squeezers not on.
Speaker 1 (27:20):
They're like, oh, okay, yeah, I was gonna put it
on a second. I'm like, wait, wait, wait, you're gonna
put it on in a second. Do you put the
bun before you put the patty? What does that mean?
Speaker 2 (27:28):
There's an order to this. They need to be on.
Speaker 1 (27:30):
Not only they need to be on before they go
to sleep, because once the anesthesiology gives them the drug
starts the dilation. You put it on after for all
you know, you're shooting the clot off. So that's how
important this is. And again it's not an option. You
don't have an option to have these things. These are required,
and to think that you've been in facilities. Again, I'll
(27:52):
keep underscoring this throughout this episode. Reputable surgeon, Beverly Hills,
not some shoddy ass place, some strip mall in Miami. Okay,
then we're going to go to the idea of you'd
come into the or and you'd see that they're reusing stuff.
So this is an interesting concept because there's this fine
(28:15):
line that we say in everything we do today. It's
about carbon footprint, right, so carbon interesting, we're talking about
carbon footprint here.
Speaker 2 (28:23):
It's the idea of wastefulness.
Speaker 1 (28:25):
One of the things I experience, and I've watched for
twenty years is a total total amount of waste we
have in our medical system. If you've ever been in
a hospital, they literally open something on the back table.
They don't use it, they just opened like a doctor
has a preference card.
Speaker 2 (28:41):
So, oh, we're doing a total hip today.
Speaker 1 (28:43):
Great. So the nurse before the oar start the case starts,
opens up fifteen things, sets them on the back table,
so we're ready. The surgeon comes in and they're like, nah,
I don't want to do that today, or I want
to do this or whatever, and all that stuff gets
thrown in the trash. So, in my opinion, that's waste
because I've done many mission trips in Guatemala and El Salvador,
and we have operated on children and saved their lives
(29:06):
with so called stuff that's expired or used, right, because
at the end of the day, we don't have anything else.
So there is this fine line between reusing things or
resterilizing things. So if you open up a package of
laps which are just towels, for example, and you don't
use them, and they've never been touched and you are
able to resterilize them, I think it's arguable. I think
(29:29):
that's in my opinion, saving the world. But you're not
going to use a suture, a suture that's gone through
a person's body, been contaminated, used half of it, and
then resterilized that. So I think you've seen some things
being reused or repurposed that frankly, is not in the
purpose of saving.
Speaker 2 (29:49):
The planet or the landfills.
Speaker 1 (29:51):
It's just old fashioned cheap you're trying to cut corners
and tell me what some of the things you've seen.
Speaker 3 (29:58):
Sutras is a big one I'm accustomed to. You know,
we don't there's a suture left, you don't finish it,
you put it in the sharps container, you dispose of it.
So there's been a lot of centers I've been at
where the texts were usually there full time. Will be like, oh,
where did you put this suture? And I'm like, oh,
I just put it in the sharps Like, oh no, no,
like we keep that. I'm like, what do you mean
to keep a suture like that was just inside of
someone else's body? You're going to use that on a
(30:18):
different patient. And they'd be like, yeah, the surgeon wants
to do that because the sutures are like thirty dollars
each and I'm like, what do you mean you want
to reuse the suture. So things like that, I've seen
a lot of using different like sterilizers like for breast
and plants and things like that there one time use. Also,
I've seen a lot of that being reused because they
tend to, you know, be expensive and whatnot, insurgeons want
(30:40):
to reuse them.
Speaker 4 (30:41):
So a lot of a lot of surgeons do that.
I've seen that a lot too.
Speaker 1 (30:46):
So for example, one of the things I remember early
on in my career, I think I was out a
year or two. I went to as kind of like
what you're doing. I went to a lot of centers, right,
I was a hired gun. Wherever there was a case,
I would go because I needed to be busy and
I need to work, and I didn't give a shit
how much money I made. I remember showing up in
this one guy's facility just like you didn't know where
I was going. Really, to be honest with you, and
(31:07):
to be honest with you, I didn't hadn't done.
Speaker 2 (31:10):
I wasn't in a place that I am now.
Speaker 1 (31:11):
I couldn't call the shots, so I show up. It
was it was an obgyn who was doing cosmetic surgery.
Again back in the dadn't really fully understand cosmetic surgeon,
plastic surgeon, board certified, non board certified.
