Saturday, June 2, 2012

My Anesthesia Nightmare--Literally

I just woke up. My alarm went off at four-ten. It is really set about twenty minutes early.

It is the first time I was glad to hear it. I had been having a doozy of an anesthesia nightmare.

I have them. All of us in the hospital do.

Let me tell you about it.

I was teaching one of our weaker new hires how to do anesthesia for in-MRI pancreaticoduodenectomy. The patient had pancreatic cancer. And instead of just doing it in the OR like always, we were at a remote location, the MRI suite. And instead of a nice OPEN MRI it was the tube. It could have been a CT scanner. All I remember is the patient was to lie on her back in the tube.

She was a heavy-set middle aged woman with short curly hair, likely from a perm. She was white. She had pancreatic cancer.

I can't find the right equipment. The lubricating gel for the equipment is liquid automatic dishwashing detergent, not KY, I discover after I put it on the equipment that goes into the patient.

I tell him to induce anesthesia and intubate the patient.

It turns out he does not know how. And I am in teaching mode. I am not in 'giving anesthesia mode'. I don't have MY set up ready. I am dealing with HIS set up, which is not correct and I completely don't understand.

Because we are in a remote location, our anesthesia cart is not well-stocked.  Every time we try to put this woman to sleep, the breathing tube goes in. And as we look through the work area and cart for the next thing that is needed, she wakes up and pulls the tube.

Sometimes she is on her stomach, propped up on her elbows.  Sometimes she is sitting up. She is always pleasant, always smiling. But she just won't go to sleep. I put her to sleep again. And again. Each time I see the cords and insert the tube. By the end, I am not bothering with gloves, or a stylet. I am not even using a laryngoscope. I just use my hand.  And every time I turn my back, like in a scary movie, she wakes up.

I am telling the person I am supposed to teach, 'I am just supposed to show you how to do the case, not how to start an anesthetic. I should be home by now!' But the patient wants me, and I keep my promise to help. I take over the case. And I tell her, 'This one will work, it is a CARDIAC anesthetic'. That one uses ten ml's of fentanyl and ten of versed, two agents that had been notably absent  (I use five and two typically) from the work space.

Right when I was about to get it to work, the alarm went off.

I get my most powerful guided information when I wake up, usually in the form of a one-word command. Today it was WRITE. My subconscious is laid bare in this.

I am scheduled to have surgery next week. It is very difficult for me to undergo general anesthesia. Frankly, I have seen too much. If it wasn't for the pain that is caused by my current condition, I would not undergo it at all. We anesthesiologists are compulsive, neurotic, and anal-retentive. That is a good thing when someone you take care of is unconscious.  I am the queen of them all (except the one new hire in real life--they set up beautifully--but don't pay as close attention during the cases I have seen as I do). The challenge is trusting someone else enough to do the same for you for your operation.

Who was that chunky lady with the bad perm in my dream? She could have been a cuter sister to Susan Boyle...

Why couldn't I get her to go to sleep?

Why was she smiling? And so good natured?

Was it Gaia? The collective consciousness?  Or me? The part of me that feels like a frumpy, middle-aged mom who works all the time? And barely has time for herself?

My recurrent dream, since major surgery when I was twenty-five, was where it (the thing I had major surgery at 25 to take it out)  grew back, and I had to go for surgery again. The same kind. But the minute I get on the Operating Room Table, I change my mind and run away. I have had that dream for decades. It terrifies me. Every time. I have had surgery since, once with a general, and once with an epidural. No nightmares about those, oddly enough. But the first? Absolutely yes! (Maybe if I had intraoperative recall that would explain my reaction. Will write on Recall another blog post.)

Let me tell you, this new one was an improvement.

One of the concerns I have with New Age Medicine people, is that they totally discredit the people that work within the system. I have been told by a big blogger that 'I work in a candy store and that all sugar is evil. You might like the customers but the store is still bad'. I changed the profile to 'acquaintance' because  their heart was deaf when I shared, 'this is my dream, this is my calling'. Just automatic 'NO'. And this sentiment represents a big chunk of people who are Reiki and Channel and New Age who are out there. 'I am the healer!' Ego. Enough said.

Did you know Pasteur had an incredible devotion to Blessed Mother? So much he probably was in communication with her, much like in my own experience? He came up with a process to make milk safe for many. Sure, milk may not be the best for you, and avoiding wheat and dairy now is big. Back then dairy was a staple. Everyone had a farm, everyone had a cow. But as industrialization progressed, people were getting sick. Maybe dying. Pasteur saved a lot of lives through his hard work. He thought science and religion were one. In some ways, this made his spirit very much a pioneer.

We health care workers, in modern day medicine, are human.

We are overworked, just like you. Want to check? Just ask any nurse, especially an ER nurse, how long they can hold their pee. Feed a doc a heavy meal and put them in a dark room to watch a lecture. See how fast their sleep-deprived bodies fall asleep.

We are disturbed by some of the conditions that we see. Child abuse is one. I have seen the retinal damage from a shaken baby, felt rage over the abuse, and wanted to hurt the abuser. But I couldn't. We had to go through the proper protocol. I have seen cancer all but destroy a beautiful person, leaving a great big rotting hole in the chest that needed to be packed and the packing exchanged in the OR twice a week. I have seen people go in for something and not wake up. Usually it's for a ruptured AAA or trauma. Others 'wake up' enough to go to ICU but never recover. I see death and dying every day. And with Reiki Intuition, I know a lot more about their current state...

Someone I had to sign the medical record on from a couple weeks ago, turned out to have deceased between the time I took care of them, and the time I got called in by Medical Records to sign my charts.
Good thing I had given the transition symbol at the time of care. I had a hunch this patient was on the way out and needing to use it.

It etches on the soul. My soul. The good and the bad. And sometimes the bad really affects me at night.

And when my patients die, I cry when I get home.

Every time.


Reiki Doc