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STANFORD, CA – Dr. Stav Señor, attending anesthesiologist at a large tertiary-care facility affiliated with a prolific medical school and residency program, was caught in a pinch when placed in truly unfamiliar territory.

With his senior resident called to a Code Blue, and his two fellows running concurrent rooms, Dr. Señor was called upon to start a case without his trainees. However, things quickly became uncomfortable when the seasoned veteran anesthesiologist approached the patient, intent on initiating his anesthetic, and realized there was no IV set up. Clearly perplexed, the doctor asked the OR nurse why the patient didn’t have access.

“That’s normally your job, Dr. Señor,” Nurse Joy calmly replied. “The Anesthesia team always starts the case by ensuring the patient has functional IVs.”

“Well I knew that,” the attending retorted, “But how does it get there?”

Dr. Señor clarified, “I’m excellent at delegating responsibility and telling people what to do, but I’m not so familiar with how some of these things actually get done.”

The doctor spent about 15 minutes fishing around in the anesthesia workstation for the correct equipment, before finally approaching the patients exposed arm. Five unsuccessful pokes later, the dual cardiac-thoracic trained expert was sweating. “I can cannulate for ECMO, but it’s been 3 decades since I’ve put in a 18G IV! I think someone’s changed the needles!”

Dr. Señor’s resident soon returned from his duties at the code to find his staff flustered and diaphoretic. “Thank god you’re back!” The attending moaned. “A couple more minutes, and I was going to have to cancel the case.”

After a successful induction, Dr. Señor left the operating room muttering to himself, “There really should be a bigger billing code for this.”

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ATLANTA, GA – In an effort to better encourage patients to do their breathing exercises, a newly-designed incentivized spirometer will pay patients $50 per deep breath – that’s right: cold, hard, cash – including a bonus of $100 every time they hit 1500.

“One of the most common complaints in patient satisfaction surveys had to with incentive spirometers: what was the incentive?” explained respiratory therapist Artie Blood-Gas, who carries his own incentivized spirometer to make a little cash on the side.  “Patients were never motivated to use them.  All they said was, what’s in it for me?  Not only are they motivated, heck, I’m motivated too.”

An incentivized spirometer works exactly like a conventional incentive spirometer: the patient inhales, holds their breath for 5 seconds, and exhales.  The only difference is with every breath the patient gets a cash payout.

“Hell yeah, there’s a whole lot of incentive!!” said patient Jackson Jones, who has been inhaling and exhaling like crazy over the past several hours.  His bed is overflowing with an unholy amount of cash, and not a single collapsed alveolus exists in his body. “This is way better than the slots in Vegas!  I got you, alveoli, I got you!!”

One incredibly motivated patient managed to move the gauge past 3000 in a single breath, after which her incentivized spirometer spit out an entire gold bar.

Blood-Gas is pretty sure he has a respiratory alkalosis going on based on his incentivized hyperventilation. “Cha-CHING! Thanks to these new devices,” he said, “atelectasis will be a thing of the past.”

In other news, several interns were caught in a back alley using dozens of incentivized spirometers to help pay off their student loans

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BOSTON, MA – 94 minutes into what was a routine total knee arthroplasty, Dr. James Nairbear suddenly felt lightheaded and fell backwards landing in the arms of OR Nurse D’nica Gurley. Nairbear was an apparent victim of aerosolized fentanyl just like many law enforcement professionals across the country.

When he awoke, Dr. Nairbear declared “It’s that damn fentanyl! I saw the CRNA open a syringe of it right before I fainted!”

“Why am I the only one feeling lightheaded in here?!?!”

A peculiar aspect of this “fentanyl exposure” much like many others reported in the media is how only 1 individual out of several in the same confined space had symptoms. The resident, scrub nurse, CRNA, Stryker rep, and fellow in the room had zero symptoms despite breathing the same “aerosolized fentanyl” contaminated air.

