The lab technicians
You will be asked to take a number of tests before weight loss surgery. These might include an electrocardiogram (EKG), chest x-ray, and some blood work. Your weight loss doctor usually orders these tests done a week before weight loss surgery so any abnormality can be checked out. However, the day of bariatric surgery you may need to have other tests. Some hospitals require you to have a blood test the week of your weight loss surgery to check for anemia, and all hospitals require women who are fertile to have a pregnancy test the day of bariatric surgery. Even though you may feel you gave a lot of blood a week or two before weight loss surgery, you may be asked to give again.
The volunteers, technicians, nurses, and the sleep man
When you arrive at the registration desk you will probably meet a volunteer, although sometimes it might be a paid employee. At my hospital, there are several people who fill this role, but Mary, a Virginia Mason employee, was my absolute favorite. Mary was a friendly person who could talk to anyone about anything. She was smart, efficient, and knew where to have labs drawn or where get your x-ray done, and if the doctor forgot something, she would take care of it without batting an eye. When I needed my operation done—I was a young resident then—she made certain any labs I needed were drawn (my cholesterol was checked just because I was curious). Mary, and her husband, John (honest, I am not changing names here, Mary and John) became good friends of mine. I knew them well (having scrubbed on surgeries for both of them) and have kept in touch with them all these years. They keep wondering when I am going to return to Seattle—and so do I, but that is another story.
Mary, or someone like her, will send you to the registration deskwhere you will begin filling out paperwork. If you were smart, you pre-registered, and much of this paperwork has already been filled out. You will be asked all sorts of questions, including history of drug allergies, allergies to latex, what medications you have taken, and, of course, they will want a copy of your insurance card. Once you have filled out the paperwork and they have verified your insurance (for the umpteenth time), someone will escort you to the lab to have some laboratory work done. If your lab work was done earlier, you will be taken to the preoperative holding area.
The weight loss surgery pre-op area
So, who are all these people who make this system work? The first people you encounter on your way to the operating room are the nurses in the holding area. These “greeters” get you into the proper holy attire, begin an intravenous line, and maybe even give you a little shave. If you need some blood drawn for the laboratory, an EKG done, or anything else, they arrange it.
Speaking of intravenous lines—or IV’s—Hey, these nurses are the best. They start IV after IV, day after day. Now, weight loss surgery patients with obesity often are “hard sticks.” That is, it is difficult to start an IV on them. Some bariatric patients insist that the anesthesiologist begin their IV, but, trust me. These nurses start more IVs in a day than an anesthesiologist. Placing an IV is a skill. The more you do it, the better you become. So relax, these nurses are pros—let them start your IV.
I had a knee operation many years ago, and my buddies, the anesthesiologists, decided to do me a favor and start my IV. Now, I have great veins—I mean I have pipes in my arms that you can drive a small truck through. After my buddy blew four veins, he went out to get another friend—cursing under his breath. I saw one of the pre-op nurses and asked her to start the line—she didn’t realize that my buddy had tried, and in about sixty seconds, I was hooked up. The more nervous you are, the more you transmit how hard it is to start an IV, and the easier it is to blow it. My buddy was probably nervous about starting my IV, and the nurse just took care of me without regard for anything—she never did give me her phone number (oh, sorry).
The anesthesiologist usually calls you the night before or the week before weight loss surgery. Not all anesthesiologists do bariatric surgery Some anesthesiologists don’t feel comfortable with heavy bariatric surgery patients, but these are few and far between. I use a few anesthesiologists selectively, as do most weight loss surgeons. These are physicians who I trust to put my patients to sleep safely and who are familiar with bariatric patients. One hospital I visited was beginning a weight loss surgery program and the anesthesiologists were upset. Many of them didn’t want to work with weight loss surgery patients. The administration asked for my help with this. I asked if the weight loss surgeon who was coming usually worked with a certain anesthesiologist. He did, so I suggested they both come to the hospital. After several months, the local anesthesiologists began to change their mind and asked to be called for the bariatric surgery, but the weight loss surgeon remained true to his anesthesiologist. The moral of the story is that weight loss surgery is a team effort, and the anesthesiologist is a part of that team. Your anesthesiologist has probably taken care of many bariatric patients like you.
You will probably meet your anesthesiologist for the first time in the pre-operative area. Again, you will be answering more questions about medications, when you last ate, whether you wear dentures. Again, you will wonder if anyone bothered to read the chart. They did, but they need to hear this information from you. It wouldn’t be the first time that charts got mixed up, two weight loss surgery patients had the same name, or information was placed in one chart that belonged in another chart. They don’t want to hear your entire history, just an abbreviated version of it. This not only helps them plan the anesthesia they will use, but helps determine if you need other medication while you sleep. If you have had anesthesia before, they will ask about your experience, whether you had a problem with anesthesia or became sick to your stomach after you woke up. They will talk to you about general anesthesia, maybe an epidural.