Tuesday, May 24, 2011

In the Usual Fashion

Today I began dictating an operative report for an exploratory laparotomy.  Distracted, I accidentally dictated breakfast.
"The placemat, spoon and bowl were arranged in the usual fashion.  The Cheerios ™ box was removed from the shelf and the bowl was filled to approximately one centimeter from the superior lip.
Attention was then turned to the refrigerator.  A one-gallon milk container was removed and brought to the field.  At this point it was realized that the milk was the incorrect lipid percentage and was exchanged for the two-hundredths fraction.  During exchange of the milk containers, a V-8 juice ™ can was inadvertently exposed posteriorly in the refrigerator.  Palpation of the can revealed adequate cooling, however inspection revealed partial disruption of the superior stomal closure and leakage of contents…"
How did surgeons land on this periphrastic passive, third-person, past-tense, objective voice as the op report standard?

I tried less excruciating narrative voices.
"They prepped and draped in the usual fashion.  The surgeon then made an incision from umbilicus to pubis, taking care to avoid the patient’s known incisional hernia.  He divided the subcutaneous tissue with electrocautery."
Active verbs serve for more interesting action and land more softly on the ears, to be sure.  But the third-person, objective narrator maintains the neutral, scientific air.  Bo-ring.  And talking about myself in third-person?  Homey don’t play that.

So I add life with present tense, first person:
"We prep and drape in the usual fashion.  Careful to avoid entering the known hernia, I now incise from umbilicus to pubis.  I divide the subcutaneous tissue with electrocautery."
Inching toward awesome.  Now we'll raise the roof – future tense, first person plural:
"We will prep, and we shall drape. We will then incise from umbilicus to pubis, wary of the hernia. We shall divide the subcutaneous tissue with electrocautery."
Almost there.  Use imperative, second person voice:
Mic the Scallywag - photo courtesy of David Ball
"You!  Prep and drape!  Incise from umbilicus to pubis, missing his hernia!  Divide the subcutaneous tissue!"
Spread the word!  Pirate ship captain is the new narrative voice for operative dictations.