Renowned toxicologist, fentanyl aerosol exposure denier and logical thinker Dr. Ryan Marino agreed to be interviewed about his thoughts on the subject.  “Fentanyl toxicity cannot occur through aerosolized means unless a kilo of fentanyl was ground up and blown directly into the nostrils. I’ve done the experiments.”

When asked why none of the other 5 people in the OR had symptoms, Dr. Nairbear was indignant, “Well they clearly didn’t inhale as much as I did, clearly the fentanyl was directed right at me due to my superior breathing!”

Gomerblog later learned that Dr. Nairbear hadn’t eaten in 17 hours prior to his syncopal episode as he was preparing for a beach vacation. 

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SCHAUMBURG, IL – Throwing away the old blueprint of simply accepting the blame, Anesthesia has opened up a brand new playbook and is going all out on the offensive, blaming every else in medicine.

“F**K THIS SH*T AND F**K ALL Y’ALL!!!” the American Society of Anesthesiologists (ASA) boldly announced in a statement targeted at all health care professionals not in their field of Anesthesia.  “Hear us loud and clear: Anesthesia formally blames every subspecialty in medicine.  SUCK IT.”

“Woah, big words from a field who takes pride in hiding behind drapes,” said unimpressed orthopedic surgeon Brock Hammersley, who admits he does admire anyone who can use big words.  “Anesthesia is a field built on blame, it’s their foundation, their skeleton.  Without blame, they have nothing.  This’ll blow over, don’t worry.”

The mid-section of the ASA statement is an impressively long litany of blame assigned to others:

Anesthesia blames Allergy & Immunology.  Anesthesia blames Dermatology.  Anesthesia blames Radiology.  Anesthesia blames Emergency Medicine.  Anesthesia blames Internal Medicine.  Anesthesia blames every Internal Medicine subspecialty.  Anesthesia blames Family Medicine.  Anesthesia blames General Surgery, Orthopedic Surgery, Trauma Surgery, Plastic Surgery, and Urology.  Anesthesia blames Neurology and Neurosurgery.  Anesthesia blames Pediatrics.  Anesthesia blames OB/GYN.  Anesthesia blames Ophthalmology and “all their Hs.”  Anesthesia blames EMTs and ENTs.  Anesthesia blames RNs, NPs, and PAs.  Anesthesia blames PT, OT, the cafeteria, the volunteers, palliative care, even pastoral care.  Anesthesia blames the sun, the moon, the stars, and the heavens.  Anesthesia blames the New England Journal and the New England Patriots.  Anesthesia blames oxygen.  Anesthesia blames airways.

The list goes on and on for 34 pages and finally ends with the statement:

Finally, to those whom we have not mentioned, WE BLAME YOU F**KERS TOO. 

Like their orthopedic colleagues, other specialties are not taking Anesthesia’s outbursts too seriously.  “It’s just Anesthesia, don’t be scared,” said one health care professional.  “They’re probably just bitter from sudoku withdrawal or something like that.”

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HOUSTON, TX – Finding it to be a particularly slow day in the operating room today, bored anesthesiologist Lee Maxwell has been spotted running around Houston Medical Center, intubating med/surg patients on the floor at random.

Nurses were puzzled when they found several patients on the floor with an endotracheal tube in place, even though they were thought to be medically stable for discharge.  During the first few hours of the morning, blame was being placed on Anesthesia, even though health care professionals on the floor lacked the incriminating evidence they needed.

“What do you mean we didn’t have proof?  All these patients had tubes in their throats,” said charge nurse Frank Schumann, whose floor has more intubated patients than the ICU upstairs.  “If that isn’t Anesthesia’s calling card, I don’t what is.”

Just before lunchtime, a patient was heard coughing.  Schumann astutely ran to the patient’s bedside, and there he spotted Maxwell throwing down what would have been the 43rd endotracheal tube placed this morning on a floor patient if Schumann hadn’t intervened.

“What on earth do you think you’re doing?!” Schumann shouted at Maxwell.  “He’s just coughing.  He’s not hypoxemic.”

