doctor's visit

doctors don't like to go to doctors. i suppose we might see it as a failure or more likely it is pure intellectual arrogance. whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. one way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a colleague in these uncomfortable circumstances.

dr peter swann, a tall dark and handsome man, wise and hyperintelligent, popular amongst women, with a vodka martini (or was that an austin martini, i forget), was required by his insurance company to get a signature on a form at least saying he was not quasimodo and had a blood pressure no more than moderately elevated. there was no option. he had to go to one of the local general practitioners.

as consultations went, this one was going quite well, except for the awkwardness inherent in having to examine a colleague. the gp had managed to establish that is was unlikely that dr swann would suddenly drop dead in the next hour or two, thereby defrauding his insurance company of millions and millions of rands (about a dollar fifty). in fact dr swann was even beginning to relax. so when the gp asked about any previous surgery it didn't seem at all inappropriate for dr swann to discuss in detail his recent minor surgery in the local hospital. in fact he decided it would be a good idea to wax lyrical.

"i recently had a small procedure done. everything went well, but it was a strange, somewhat unnerving experience."

"why is that?" the gp feigned interest.

"well, as you, know, in my line of work we don't really get to know the anesthetists too well. so i was quite surprised when this elderly blond haired wild looking lady introduced herself to me as the person who would be keeping me safe and soundly asleep while under the knife. when i told her i was a colleague she seemed much more nervous, and that's saying quite a lot because her general appearance and demeanor hardly radiated the impression of someone in control." the gp seemed suddenly a lot more interested in doctor swann's story, so, feeling encouraged, he continued.

"everything went ahead as i suppose it does just before an operation. i was moved across to the theater bed and all the necessary wires were attached to me. of course i was nervous, but i was trying to put a brave face on it. i even tried to make a joke or two, but she seemed much too tense to laugh and in the end her reaction just made me more nervous, so i decided to just quietly lie there and pray that everything went well. then she started to inject the white stuff that brings sleep. but just as she did, she suddenly stopped and spun around in a panic. she then turned to the nurse and spoke.

"where is the thing? you know that think i need? dam, why does this always happen when i'm working on a colleague?" obviously i was terrified. what was this thing that she referred to and how important was it in keeping me alive during my operation? why does what always happen when she is working on a colleague? was i going to survive or were these my last thoughts on this earth? i just started trying to ask her these questions, but it was too late. the white stuff she had injected was doing its job and i drifted off to sleep with more than a little concern for my safety." he stopped for effect. the gp was looking on intently. swann smiled. it was a funny story and he felt he had told it well. in fact he felt sure any ice that may have existed between him and the gp had surely now been properly broken. it even seemed strange that there had been any tension between them earlier.

"do you know the anesthetists at all?" asked doctor swann.

"yes, some of them"

"do you know the one i'm talking about?"

"yes. she is my wife."

the ice froze over instantaneously.

banter

of all the specialities, i like the anesthetists the most. some of them are even my friends. this doesn't mean there isn't some degree of niggling that goes on between us.

during anesthetics there are two crucial times when things can go horribly wrong. the first is when the patient is put to sleep and the second is when the patient is woken up. during most operations the time between can be quite routine and even mundane. the patient can almost be put on autopilot and the anesthetist has very little to do except maybe catch up on a bit of reading (there are exceptions). yet strangely enough the one quality gas monkeys appreciate above all else in a surgeon is speed. somehow they seem to want to get through the stress free stage of the operation (for them at least) and move on to the part where things could potentially go frighteningly wrong. maybe they get bored, i don't know.

so the anesthetist thinks the surgeon is great if he gets the operation done fast and he also takes a certain amount of pride in waking the patient up moments after the operation is finished. this way the surgeon, who usually does not appreciate waiting around for anything, doesn't end op waiting around for changeover time. i suppose you could say we work fast to impress them so that they will work fast to get the one patient awake and the next one on the bed as fast as possible and thereby impress us. yet in my opinion there are things worse than waiting a minute or two longer between cases. i don't like working on awake patients. also for some reason that i can't fully explain if you finish the operation before the gas monkey is completely ready to wake the patient up, they tend to get the impression you are super fast.

