Tuesday, May 25, 2010

Running Man

Anaesthetists are like the Bomb Squad. We are bloody good at defusing difficult and dangerous situations and we are generally calm and collected when things are going wrong. We differ from the Bomb Squad in one important respect. If you see a member of the bomb unit running, they are running away from trouble. If an anaesthetist is running, they are running towards the problem....

The other day, I was making a rare :) trip to the tearoom when I was literally bowled over by a colleague running in the direction from which I had come. No time for questions, I turned and followed him at high speed to the Urology theatre. He had received the dreaded phone call, the one that goes something along the lines of “Resus in theatre...”

Turns out the Urologists (bless their little frustrated plumbing souls) were removing a renal cell carcinoma from an unfortunate gentleman. The tumour had, as they are prone to do, invaded the inferior vena cava. In a startling flash of insight, they had asked the vascular surgeons to help out. So Dr Vascular surgeon clamps the IVC, proceeds to open it, and then all hell breaks loose because the clamp slips off. Suddenly, 3 litres of blood appear in the suction bottle, our previously stable patient now has no blood pressure and things are going horribly wrong.

Our intrepid urologist peers over the blood-brain barrier and says, “we have a little bit of bleeding here..” No kidding Sherlock....Fortunately they soon get control and we spend 15minutes filling the patient up with blood and blood products.

So now, I offer some thoughts on the running anaesthetist...
  1. If you see an anaesthetist running, GET OUT OF THE BLOODY WAY! - this is my pet peeve - Sometimes we have to run to labour ward theatre, which is a LONG way from our department and I am always amazed as to how 2 people wafting down the corridor can manage to block an entire passage. It could be your relative I am running to...
  2. The older I get, the less use I am when I arrive at the scene of the disaster. I tend to be in so much oxygen debt that I have to spend 30 seconds gasping before I can offer any constructive help to the resident. One of my mentors insists that you may as well walk and not be out of breath. I think he is just old.
  3. Why do bad things never happen in the theatre you are right next to? Always with the marathon runs....
  4. A little information prevents a lot of chest pain. Often, there is no need to run.           Unfortunately, I often have to run to figure that out. Sigh.
  5. Did I mention...... GET OUT OF MY WAY?

Monday, May 10, 2010

Itchy Fingers

I work in a teaching hospital 80% of the time. Despite the fact that I love to teach and convey my knowledge to our residents, there is one aspect of teaching that really grates me.

Anaesthetists are not really perceived as being great procedural doctors. Most of our day consists of putting up IV lines and injecting stuff through them. Yes, we regularly insert endotracheal tubes but that to me is not a procedure - it is more like breathing or, to put an aeronautical spin on it - more like raising the undercarriage on an aircraft after takeoff. It is part of the process.

However, occasionally, we do get to do procedures. I am talking about things like epidural catheters, central lines, nerve blocks and procedures specifically aimed at control of chronic pain. This is where I have my great difficulty.

You see, I have very itchy fingers. I find it really difficult to watch a trainee do a procedure. It always seems to take forever if I don’t have the needle in my own hand. What they are doing never looks right - and as a result, I tend to want to jump in and get my hands on. NOW. Often, this is the only way to actually help. In many procedures, the way the needle feels as it passes through tissues is crucial to safely placing the catheter. And until someone figures out a way so gauge feel by simply looking at someone manipulating a needle, I will continue to pace, get agitated, and then shove on a pair of gloves and take over.

Does this make me a bad teacher? Probably. But that is simply the only way I know how to do it. Perhaps a daily supratherapeutic dose of Patience will help......