Friday, October 26, 2007

anesthetics


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.

13 comments:

Sid Schwab said...

In doing bariatric surgery, I work with a group of anesthesiologists who have mastered the art of fully relaxing 400# pound people to faciltate laparoscopy, and to have them, nearly without exception, extubated before the drapes come off. And ready to go home a couple hours after that. Surgery is much easier when the patient holds still.

rlbates said...

When doing liposuction, it is also much easier to put them in one of these girdles (http://designveronique.com/cgi-bin/ic/dv2/855.html?id=baSRg3M2) when done prior to the patient trying to help you.

Ladyk73 said...

Oh my god...your c-section story was awful! I wonder if the @(%^&* doctor is still working?

Buckeye Surgeon said...

hilarious.

Roer said...

Hilarious?!!!!!

lady patient said...

buckass surgeon, picture that female patient as your wife. Still laughing?

Bongi said...

in the defence of buckeye i'm sure he is not saying that what happened to the patient is hilarious. the story is one you'd expect in a series like scrubs. there is an element of humour, agreed not to the patient and quite frankly at the time not to the surgeon either.

although i enjoy any comment on my blog may i kindly request not to insult other commenters on a personal level. your comments would carry more weight if they were not marred by unnecessary personal attacks.

red rabbit said...

This scene is not so uncommon. When I was working in Malawi, the surgeon often had to remind the MO anaesthetist (loudly) that the patient needed to be asleep.

It was creepy to say the least.

Buckeye Surgeon said...

lady patient:
calm down. A lot of things happen during surgery that are actually....funny. It's ok. Laughing is actually a fairly normal human activity. No disrespect to the patient at all. The behavior of the anesthesiologist was amusing.

lady patient said...

>> Bongi said:
may i kindly request not to insult other commenters on a personal level.

Bongi, you are right. Although the sentiments of my message are the same, please excuse how I addressed the poster.

Bongi said...

no problem lady. your comments are welcome as well as your sentiments.

i actually used this exchange as the basis for my next post, so i probably should actually thank you for being a muse albeit temporarily.

Amanzi Down Under said...

Bongi, before you praise your gas man too much, another difference between state and private is the price of the drugs ie: Sevoflurane compared to Desflurane. I grew up on Sevo (not literally) but now I work in a very wealthy state hospital and using Desflurane takes a bit of getting used to, namely the predictably sudden emmergence. So as I'm sure your Anaesthetist is only too happy to take some credit for a job well done, (as most of us utterly crave any recognition:) most credit should go to your hospital accountant for realising the overall economic use of Desflurane. PS: Don't tell YOUR gas man that as he might conveniently 'miss' a leak in the machine during your next operation and his immune face will smirk as you and the theatre staff perform bad Monty Python renditions. Keep a look out on Youtube if that happens! Ha ha!

Anonymous said...

"the anesthetist is a medical officer from pakistan."

I wonder how back this happened?
Coz now you are gonna get a lot more of us since we are being kicked out of our country