Thursday, February 23, 2006

Mama Said Knock You Out!

I'm doing anaesthesia at the moment. I had my biases and preconceptions before the week started but I've got to say that the experience has changed my views on the subspeciality. To us, the medical students, the anaesthetist is the guy sitting on a stool in the operating theater doing a crossword puzzle and occasionally writing down a few things. The surgeon would ask for more sedation, an infusion bag would need to be changed, an antibiotic would need to be pumped into a vein or necessary measures would be needed to control an escalating heart rate or a decrease in blood pressure.. and then its right back to 5 DOWN: "a river in egypt - 4 letters".

To the student, the surgeon is "the man/woman" (gotta be PC these days).. the anaesthetist is simply backup staff, much like the scrub nurses. Now I don't mean that to be derogatory in any way, because without the backup staff the surgeon would just be an idiot standing around in an empty theater holding a scalpel over an awake patient who's screaming and bleeding to death. Unfortunately, power and authority are seductive.. and since the surgeon practically runs the OR, us little ones (within the heirarchy) can't help but compare everyone else in that room to "THE MAN". And so the anaesthetist is just that quite chap in the corner whom we don't really think we can learn much from.

Big mistake. You'd be surprised by the amount of knowledge those doctors have. They drill you on your physiology and pharmacology, your drug interactions and side effects.. things that you thought no one could possible recall off-hand and at such a fast pace. Drug measurements and efficacys, the ability to tailor the choice of drug for each highly individual situation.. they really need to know everything about everything because what they do involves.. EVERYTHING. Not just one part of the body, but every single tissue, every single cell and every single chemical within those cells.

What I found truly intriguing was the prep room, a little room attached to the operating theater where the anaesthetist reigns supreme. They wheel the patient in as a fully conscious human being, chatting away.. either allaying their fears of the impending surgery or in good spirits with a positive outlook on the outcome of the next few hours. Next thing you know, little old lady O'Brien is counting backwards from 10 and she stops at around 7.. and then she's dead. Well, sort of. She has a machine breathing for her, you can cut her open and she wouldn't feel a thing. She gets picked up and placed onto the operating table, people are prodding and poking at her and she just becomes..... work. That's what really struck me the most, how the anaesthetists can be talking away to the patient, and then the next thing you know that person is pretty much gone for a few hours. I just found it all a bit disconcerting at first.

Anyway, still doesn't change my opinion about ruling out anaesthesia as a future career path, but it sure does change the level of respect which I have for the job. Still though, if I were in that field of medicine then I just would NOT be able to restrain myself from having that LL Cool J song blaring in the background before every patient is sedated. Bad practice? Maybe.

Don't call it a comeback, I been here for years.. I'm gonna knock you out!

1 Comments:

At 2:18 AM , Blogger Mo said...

Anaesthetists give three classes of drugs prior to surgery which, simply put, are:

1. Sleeping drugs, used to induce sleep and then an inhaled gas is used to maintain that state.
2. Muscle paralyzing drugs, necessary to ensure that muscle surrounding the area operated on (or in the trachea due to intubation) doesn't spasm during surgery.
3. Painkillers, to numb the pain experienced after surgery.

Very rarely, agents used for induction or maintenance of sleep are of inadequate volume, thereby creating that dreaded situation where the patient is awake, feels the pain and is yet immobile. This is the worst possible thing that could happen during anaesthesia, and is VERY, VERY rare. It creates more anxiety towards general anaesthesia than it should because the prospect of it happening to you is so horrifying. Anaesthetists always err on the side of caution to avoid such a situation.

You could almost compare it to getting on an airplane. The crash stories frighten the hell out of you, but they don't stop most of us from flying now, do they? Its all about odds, and if you're unfortunate enough to draw the short straw then I'm truly sorry.

When you think about it, there's no current adequate alternative to general anaesthesia or flying.. so we just have to get on with both and accept the risks.

 

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