The sleep doctor

I am doing my anaesthetic rotation right now and to my dismay, I enjoy it so much. Many of my friends hate it because of its lack of human interaction but there is something about being on the end of the operation table, behind the screen created by the sterile drape, and ensuring the patient is in deep sleep so that he or she does not feel any pain. 

When I told my friends that I really like anaesthesia, they were surprised because they thought it would be too gloomy for me. I am surprised myself too.

I feel that anaesthesiologists do not get much credit they deserve. Imagine going through surgery fully awake and conscious. We would die from the pain, if anything else. 

The fourth case scheduled for the OT I was assigned to was a gynae-onco case. The patient was a lovely 57 years old lady who did not scream or yell when I inserted a second IV line on her hand. She had stage 4 ovarian cancer which was sticking to her bowel. I took a look at her CT and the radiology report. Her cancer was massive. It was bigger than a newborn size. Her husband has passed away and they had no kids. As a lady from a remote area in Malaysia, she thought what she was having could have been treated with traditional massage. She held my hand before she slept and asked me to pray for her.

My anaesthesiologists had discussions about her.

"This patient has diabetes, hypertension and congestive heart failure. Her ejection fraction is not great either"
"Her Hb was 8, then they transfused 2 pints. Now it's 10"
"Put arterial line and central venous line"
"I am going to put another IV line to anticipate things"

The Gynaecology resident came in and when she saw how my consultant was scrubbing in and getting ready to insert a central venous line.

" Ah, you guys are inserting a central venous line? That means this case will not be starting soon!"

My anaesthesiologist shot back.

"You do know that we won't be doing all these unless they are really necessary. And your department has the worst mortality rate. We are doing you a favour so that the patient does not die from massive blood loss as you guys cut her open."

Arterial line was inserted because she wanted real time more accurate blood pressure monitoring. Central venous line for not overloading the patient with fluid given her heart status that was unable to pump effectively. Arterial blood gasses were taken through out the surgery to ensure that all electrolytes were normal and she was not retaining carbon dioxide. Heart rate was kept to below 80 in order to not tire her heart. Emergency meds were on a tray to anticipate bad things. 

Medicine is more than just science and knowledge. It is an ever evolving art. Despite the stress and ever constant struggles, I am grateful to be a doctor. 

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