Speaker 2 (31:24):
He wasn't doing the case. I was doing the case,
but it was his center, and I remember starting the case.
First thing we.
Speaker 1 (31:32):
Noticed is that they didn't have backup oxygen. No backup oxygen.
The what does that effing mean?
Speaker 2 (31:38):
How do you jump out of an airplane without a
backup parachute? Like, what do you?
Speaker 1 (31:41):
So the antepesiologist was freaking out about that, and then
the next thing was they were like we started the case,
they used a backup, a small canister, and then the
BOV wouldn't work. And I'm just like, guys, I'm in
the I have a bleeder here, I need a bovy
And they kept reusing the BOV pad And a BOV
(32:02):
pad is about contact. The gel has a stick on
your thigh so they can conduct, and it wasn't working
because they reused this BOV kind of like, it's three
dollars you're charging me, who's charging the patient thousands of dollars? Thousand?
Speaker 2 (32:18):
You know what you want to save save?
Speaker 1 (32:20):
Tell the patient, Hey, we're gonna reuse our suture, and
instead of charging you three thousand dollars for the oar,
we're gonna give you a discounted rate.
Speaker 2 (32:27):
It's five hundred dollars. Are you okay we're using suture?
Speaker 1 (32:30):
Hell yeah, If you give me twenty five hundred dollars off,
that's between you and the patient. You cannot charge them
Rich Carlton prices and then make it a Motel six
like what the so we had that then I was like,
I need a suture. I need this suture. We don't
have that suture. I need this other future. We don't
have that one either. Why don't you use this instead?
What do you mean use this instead? I need oil.
(32:51):
We don't have oil. Why don't you use coolant? So
I ended up scrubbing out, losing my mind. I was screaming,
blow murder. They had to come in, like I was like,
and I was like a year out from training, so
I was in no position to the lady.
Speaker 2 (33:07):
The wife was running the center. She had to come
and calm me down. I was like, this is I'm
calling them? I was, and they were like, okay, let.
Speaker 1 (33:14):
Us catch you. It was just and they had to
go next door and get all this stuff. It was insane,
needless to say. I never went back there and and.
Speaker 2 (33:20):
All that other stuff.
Speaker 1 (33:22):
But at the end of the day, at the end
of the day, this is common practice. Common practice is
let's cut corners, let's save money, and and let's not
tell the patient. And that's how we make a dollar,
that's how we we make sure our profit margins are higher.
Speaker 2 (33:38):
There's so much.
Speaker 1 (33:41):
Valuable information here that no one knows besides people that
are in the business. No one understands these things. Because
you have no advocate. You go to sleep, you have
not a clue what is being done to you, and
you make a very very large assumption that someone is
watching out for you. And while I would say, let's
(34:03):
pray that most of the time that's happening, right, even
five percent or ten percent, your experience is insane, right
because it's saying, Wow, I've been to a lot of centers,
and I would say that ninety percent of them are
doing something mickey mouse, that's just wrong. The last thing
we're going to talk about is some anesthesia nightmares. So
(34:26):
remember the nurse, with all due respect on the totem pole,
is is low on the totem pole relative to the
anesthesiologists and relative to the surgeon. In other words, it
isn't and again with all due respect, just for analogy purposes,
if if a child is calling out their parents, we
got a problem here. We got a problem. If hey mom, Mom,
(34:49):
you're driving erratically? Why you mom?
Speaker 2 (34:51):
You should have signaled like, whoa waitit.
Speaker 1 (34:53):
You're the parent, Like you're the one who should be
setting the example, calling the shots, setting the bar. So
one of the things is sometime often the anesthesiologist is
doing whatever, more times than not, the surgeon is cutting
corners and everyone has to toe the line, and everyone
has to be button lipt, and the anesthesiologist gets paid
by the surgeon. Everyone's sort of at the mercy of
(35:14):
the surgeon. But every once in a while, you got
some crazy ass antithesiologists. In my practice since the day
I've been in practice, not the day, but essentially there
soon thereafter. I've used the same tow anthesiologists for twenty
years because I know who they are, I know how
they do it there, and then I can say with
confidence anesthesia is gonna be done right. Most surgeons get
(35:39):
the anesthesiologists de jure. They have a few cases a month,
they don't have enough cases to sustain an ongoing anesthesia relationship.
Their office will call and start scrambling for whoever's available.