then of course you get the two basic types of anesthetists. the first type shows an interest in the operation and knows when to start decreasing the gas. the second type has little interest in the operation and is possibly more dedicated solely to his craft. he will often ask for a heads up when the operation is nearing its conclusion (i once wrote about such an anesthetist)

if you put all this together, due to the fact that i can't always predict how far i am from the end of an operation and that i've had a previous nasty experience with patients moving while i'm trying to place the last stitches i tend to wait a while before i warn the gas monkey (that's if he asks) that things are coming to an end. so a typical conversation with a good gas monkey friend of mine would typically go like this.

"bongi, give me a warning five minutes before you've finished."

"sure." i'd answer, wondering how exactly i would know when five minuted before the end would be. then i'd go on merrily, secretly keeping one eye on my sandman friend to see if he was following the operation. if he was not i'd pretty much wait until i had only one more stitch to place. i'd then glance up and announce;

"five minutes to go." i would then bow my head and carefully place the last stitch. once i was happy with that stitch, i'd look up.

"finished."

i'd be lying if i said i didn't enjoy the reaction this usually elicits from my friend. he tends to go on about now having to wait for the patient to wake up, something i'm not overly worried by as i have said. i also enjoy the illusion it creates with him that i operate fast.

it is all done in a very good nature and our friendship is not at all affected by my possibly juvenile behaviour (i hope).

friends?

there is a sort of love/hate relationship between the surgeons and the anesthetists. neither one can survive without the other. we supply them with work and they get the work to lie still while we cut and dice. yet their job is to keep the patient alive while we challenge their ability to stay alive. at the moment of surgery they play good cop and we play bad cop. of course after surgery the good cop is suddenly the surgeon through and through. but that is another story.

i really appreciate a good anesthetist (i've had bad ones) and to tell the truth these days i'm spoiled by the quality of the gas monkeys that i work with. however many years ago i remember a case where the anesthetist and i had a misunderstanding about time frame.

i was doing a laparotomy in kalafong. the gas monkey was a long term medical officer. he had attempted to specialize in anesthetics but simply had not been able to pass. in the end he found himself stuck in a senior medical officer job with no way of advancing himself. he was a bitter little man and it was easy for him to take his bitterness out on surgeons.

towards the end of the operation when i started closing the sheath the patient's abdominal muscles were so stiff that he was pushing all his intestines through the wound. this did not mean the patient was awake. it simply meant that his muscle relaxant had worn off. it was a tricky time. i needed the patient to be at least partly relaxed, but if the gas monkey fully relaxed the patient he would not be able to wake the patient directly after the operation, thereby wasting all of our time. a good gas monkey will find a compromise between these two extremes. i did not have a good anesthetist. he was also more stuck on the hate side of the relationship between our two disciplines.

"the patient is pushing a bit." i hinted.

"the operation is almost over," he snapped, "i'm not going to relax him any more. otherwise he'll still be asleep half an hour from now". i was annoyed to say the least, but i knew it was a fight i couldn't win. it seemed so important to him to get this patient off the table in half an hour. i smiled. i could close this abdomen with the patient pushing against me, but i couldn't do it in half an hour. it would take longer. i decided not to share this information with my touchy friend. i buckled down and got to work.

it turned out more difficult than i initially thought it would be. each stitch was an effort and my assistant ended up straining against the patient to keep the tension on the suture. the gas monkey started becoming edgy, but i ignored him. if anything i slowed down my pace, making sure that, despite his best efforts, i closed the sheath properly.

about an hour later when i finally had it closed the qwasi-gas monkey was so irritated that he couldn't sit still. i was smiling behind my theater mask. i knew i had closed the sheath properly despite his inadvertent attempt at sabotage. and maybe next time he would pay slightly more attention to my seemingly ridiculous demands.