Friday, October 26, 2007
without anesthetists, we couldn't do our work. but sometimes the relationship between surgeon and anesthetist may be quite odd.
having worked for some time in government hospitals where the anesthetic is seldom, if ever, given by a consultant i was not entirely used to the privilege of consultant anesthetists doping for me. in private it is always a consultant. this obviously means there is a difference in quality of anesthetics.
probably the least important of these differences has to do with changeover time between cases. but, having said that, anyone who has worked as a surgeon for the state in this country most appreciates this difference. in the state changeover time can easily be up to one hour. it is not unusual to only do three cases on a list because of this. in the typical efficiency of the state, the rest of the list is then canceled, leaving the surgeon to 'please explain' to his patients why their operations are being postponed. in private, the list can't be canceled, so it is in everyone's interest to get the one patient off the bed and the next one on as fast as possible.
with this as a backdrop, a good private anesthetist can time his doping to coincide exactly with the end of an operation. as you down tools, the patient wakes up. i think it is quite an art. in the state, when you down tools, you wait with a mixture of boredom and irritation for the patient to slowly come around before he can be bustled off to recovery.
once there was an exception to this fairly general rule. i was a house doctor, the most junior of all doctors. i was working in a fairly remote part of the country. there, the caesarian sections were done by the most junior doctors (me mainly).
so i'm cutting another baby out of one more of the continuous string of pregnant women. the anesthetist is a medical officer from pakistan. finally i get the baby out and start closing. the anesthetist was trying to perfect the art of waking the patient up as the operation ended, but hadn't quite perfected it yet.
half way through closing the skin, the patient starts moving. i mention to the gas guy that the patient is moving. he tells me he knows, but he does nothing. being very junior and not exactly full of confidence, i keep quiet. i think i sort of assumed he knew what he was doing.
as i placed the next stitch, the patient almost sat up and tried to grab my hand. i stopped dead in my tracks and once again brought the patient's near fully awake state to his attention. i expected him to crank up the gas or to inject the patient with something or both. he did neither.
instead he moved casually towards the patient's feet. i waited to see what he was going to do. maybe he is going to get some drug from somewhere, i thought. how wrong i was.
suddenly he grabbed the patient's legs and held her down. 'quickly finish!' he yelled at me. i was shocked. i swear the blood drained out of my head (not quite like later in my career, though). i didn't quite know what to do. it was a very surreal moment for me. being very junior (or did i already mention that) i listened to him. with shaking hands i placed the last stitches. (the memory has been somewhat blocked out because of the trauma of the whole event but i suspect the patient actually helped me to cut the last suture she was so awake).
so these days, when i'm working in private i take time to appreciate the speed with which the consultant anesthetist wakes the patient up after the procedure and when i'm working in the state i am only too grateful when the medical officer struggles to wake the patient up long after i've finished.