Thursday, August 9, 2012

Intuition in the O.R.



Come to think of it, I actually came 'out' in the O.R. a different way yesterday, earlier than the one I wrote about.

'Put a-line' I got, as a message. Even though the patient was my age and relatively healthy. It was a spine surgery, on the neck, from the front, a very minor one as far as neck operations go.

The neurosurgeon, Mr. I-am-from-India-and-I never-Sleep (he goes to the gym at 3 a.m.), gave me a hard time for it. 'I have NEVER seen invasive arterial monitoring for a one-level anterior fusion!'

I kept quiet, but was glad I got it in, easily.

The blood pressure 'relay' built into the human body is in the neck. It measures stretch and pressure from within at the birfucation of the carotid artery (the y where the vessel splits into internal carotid and external carotid). It is called the carotid body and is just a speck. On carotid endarterectomy, we see the pressure go up and down depending on how much the surgeon is touching it. For this surgery, we are not in that area.

But tachycardia and hemodynamic instability was seen through much of the case. It took four drugs for me to control it. Any higher pressure and bleeding would have made it hard to see the surgery.

At the end of the case, I mentioned to Dr. I-am-from-India-and-I-never-sleep, I am sorry. I couldn't explain it. After all my years as an anesthesiologist, I took one look at this patient, and I knew. I just knew I had to put it in and I did. Look here are all the drugs I gave, and how hard it was for me to lower the pressure. I wish I could explain it, but I can't.

'Did the patient, like, see their doctor or is this one that never goes?' the Physician Assistant asked, raising a good point. Sometimes people sound healthy on paper when in fact they are not. Just undiagnosed.

'Well', said Dr. I-am-from-India-and-I-never-sleep, 'That is what you are here for. It is your job to take care of the patient, and it is your expertise that is required. Even if you can't explain it.'

It was so subtle, but honesty on my part to explain the shift in my care of the patient, by using intuition as a guide.

Namaste,

Reiki Doc

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