Perhaps nothing is more troubling than seeing a normally good-natured person become Rambo before my very eyes.

I love my job. I get to help folks every day and rejoice when patients tell me that their shoulder pain has gone or that they can sleep at night. Sadly, not every patient encounter is wine and roses. Every surgeon and nurse knows that in a given day, anything can happen. Here are some of the nightmares I have experienced after successful surgeries.

• Narcotized nightmare. One unfortunate event I see is the overly narcotized patient. Perhaps these souls are more sensitive to morphine than an in-law is to criticism. Or, perhaps they lied about reactions to medications. Regardless, my worst memories involve hearing the dreaded words: "code blue PACU." After completing the successful surgeries and assuring the families that "the case went well," I have suffered through several, ahem, events in the PACU. On one occasion, while scrubbed in for surgery, the head nurse sauntered in and exclaimed "Dr. Kelly, your last patient is coding!"
  
  Three Hail Marys and 2 Xanax pills later, I discovered my petite female patient had an extreme sensitivity to morphine. Micrograms could turn her into the Mummy. Thank God for Narcan! On another occasion, when visiting a post-op patient in the PACU, I discovered that she was asleep. Merely thinking that she was resting, I was treated to another "code blue PACU" minutes later when her respiratory rate approached Dracula's.

• Hallucination hassles. Perhaps nothing is more troubling than seeing a normally good-natured person develop personality changes and become Rambo before my very eyes. Months ago, a known kind soul underwent a major knee surgery. Shortly after awakening in the PACU, this normally good-natured person morphed into Frankenstein over the course of a few minutes. More agitated than a teenager grounded for the weekend, the patient tried to pick a fight with one of the OR attendants. Foul language and smack talk filled the recovery room. This poor chap wanted to fight everybody and he wasn't even Irish! After a negative work-up for any pulmonary or medical issues, the cause of the agitation was ascribed to narcotics. Duh!
• Nausea naughtiness. Just a few weeks ago I repaired the shoulder of a former football player whose physique would have made Arnold envious. Sadly, the patient awoke to more nausea than a woman carrying triplets. I received a text message from the PACU nurse stating: "Mr. X is very angry. He wants to know why he is so nauseated!" Apparently the patient warned anesthesia that he had a problem with this issue in the past. I am sure anesthesia did a commendable job. Despite our best efforts guano happens! This guy was strong. His biceps had their own ZIP Code. Thank God he wasn't mad at me!