The patient doesn't know that, the patient doesn't know the
pilot is flying with a co pilot that just happened
to be walking by and they grabbed him. So tell me,
(36:03):
I think you've seen some anesthesia like and ctesiology just
doing some things and you're like, oh, oh, oh, no, no, no,
what is going on here?
Speaker 3 (36:10):
Uh yeah, there's been a lot of instances, but there's
a lot where a big one is a lot of
patients are scared of anesthesia, sure, and they're scared of
the word general anesthesia, right, and they think that's just
so scary, and they much rather do kind of what's
known as like a toilet like a moderate sedation. And
a lot of times anethesiologist the surgeon will tell the anetheseologists, oh,
(36:32):
this patient wants to do a moderate sedation for like
a seven hour facelift, rhino whatever we're doing on the face,
and patients think that sounds amazing and great. But in
reality with that, they don't have a what's called like
you know this, but yeah, I don't know that. Yeah,
what's a protected airway? So essentially they're not integrated, their
airways not protected. They have all this bleeding, and it's
(36:54):
just the way that I've seen some anises all just
go bad as they kind of just jerry rig it
in order for it to work, so they'll connect oxygen
lines with co two lines, which I'm just watching and
I'm like, I've never seen this in my life. Just
they don't have to call it, you know, like quote
unquote general anesthesia. But it's just at the end of
the day, extremely unsafe. For the patient, especially for long surgeries,
(37:16):
and you know these patients are getting are usually older.
So I've seen a lot of that happening just because
the anesthesiologist wants to keep the surgeon happy.
Speaker 1 (37:25):
Right, So what Paul is referring to is this idea
or notion. One of sometimes the most frightening part of
any surgery is the anesthesia part. And I've had patients
who have like, oh my god, doctor Bonn, I trust
you with my life. It's amazing whatever. I am not
worried about you, but I'm so afraid to have anesthesia,
have three kids?
Speaker 2 (37:45):
Can you make sure I wake up right?
Speaker 1 (37:47):
And so as a result, we've done many episodes on
general anesthesia. I brought doctor Houston on and we talked
about it, and it's kind of like being afraid of
something that historically was dangerous back in the day, but
like we haven't updated our que cards right, general anesthesia
today is so safe again, everything with the assumption is
(38:08):
done correctly. Is like I would personally rather go to
sleep and wake up and be out of the room
and make sure that I was fully under control. But
a lot of patients are afraid and what they want
is to do the surgery, but they don't want to
go to sleep, and so there is another method of anesthesia,
which is that you refer to as twilight or conscious sedation,
(38:30):
which is basically the following difference. The difference is that
you are not intubated.
Speaker 2 (38:37):
So let me explain that.
Speaker 1 (38:39):
In general anesthetic, they take you deep enough where you're
fully out of it. You're not moving, you don't feel anything,
your body's disassociated, and as a result, you can't breathe.
So we put a breathing too connected to the monitor
to the anesthesia machine, which is a ventilator, and we
breathe on your behalf. The reason why that advanced is
(39:00):
so critical is that when you're asleep and you're under anesthesia,
your ability to close off and protect your airway your
trachea to your bronchial to your lungs is compromised. So
if you were to vomit or fluid were in your mouth,
you could your normally you and I are talking here,
(39:21):
if you were to vomit, your body would close off
the path to your lungs. You're not going to vomit
and then it goes into your lungs, you'll immediately die
because you'll get all that shit in your lungs. It
causes ards inflammation and your lungs shut down and you
can't breathe. So in anesthesia, while you're knocked out, we
(39:41):
block and close off your airway. Your airway is protected
because it has a tube and it has a balloon
in it, so if you were to vomit, if you
were to whatever, none of it goes into your lungs,
so you're totally protected. The anesthesiologist is doing all the
work for you. When you are at any type of
anesthesia lesser and you're semi awake, but you don't remember
(40:06):
your airway is not protect there's no tube in there.
You're breathing on your own, or you use something called
an LMA, which only covers your throat, and if you
were to aspirate, if you were to vomit, it would
go into your lungs. And that's kind of what we
were talking about with munjaro and semi glue tides, And
there have been deaths because people vomited and it went
in their lungs and then their lungs shut down, and
then they went to the hospital and then they were
(40:27):
on the ICU and they couldn't be ventilated, and they
dropped dead. I'm not, by any means suggesting that conscious sidation,
which is a massive part of anesthesia, shouldn't be done
at all. If your anesthesiologist is badass, then knock yourself out.