“He can’t maintain his way,” Maxwell insisted.  “Must intubate.”

“Are you out of your mind?!”

“MUST INTUBATE.”  Maxwell was now talking with a monotonic, almost robot-like tone.  “I need… to… protect… his airway… Need… more… airways… Must… intubate…”

Talk to any anesthesiologist, and they will tell you that the profession is riddled with stresses.  But if there was one thing that scared an anesthesiologist more than accidentally intubating a patient’s rectum or putting on a puppet show that didn’t bring joy to an OR, it was intubating a patient out of sheer boredom.

Always fear the bored anesthesiologist.

Luckily for the coughing patient, Schumann’s words got through to Maxwell and snapped him out of his intubation spree.

“Good God, what have I become?!”  Maxwell put the Mac blade down, which he realized he hadn’t even sterilized from patient to patient.  He surrendered to hospital security.  “Please.  Please help me.”

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MONTREAL, QUEBEC – Tired of looking after every airway in this world, anesthesiologists admit they occasionally wish patients wouldn’t be so lazy and unmotivated, and could occasionally show at least a little interest and intubate themselves every once in a while.

“I’ve been doing this for several decades and never once have I had a patient look up at me from the table and say, ‘You know what, it’s okay, I got this one, you can sit this one out,’ it’s really unbelievable,” explained McGill University anesthesiologist Eric Drouin, M.D., who is still recovering from an impromptu request to adjust the table height last fall.  “I mean, thousands and thousands of patients, and not a single self-intubation.  What ever happened to good old self reliance?”

Anesthesiologists want patients to realize that they’re multitasking back there, what with having to iron and put up the drapes, and lay out all the crossword and sudoku puzzles.  “Then to add managing airways, paralytics, sedatives, blame, and anesthetics on top of an already-long laundry list?” Drouin added.  “I mean, it’d just be nice to be offered a hand, you know?”

Do you know what really gets under the skin of anesthesiologists like Drouin?  At the most critical time in the OR, just when an anesthesiologist’s hands are at their fullest, just when they can use the most help, the patient has the audacity to fall asleep.

“It’s insulting, to be honest,” admitted Ryan Grossman, an anesthesiologist in Atlanta, Georgia.  “I mean, come on.”

Anesthesiologists have always wondered how patients can self-diagnose, self-medicate, and self-treat, yet there hasn’t been a single patient who has ever self-intubated.  It’s baffling to them.  The fact patients self-extubate with such high frequency makes it that much more frustrating.

“If that day ever comes, when a patient self-intubates,” added Drouin, “you better believe the flood gates are going to open and I’m going to cry such tears of joy.  Ask any anesthesiologist.  That’s the dream.”

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ATLANTA, GA – An inpatient health care team has been baffled all day by a patient’s persistent requests for pain medication, but it’s not your usual suspect.  The patient keeps asking for that pain med that begins with an E.  That’s right, an E, not a D

“I mean, the guy complains of 80 out of 10 pain, is never in any apparent distress, watching TV and texting on his phone all day,” observed his nurse Avery Jones, scratching her head.  “He made the request, and I thought I heard him wrong.  I, stupidly, corrected him.  You mean the one that begins with a D I said?  He looked at me and said no, the one that begins with an E.” 

“That pain med that begins with an E, which one is that?” is what third-year internal medicine resident Daniel Mann said when Jones paged him with the patient’s request.  “Something’s not right.  I’ll be down in a sec.” 

Jones and Mann went to the bedside and explained that the patient had no indications that would warrant treatment with narcotics, stating numerous dangerous side effects and the current opioid epidemic.

“I don’t want any narcotics,” the patient insisted.  “I just want that pain medication that being with an E.” 

“Excedrin?!” Jones quickly responded, hoping it was eureka.

“If I wanted Excedrin, I’d get it myself over the counter,” the patient snarked back.

