If one is working in an institute where the last operation will be permitted to be done only if the patient is on the operation table by a specific time, you experience this syndrome in its various flavors. Let us take a random time, say 1:00 P.M. They do not permit new cases after that time because then the operation does not get over by the time the nurses and servants of the first or morning shift go off duty. The hospital does not provide personnel for the second shift, even for a short duration. The solution is denial of service. The poor patient who has been anxious overnight and till 1:00 P.M., has remained starving, has received an enema and an injection of atropine or equivalent drug in the morning (now useless because the action has worn off for quite some time) useless is asked to go back to the ward and eat something, to wait for another week only to go through the same experience again.
There are many etiological factors for this syndrome. We shall list them.
1. The operating surgeons arrive late, so that the operations start late.
2. There are no sweepers and/or ward boys in the morning, because they remain absent together. Substitute arrives quite late. So the theater work starts late.
3. There are not enough nurses, many remaining absent. This occurs around festival time, or when children’s examinations are due or going on. So the theater work starts late.
4. The senior or qualified anesthetist does not arrive early enough, and the junior anesthetists keep waiting, not giving anesthesia to any patient. So the theater work starts late.
5. A patient found fit on the anesthetists’ round the previous day develops a cardiac murmur or hypertension or dyspnea which requires a specialist’s or superspecialist’s opinion. Then about 45 minutes are lost from the total time available.
6. The resident doctors spend a lot of time between two operations, getting the operated patient out or a new patient in. Though the job is that of the ward boys, they need to be told to do it, and the resident doctors just remain in a festive mood that the operation got over successfully.
7. Trainee anesthetist takes multiple attempts at finding the subarachnoid space to give spinal anesthesia. Sometimes they move up in the hierarchy serially, from house officer to Associate Professor until the last person to try gets the correct space.
8. Spinal anesthesia fails and general anesthesia has to be given. That adds the induction and recovery time of the general anesthesia to the total time lost.
9. Trainee resident surgeons take a long time to operate, partly because they do not know the exact steps, partly because they know the steps but do not have the technical expertise, partly in tentative steps taken to avoid actually cutting something (out of fear), partly due to spending a lot of time between operative steps doing nothing except holding hands hovering over the operative field.
10. Senior assistants going slow so that the operation does not get over before 1:00 P.M. so that they do not have to assist a trainee doctor until late, or because they have something else to do which in their minds is more important than that patient’s operation.
The result of this syndrome on the victims (patients scheduled for operations) is described in the beginning. The effect on the other victims (surgeons who were looking forward to performing that operation is depression, frustration, anxiety, and anger against the system. If they become victims of the syndrome repeatedly, they may develop suicidal tendencies, destructive tendencies, tendency to make fit patients unfit as revenge against seniors who keep operating. Coincidental victims are the bosses who are stressed trying to somehow rush through the operation so that it gets over before the deadline and the next case can be operated on. Suggestions to prevent this syndrome are not included in this post, because that would be just an academic exercise, never to be implemented.
