Healthcare Blog of Dr. Remo Aguilar

Last in, last out….

in Medicine/Orthopedics by

I’ve always been strict about time. I make it a point to be on time whenever my presence is needed. Or I’m I don’t go to any appointment or meeting at all. During my residency training  that obsession with time worsened. I get edgy when someone else is late for a meeting or something. Even if the late comer is me.

Training thought me to develop the habit of coming into surgeries way before anyone else in the team does.  I rehearse the  surgical procedure and arrange  instruments way before the actual surgery. I also “acclimatize” myself into the OR room during this brief period of pre OR time, condition my mind and shutting down any external nuances that might bother me or the operative procedure. I require total concentration from me and my OR staff. That includes coming on time for the surgery itself.

One emergency OR night during residency and after waiting an hour or so for this perennial late comer anesthetist , I took steps to freeze stop this bad behavior. I rolled my patient  to the side and into an induction position. Then I  prepped his lower spinal area and asked for the “spinal set”. I asked the staff to warn me whenever the anesthetist is already in sight, so I could assume a position of inserting a spinal needle into the patient’s lower back. (Of course I’m not going to actually do this on any patient, even if I’ve done a few during my medical clerkship, but just to scare the late comer, I’m willing to be an actor).

When the anesthetist entered the room, he gasped for words and is shock seeing what I’m about (or acting out) to do. The OR door is situated opposite the induction area and the patients back so he didn’t notice the spinal needle was inches away from the patients skin.

“What the…?!” He panicked and called the circulating nurse to tell me to stop while he was still changing OR gown.

“Please, stop doing what you’re doing now sir!” He shouted .

“It’s OK I can handle this one” I answered without looking, leaning and bowing forward to my patients back as if inserting a spinal needle.

“The Bupivacaine ampule was accidentally opened hours ago and I’m just afraid this would expire before you would even come to our OR room. Added cost to patient if  you ask for a new one, you know..” I added, grinning.

The anesthetist hurriedly donned a sterile suit and took my position at the induction area. He is surprised the needle was not in any way near the skin of the patient. Before he can even muster a word, I went out the room and re scrubbed again to prep my operative site. He was not uttering any word from then on.

The OR room was eerily silent. But I can see the smiles behind the mask of all those nut cracks with me in the OR. Needles to say, my OR went totally silent and fast without any grumbling word from the anesthetist. I was even singing “Estudyante Blues“..

Ako ang nakikita, ako ang nasisi, ako ang may kasalanan…” Alluding to a perennially wrong doer, caught red handed.

Near the end of my OR, I noticed the familiar “restless” standing and walking of the anesthetist around me, peeping into my operative field and guessing when  will I finish. “He must be ashamed to ask me now” I muttered.

But he persisted with the annoying peek a boo. So I secretly nudge the extremity a bit and shouted

“Patient is moving!. “I’m not yet done!” even if I’m already closing the wound. Orthopods usually put splints and cast around their operative site post op. I have encountered anesthetists in the past who would prematurely wake patients up and make casting especially difficult. So this time, I asked to delay “waking up” the patient. I suspect the anesthetist is inkling to get out of the OR faster than anyone, so I made it a point that this time, he will be the last one.

When the anesthetist went out of the room for some reason, I hurriedly applied dressing and did my casting in less than a minute. I asked all the staff to clear up the table fast. When the anesthetist came back, he was in his second shock. The OR table is clean save for  the patient, who is snoring heavily.

Then I left the OR room whistling…”Wake me up before you go, go”…

I hope that anesthetist learned something from that OR. But I never found out really. That was the last time he induced a patient for me.


Dr. Remo-tito Aguilar co-founded #HealthXPh. A board certified orthopedic surgeon, he is Chief of Clinics at General Santos Medical Center and Medical Specialist II Orthopedics at the Southern Philippines Medical Center in Davao City. Dr. Aguilar is a healthcare social media evangelist and writes his medical musings at The Cast & Curious (

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