Jones and Mann started rattling off medications, unable to identify a pain med that being with the letter E.  They stepped out and beckoned their best medical resources: Siri and Google.  They came across Exalgo, another trade name for hydromorphone.  That had to be it.

“Is it Exalgo?” Jones and Mann asked their patient, peaking their heads into the room.

“Exalgo, what the hell is that?” he replied.

Back to the drawing board for Jones and Mann.

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Intern: Patient’s BP is now 90/50.

Resident: This is from pulling too much fluid with dialysis

Intern: Patient didn’t get any dialysis today

Resident: Then, it is from the dialysis done 2 days ago

Intern: They just called me, patient is altered and has left sided weakness

Resident: This is uremia. Call renal for emergent dialysis

Intern: He just had dialysis yesterday and he doesn’t miss any session

Resident: It doesn’t matter. It is always uremia

Intern: Patient is complaining that he is bored and wants to go smoke.

Resident: This is from not removing enough fluids with dialysis. Call renal for additional UF

Friday at 5 pm:

Intern: Patient’s creatinine is 1.8, has been like this for the past 2 weeks

Resident: Make sure to call nephrology before the weekend

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Kearney, NE – Kind Samaritan Hospital. Operating Room @ KSH has entered a third week of shutdown as Anesthesia and Surgery continued to spar over their demands for the surgical drape wall. Both sides remain unwilling to compromise on any of their demands for the wall.

Anesthesiologists insists on a fortified construction with multiple reinforcing drape layers and drones to patrol the wall from above. They assert that such a powerful and tall structure is needed to contain the flow of undocumented body fluids, foul surgical language and illegal surgical elements emanating from the surgery side of the wall.

Surgery insists on a light and flexible structure, siting diversion of scarce drapes and clamps from unpredictable and rapidly changing conditions on the southern side of the wall. Location of the wall also remains a major issue as surgeons assert that the wall should abut the chin, allowing for a greater surgical field while anesthesiology insists on having access all the way to the cricoid cartilage.

Hospitalists’ attempt to mediate the conflict was unsuccessful and they had no idea where the Operating Room was and wandered on the loading dock. While both parties remain dug in, the patients @ KSH are feeling the pain. Mr Edward Dwindles, who’s ruptured AAA has gone untreated, has reported to Gomerblog that a solution is needed ASAP because having a systolic blood pressure of 60 for the last two weeks is really starting to suck.

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SCHAUMBURG, IL – Citing today as unequivocally the greatest day in the history of anesthesiology, President of the American Society of Anesthesiologists (ASA) Jeffrey Plagenhoef announced that “every sudoku puzzle ever created and placed upon this Earth has been solved,” before telling all of Anesthesia, “Mission Accomplished, it’s time to go home.”

Earlier this morning, Anesthesia solved the last of the 6,670,903,752,021,072,936,960 classic 9 x 9 grids.  All other-sized grids have already been solved.  They wanted to save the best – the final 9 x 9 grid – for last.

For years, health care professionals outside of Anesthesia have been baffled and intrigued by their colleagues’ obsession with sudoku, a puzzle game in which a grid of (usually) 9 x 9 grids is filled with numbers in such a way that patients are ignored.  Many anesthesiologists have risked their own lives in the pursuit of sudoku.  As a result, Anesthesia, traditionally known as the branch of medicine concerned with anesthesia and anesthetics, has been labeled the branch of medicine concerned with puzzle games.

“To our colleagues in subspecialties on the other side of the drape near and far,” Plagenhoef continued, “you may have blamed us for all of the ills in the universe but one thing you cannot ever, ever take away from us is today, this day in which sudoku was conquered.  It never was about anesthesia, anesthetics, you, or patient care.  It was about defeating sudokus, that’s why we went into the field in the first place.”

Under orders from Plagenhoef, drape, drape forts, and puppet shows in operating rooms across the country are slowly being dismantled with the goal of Anesthesia completely withdrawing and retiring from Medicine by the end of 2019.

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