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Friday, April 8, 2011
Inside the Anesthesiologists' Mind
Today I had two cases that illustrate the cohesion of teamwork, spirit, empathy, and anesthetic skill.
Last night I had been on the obstetric anesthesia twenty-four hour shift, when a colleague of mine approached me with a favor. A cardiac case had been added. Instead of the two of us going home the following day, only one of us was. He was planning to take his dad to follow up for his cardiac surgery, and would I mind doing him a favor? I could not say no. So I faced more than twenty-four hours away from rest, as a favor to him.
The OR is full of favors. It is how you and your teammate/colleagues get the time you need to get anything done. If you want to go to your child's Open House, you have to make arrangements for it, not to be on call, to be first in line to get out early, and also for a person to take your place at the last minute if there is not time.
You can imagine my heartache when at one-thirty a.m. I was woken up out of a deep sleep to go do a c-section in thirty minutes. I did it, full well knowing I would pay the price for it the following day.
The nurses on that night stalled the calls for epidurals for me so I could get sleep. I woke up at seven, and was surprisingly refreshed. I had fifteen minutes to assemble the syringes and equipment and interview the patient for my case.
Patient 1: the umbilical hernia repair, a two stitch operation. A very large, basketball player-sized patient, I planned for a general with an endotracheal tube to provide full relaxation for the surgeon.
At the bedside in pre-op, I learned due to complications from a prior surgery, no tube was desired. Fine, there were no contraindications, so I switched to LMA. The wife was anxious, as he 'almost didn't make it' during the last trip to the OR, and was in a coma for three days.
The anesthesia airway was uneventful, but the anesthetic was. Low blood pressures, typical of poor function of the heart. Anesthesia is a stress, and this man was not up to it. Deep down, underneath, the couple both must have known he was not 'at his best', hence the nerves about the surgery.
I supported the blood pressure with pressors, gave minimal anesthetic, and he was fine in recovery room. I went to find the wife, reassured her. And she paused. She said, "I want to give you a big hug but I am not sure if it is okay with you." I said fine, and as she hugged me, I knew why I had been put on this case. To help the couple cope, both technically and emotionally. I never did conscious Reiki. There wasn't time, not with the paperwork and orders and preparation for the next case. But the Reiki Way helped nonetheless.
Scheduled one cancelled. ER patient direct admit to OR. Doctor's mom. (Murphy Law to the MAX, LOL). I knew it could go either way. Was going to the ICU for post op, no matter what. I lined her. Yes, a large bore i.v. and an arterial line. The former to fluid resuscitate the impending septic patient. The latter, to save her on blood draws in the unit as well as to watch pressure more closely than with cuff.
I was worn out by the time I got everything started and finished with my orders, charts, and the documentation on the electronic record. PACU nurses HATE having to enter lines into the system. So I did. All of them--NGT, a-line, i.v.
A colleague of mine came to relieve me. There is a macho rule that if there are less than thirty minutes left, don't let someone finish your case. He said, 'this place is different. you were up all night."
I left. Yawning.
At noon I went to the reptile store to get new bedding for our pet. And I was so tired I couldn't think of a place to eat. So I leaned back the seat and slept in the car. And started to cry. When you are that tired, what else can you do?
Home, lunch, a bath, and now ready to start my weekend.
The moral of the story is: your health care provider's life is as complex as a kitchen in a restaurant. Like a good server, they work hard to make the surgical experience right for you. Being in partnership with spirit, sometimes strange coincidences work to make sure YOU are the one for the job. Whether you like it or not. It is only at the end you see what your meaningful contribution actually was.
Take care and have a good weekend!