What we're referring to is there are instances where a
(40:48):
patient is not a good candidate for conscious sedation, they
are at risk, they should have general anesthesia. The patient
is afraid, the surgeon doesn't want to lose the case.
The surgeon tells the anthesiologists, and the ant caesiologists buckles,
and instead of standing up against the surgeon and saying no,
(41:10):
I don't think that's safe, we should do it this way,
does it the way they want. And then there are
some anithesiologists that sort of we call the maguyver it
and sort of connect things. I mean, you're not again
in Guatemala. When we're in Guatemala and I've had both,
I'm in Beverly Hills, endless amount of money available to
(41:31):
the patient in Guatemala, zero money. So I've seen all
the spectrum. And when you have no choice and a
kid sick, you do whatever it takes. But you don't
need to do. It's elective surgery, guys. So this idea
that they're mickey mousing or jerry rigging or cutting corners
for anesthesia is something that patients don't understand. And that's
why when I tell patients during their consults, da da
(41:53):
da da da da da and my anesthesiologists happen to
be two people that put my mom, my wife, my sister,
my mother in law, my four nieces to sleep we're
at my wedding. I tell every single patient that because
then they know that I'm not just going to pull
some asshole out of my hat show up that day
and God knows what they're going to do and not do,
and then they're not going to have the balls to
tell the surgeon. Yo yo yo, hey, hey what are
(42:15):
you guys doing? I cannot tell you the times I've
seen aneczologists fall to the surgeon and they know what's
going on is wrong, and they don't pipe up.
Speaker 2 (42:23):
Have you seen that all the time?
Speaker 1 (42:25):
Right?
Speaker 2 (42:25):
You see it happen.
Speaker 1 (42:26):
You see that dynamic where the anethesiologists is concerned because
they are the others copilot. They're the other there're the
other doctor in there, and they should chime up, be
like hey Roddy, Yeah, the patient's not doing well.
Speaker 2 (42:40):
What do you can stop? And they do nothing.
Speaker 4 (42:43):
Happens all the time.
Speaker 3 (42:44):
They just a lot of anthesiologists just want to have
like a good relationship with the surgeons, so they're invited
back to the center again, right, so they'll do whatever it.
Speaker 1 (42:51):
Is right, Because what happens if you, as an anti caesiologist,
are like, hey, what are you doing? Why are you
doing that? That's not right? What happens someone else the
next time? I won't call you because you're annoying. You're
a troublemaker. Oh my god, isn't that like what happens
in every other place where there's a whistle blow or
they fire them. So that's the reason why people don't
(43:12):
do it. So as a result, really, again, like I
said at the beginning, this whole thing, everything we're about
to talk about, and we're going to talk about in
a second episode revolves around surgeons being responsible orchestrating and
setting up the environment so it's safest for the patients.
But we're gonna end this episode and we're gonna have
(43:33):
a part two, a part two of this episode of
what we called Oh r nightmares, operating nightmares, and we're
gonna keep going because I think that this for Me
is one of my best episodes because it's really sharing
the inside story, inside track of what's happening. And it
shouldn't be done to scare you. It should be done
to empower you. And I think that ninety percent of
(43:54):
the times, if you're empowered.
Speaker 2 (43:55):
You can do well. But you should know the details.
Speaker 1 (43:57):
So Paula, will you join us on a second episode? Right?
Speaker 4 (44:01):
So you're lucky.
Speaker 1 (44:01):
Paulo wasn't even sure about the first episode. All right, guys,
so that's going to be a rap. As always, at
the end of each podcast episode, I have two requests
that I ask you. Number one request is if you
like our show, please go and right right now we're
gonna end this. I know you're driving, or you're on treadmill,
wherever the hell you are, just go and write a
nice review. It makes such a difference. There's so many
(44:22):
people that put this production together, put in energy. We're
here on a Sunday, and then it allows them to
feel good about this entire production.
Speaker 2 (44:29):
So we love that.
Speaker 1 (44:30):
And the second is share this podcast with everyone you love,
because you don't have a clue. Who's about to go
and have surgery next week? And until and then when
you find out it's too late. Hey, you should have
listened to this episode, So share our episode, write a
nice review, and we'll see you next week.
Speaker 2 (44:47):
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