Thursday, January 7, 2010


As anaesthesiologists, we are present at a very vulnerable period in the surgical experience of our patients. This vulnerablility is primarily of our own making - we put patients into pyjamas to remove the power suits that define people in their daily lives, we make them lie in bed and we shine bright lights in their faces.

Then, we poke them with sharp sticks (IVs), shove oxygen masks on their faces, make them lie on ice-cold tables and render them unable to live unaided. In addition, sometimes we are our own worst enemies. A junior colleague of mine recalls the story of needing an anaesthetic. The male anaesthetic nurse didn't introduce himself to her prior to shoving his hand down her theatre dress to place ECG electrodes. As she said "Most guys would have to at least buy me a nice dinner before doing that!" She recalls feeling exceptionally vulnerable, despite being in a similar environment to the one she works in on a daily basis.

The CEO of the large multinational is lowered to the same level as the blue-collar worker, and that does strange things to people. Add a potent cocktail of mind-altering substances (think Michael Jackson), and the situation becomes even more interesting. The majority of anaesthetic agents cause some degree of disinhibition. Normally, the frontal cortex exercises some modicum of control and regulation of our desires and impulses (obviously in some people this is less well developed..). This control is released by anaesthetic drugs, and this effect is most pronounced at the beginning and end of the anaesthetic. Now let me say at the outset, that the vast majority of patients behave completely normally as they go to sleep and wake up. However, there are the exceptions....

1. The Swahili Speaker. - This guy (it is always a guy) is white, 20-35yrs old and most likely to be a heavy social drinker. They also typically are the chaps who say "Hey doc, you must be careful, because I am resistant to anaesthetic" They provide some mirth as they are being induced, because as they drift off to LaLa land (and yes, that IS a proper medical term) they start to speak gibberish, usually accompanied by emphatic finger pointing as though making a point (think Ou Krokodil).. I find the best approach is to casually say, "Yes, but we only do that on Tuesdays" and watch the confused  expresssion as the anaesthesia takes over.

2. The Nymphomaniac. Now propofol (our induction drug of choice) is a funny drug. Especially in young females coming for short/sedation procedures. I don't know why, but quite a few of these ladies wake up professing to have had "the most wonderful dream Dr." This statement is usually delivered in a very seductive way as the hapless woman emerges from her anaesthetic. Fortunately for them, they rarely remember this. I don't know, maybe I really AM that good...but I doubt it. On a more serious note, this phenomenon is a real medicolegal risk and is why a male doctor should never be left unchaperoned with a sedated patient.

3. The Brawler. These guys really scare me. There is no way to pick them up, unless they have done it before and warn me. Take, for example, a case I had a few months ago. Young, healthy guy, coming for colonoscopy (requiring light sedation). At the end of the procedure, as we are moving him off the theatre table, he sits up, looks me straight in the eye, and with no warning, delivers a fairly rapid right hook. Fortunately I was able to float like a bee and move my head back and he simply glanced off my nose. Any closer, and that would have been the end of the list. Afterwards, I went to see him. He was so embarrassed that he didn't know where to look. He had no recall whatsoever. I suggested that he warn any future dope-artists, because these guys tend to be repeat offenders. What kills me is that they are usually the nicest patients....

4. The Runner. This character is mainly seen on Saturday evenings. They are the chaps who were shot by the police "for no reason at all doc. I was on my way home from choir practice, and the police shot me out of the blue" Yeah, right. The fact that you had a 85" plasma on your head at the time had nothing to do with it. So we patch them up, and often, when they emerge, they wake up running. In their minds, they are running from the police still. The fact that they are often big strong guys makes this quite entertaining. Often quite a few nurses and porters are required so he doesn't run himself off the theatre table. (of course, if you have really BIG nurses, you don't need so many.)

5. The Sailor. Also hugely entertaining. Typically, this is an elderly, very straight-laced gentleman, you know the type, proper, ordentlike man. I recall one day working in a theatre right next door to the orthopaedic theatre. My colleague wheeled in this lovely old guy, full of beans and chatting pleasantly to her. When she wheeled him out an hour later, he was cursing so much that he was surrounded by a blue haze so profane that even the surgeons were embarrassed. 15 minutes later, and he was back to normal again. No recall (probably a good thing).

As I said before, these are the minority. And yes, we understand and don't victimise patients when they behave strangely around their anaesthetic. It is understandable. We made them do it. But don't blame us for having a little giggle, because sometimes it really IS funny....


Anonymous said...

That was so entertaining. A collection could be published!MIL

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