Monday, March 11, 2013

Would You Do It For A Kiss?

Today I had a two and one half hour gap in my morning. First case, gap, then several more. I had made plans to make phone calls and book appointments for the family in this spare time. This is something I can never do during surgery. I looked forward to it after I finished my first case. When I was in the washroom, enjoying a moment's silence as I planned my 'gap' agenda, overhead I heard the page: Dr. (me) please call the front desk.  I hurried and washed my hands, walked across the lounge, and picked up the phone.

There was an emergency upstairs. A procedure was being done under conscious sedation, and it was not sedating the patient, who was moving around too much for the life-saving procedure to progress.

I said I would go. I opened up a two-cracker pack of graham crackers, snapped them in half, and in half once more, popped them in my mouth, and walked to OR 4 to get my things.

Anesthesia outside of the operating room is highly 'underfurnished'. It frightens me. In the area I was summoned, there would be no anesthesia cart or anesthesia machine to take care of the patient properly. I brought my own syringes and needles, a big stack of alcohol wipes in those little foil packets, my metal lock box of drugs, went back through the lounge, and headed up the stairs.

I did not want to go.

I did not want to go because a flail is never any fun for anesthesia to be the 'closer' and come in to save the game. I detest being asked by the ER to intubate after they have failed because I can't tell the difference between a vocal cord and that nasty frozen hamburger they pre-form into patties by the time they call me. Every look causes swelling, bleeding, and distortion of the normal anatomy of the airway.

I also did not want to go because this place was the death of my cardiac anesthesia career.

I built the program. I was recruited. They started it up, and used my CV, which, incidentally, was 'the nicest the state evaluator approving the place had ever seen'. Of course. This was community. I was academic.

They wanted me to design my own cart. They bought an anesthesia machine and a cart. They had no concept of the equipment, how to order it, and how to make it safe. It was like having to describe how to tie your shoes. A cart is a cart that is fully stocked!  I don't know where to put the little dividers to arrange all of the tools! That is an anesthesia tech's job! Not mine. They wanted me to be both a tech, an anesthesiologist, hold hands and do critical care in the ICU after the case. I picked every drug in the cardiac drug tray at the request of pharmacy. They were clueless.

But it all came down to testosterone and my lack of it.

Testosterone that did not like my skills at transesophageal echo. I have a certificate. I go to conferences. I am as good as  cardiologist, but I don't have the technician to help me with the echo machine. I do anesthesia, put in the probe, to the study all at the same time by myself. When the surgeon 'screws up', and the valve goes in with a leak and needs a stitch, or the bypass graft kinks and the heart is doing worse upon closing the chest, it is my job to say, 'Look! See? Fix it. Now.' and the surgeon has to listen and go back into the chest. Even if they have closed it at the end of surgery.

It was the director of the heart program, a nurse in a suit with a clipboard, who hired the divorced military guy (not a nurse) to run the area. He had a nasty divorce and hated his ex for taking the children. Enter me, single mom. And add very obvious 'chemistry' between the director and the new hire. He was as dumb as a rock. And nasty. It was the worst humiliation, professionally and personally, in my entire life. Nothing I could do was right. It was toxic. And my performance suffered from the stress. I got out.

As I put my hand on the door of the stairs, I summoned 'The Buddhist', the friendly entity who was so helpful with my nana's situation and my accepting it.

I am not going alone! I am not going alone! SMACK--ever see the whales smack their tail on the water? ever see a trainer do that to call a whale to the stage?--SMACK! SMACK! I sent out a distress signal with my mind.

He showed up. And was on my right. His left arm was on my waist as I walked into my nightmare, where the people hurt me so much just three years ago, and kicked me out of my own heart room.

I don't want to do this! I can't! I won't! 

He knows me well. He negotiated. The selling point: 'would you do it for a kiss?'

Yes. From my first swim lessons, swimming across the huge pool, which terrified me, to get a Tootsie Roll, to Now, where I find myself agreeing to facing my worst demons, for the reward of a kiss. The Buddhist did not specify what kiss or how, but promised, 'there will be one at the end'. Okay.

As I continued to walk down the hall from the stairs, I was engulfed with this message from The Buddhist: I am so proud of you. I am so very proud of all you have accomplished. I am so proud of you for everything you have achieved. I am so proud...

If felt like water in the desert, a huge rain storm to my parched soul, and I thanked God for it.

I walked in to the room. I could tell the room full of people was anxiously awaiting me. They thanked me profusely for coming on such short notice.

The patient was thrashing while they were working. I can't say more, I wish I could. Just know that he was not in good shape, but the mind had no concept of the danger he was in. I asked for propofol. I asked what they had given. I used my skill....

I also used my Reiki. I comforted and soothed the patient and he calmed right down. The propofol I used was only thirty milligrams. That is fly spit. That is nothing in a two hundred pound patient. As long as I kept my heart center connected, the patient snored and I helped hold the airway open.

An earthquake struck at that time. People in the room were worried. I knew. There was big energy work going on in the area. Last time I did big work there was Tsunami in Kona on Big Island. A shift in the energy patterns in the area can destabilize it a bit, on Gaia's surface. I had just cleared and protected an entire restaurant and everyone who had put foot into it for three days right down the street. Even bigger work was happening in this part of the hospital. On me. I thought my candles had 'cleared' it. But this was the last 'knot' in my soul.

How do I know? Well, this was followed by my NEXT worst nightmare: family wanting to watch me do my work.

Because of the severity and unexpected turn of the illness, the next of kin wanted contact. We covered the patient's blood and surgical field, gowned them up, and let them in.

What happened next was sheer magic.

I let go. I was heart centered. I explained who I was and what was up. 'I am doing my thing, he is under full anesthesia. That is why he is not responding to you. This is more for you, than for him right now. Do what you need to do. We are Ohana. We treat everybody like they are our own. He will be okay.'

They prayed over him, and I both felt the energy movement, and I was saddened at how limited their Spiritual Life is. It is like a crappy narrow bandwidth on a public WiFi that is slow, and I have like, the best and can surf everything with ease! Just because of what someone told them, and their parents grew them up with. Everyone has the right to this kind of connection to Source; it is a birthright.

We transferred him next, without the family, to the OR. My OR. The one I started. The one I didn't click. I helped my buddy, who I had groomed on his arrival to the group so he would shine with the team that didn't click with me. I was an extra pair of hands, and gladly so.

As I watched him work, I saw the heart room in action I had envisioned. A nice team that was supportive. Ultrasound guidance for central line placement without having to make them run and get it from the ER.

I also saw that his skills, both interpersonal and technical, surpassed me. He was accurate, friendly, and fast, just the way I am in the main OR or Labor and Delivery. He had confidence, and the patients were safe.

I felt proud for what I did for the community. Even if I had to sacrifice myself in the process.

As he started the echo, I watched the screen. It was like a long-lost dream when I used to do those studies myself.

As he got to the trans gastric short axis view, the papillary muscles were touching in systole. 'The patient is hypovolemic', my buddy said, 'Look at what those papillary muscles are doing--they are touching. He needs volume.'

His pointing it out was all the confirmation from Spirit that I needed for this sign. I had noticed it myself too.

The way a cardiac anesthesiologist remembers the hypovolemia image is that 'the papillary muscles KISS'.

I got my kiss. Just like The Buddhist promised. And I felt Lighter as I left to get ready for my twelve o'clock case.


Reiki Doc

As soon as I focused on the chart, he began to thrash.