This is a routine cataract surgery that goes well and without complications. What is unusual about this case is the patient’s attitude prior to surgery. When I went to greet the patient prior to surgery, he was agitated and flippant with the nursing staff. He yelled at the nurse who was starting his intra-venous line and accused her of incompetence, even though she is an expert who does 1000+ IV lines per year.
Next, the focus of the patient’s insolence was the anesthesiologist who was questioned about his knowledge and competence. Finally, it came to me where the patient was rude, disrespectful, and frankly insulting. I did not let it affect me. I simply ignored the snarky comments and focused on the task at hand: doing the best cataract surgery possible.
The patient did great in the post-op period and then apologized to me and the entire staff. His wife of more than 50 years died the week prior to his cataract surgery and he just did not know how to process his grief. Now it all made sense. He didn’t mean to lash out at the surgery center staff. This taught me an important lesson:
Be tolerant, even if patients seem upset with you. Life is complicated and you never know what other stresses and challenges the patient is facing.
click below to watch the surgery but more importantly to hear my commentary:
If this happened to me, I would ask the patient what was upsetting him in the pre-operative area. If the patient’s behavior seems odd, that should be the primary focus, not the surgery. Cataract surgery is an elective procedure. It could be done when the patient is in a better state of mind. I believe the patient would have told you and the staff the recent loss of his spouse, had you asked. Tell him that at that moment in time, he is the center of the universe, you are all there for him, and perhaps doing cataract surgery at the time of deep emotional trauma is not a good idea. You are lucky the case went well. Had it not, you would have further compounded his mental stress. One last thing, his behavioral change could be due to other causes, such as early dementia. You were facing Dr Jekyll/Mr Hyde in this case, you did not know which was the real him, the gentleman in your clinic one month before or the curmudgeon in the surgery center.