Another perk of living on this little rock floating in the mediterranean, is that I've come, up close and personal, with flab ... serious flab ... I'm not judging fat people, in fact with a BMI on the verge of being problematic, I feel real compassion for anyone with a weight issue. But, what I have been experiencing here is not your average, garden variety, fat person. No, it is ... well ... a new, possibly alien-infested, genetically modified, branch of the human species.
We're talking BMI's of 50 plus!!
Bariatric surgery has never been my thing. In fact I truly believed that it is for those lazy, weak, psychologically challenged liars claiming to have tried every possible diet on this planet without success. How on earth did they actually get that big anyway? ( A bit harsh in retrospect ). So , barring your proudly South African mama, presenting for the c/section of her eighth kid, putting the michelin man to shame, and having little inclination to communication, I haven't had much to do with this patient profile until recently.
Two months ... and I realise just how wrong I have been!!
These are tortured souls, completely trapped, beyond escape, by hundreds of kilos of suffocating lard. Their bodies are physical freaks of nature and it doesn't matter how it happened ... the psychological torture is the same ... it's bad , really
bad.
They deserve to have these operations, in fact, they have earned the right to have them.
It's their only chance to have some sort of a normal life. Ok, normal is in the eye of the beholder, but never once being able to wash your own feet ( or any other, more delicate parts of your anatomy,
for that matter ) is abnormal for me. Very abnormal!
My most recent case really opened my eyes. A young mother of three (still trying to figure out by what divine intervention that feat was accomplished ) with a BMI of 57!!
To be visually affronted by the sight of such a quivering mass, stretched out on an operating table, is, to say the least, enough to ensure that no morsel of food ever crosses your lips again! Ever!!!
( Lost 3 kilos since this case...)
Needless to say, there were complications, both surgical and medical. How do you explain to anxious family members that their loved one's disfigured body is the ultimate culprit? That no matter how hard you try, it somehow gets in the way. One can only tape so many interfering rolls out of the way using the elastoplast technique. Nevermind that all that fat is metabolically active. It's a disaster waiting to happen!!
I get to know this young lady very well during her slow and difficult recuperation. I also realise again how wrong I was. She is not lazy, or weak. She is neither a liar, nor psychologically challenged, and she is definitely no fool. She is just a desperate soul severely trapped in a very, very sick body. Now, whatever resulted in this glorious abundance of glyceride esters, is totally irrelevant, because, just as a very, very sick heart needs cardiac surgery ... so too does a very, very sick body need bariatric surgery!!
She is finally being discharged from ICU, minus at least 15kg, and starting to sing - perhaps for the first time in her physically oppressed life - a merry tune!!
Sunday, February 14, 2010
Wednesday, February 10, 2010
The perfect anaesthesia
Strange that after so many years, I only now ask myself, and repeatedly so, exactly what constitutes the perfect anaesthesia. Oh I know all that stuff about amnesia, analgesia, akinesia and altered sympathetic response. Lets face it, every single patient gets that ... I also know that there are anaesthetist factors, patient factors, and drug factors that all have a role in how the anaesthetic is going to play itself out. But what I don't get, is why it sometimes goes really brilliantly, and other times less so. Especially when the basic technique used is the same, with only some minor fine-tuning to accomodate individual needs.
With time one gets a feel for the job. Sort of like baking. Yeah, if you bake the same cake every day, it gets better, easier, and quicker. You also start to get a "gutt feel" for how your cake is going to turn out. And funny enough, even though you use the exact, same , unaltered recipe, the cake is sometimes yummier than other times. Why is that??
What freaks me out even more, is that when a dope feels sort of effortless, if one could call it that, it usually turns out close to perfect. ( I say close to perfect cause I think that absolutely perfect is an illusion ). And when meticulous planning with a lot of extra-careful effort is put in,
things turn out less than satisfying. By that, I mean there is something consciously or subconsciously irritating me.
Coughing, pushing, biting, waking too fast, waking too slow, too much gob, too little gob ...
Am I making any sense here?? I am way too young for a mid-life crisis, and way to old for neon-green-behind-the-ears syndrome. My better half is a pilot and I can't help feeling that some days, although I manage take-off and landing quite safely, it's almost as if I completely miss the runway!! Why, when according to science, everything has been done to ensure the, two-for-the-price-of-one, package-deal of "state-of-the-art snooze plus awake-up", is there no guarantee?
Add to that, the fact that this usually occurs with your least favourite of surgeons ... or when you really don't want it too ... or when you secretly want to show off your cool technique a bit ... or when you really don't expect it too ... and I ask again ... what is that something that I'm sometimes missing?
With time one gets a feel for the job. Sort of like baking. Yeah, if you bake the same cake every day, it gets better, easier, and quicker. You also start to get a "gutt feel" for how your cake is going to turn out. And funny enough, even though you use the exact, same , unaltered recipe, the cake is sometimes yummier than other times. Why is that??
What freaks me out even more, is that when a dope feels sort of effortless, if one could call it that, it usually turns out close to perfect. ( I say close to perfect cause I think that absolutely perfect is an illusion ). And when meticulous planning with a lot of extra-careful effort is put in,
things turn out less than satisfying. By that, I mean there is something consciously or subconsciously irritating me.
Coughing, pushing, biting, waking too fast, waking too slow, too much gob, too little gob ...
Am I making any sense here?? I am way too young for a mid-life crisis, and way to old for neon-green-behind-the-ears syndrome. My better half is a pilot and I can't help feeling that some days, although I manage take-off and landing quite safely, it's almost as if I completely miss the runway!! Why, when according to science, everything has been done to ensure the, two-for-the-price-of-one, package-deal of "state-of-the-art snooze plus awake-up", is there no guarantee?
Add to that, the fact that this usually occurs with your least favourite of surgeons ... or when you really don't want it too ... or when you secretly want to show off your cool technique a bit ... or when you really don't expect it too ... and I ask again ... what is that something that I'm sometimes missing?
Monday, February 8, 2010
Every dark cloud has a silver lining.
I am on silent probation (so by some unspoken rule, I get all the kak patients for now), and it's been an exhausting, back-breaking, mind-numbing kind of day.
Not only have I been working since the crack of dawn, which was about 12 hours ago, but my patients have all had some element of risk, resulting in 12 hours of continuos, low-level, stress-hormone release from my poor adrenals. I'm not unable to work for so long, but thanks to "operation relocation", my career-fitness level has taken a bit of a dive...
Also with no real friends around, no coffee-break, no lunch (ag shame), the day somehow feels longer and lonelier. Reminds me of those blokes on the street corner with the cardboard signs around their necks ... You know, from my previous life ...
Anyway the last patient, is a lady that's about 95 in the shade, femur fracture, cardiac disease, cancer, and a fanatical family of ten children. Need I say more... Her induction is shaky, her intubation a nightmare resulting in 2 dislodged front teeth, (an anathema to any anaesthesiologist by the way), and her bloodloss substantial for her age. Other than that, her surgery is successful. Very importantly, the metal is in the bone! We even manage to wire her teeth back into place!! Decent damage-control I'd say!
So off we go to ICU, for some TLC.
It's my virgin flight to ICU, so I haven't met the staff yet, but I expect my reception to be much the same as everywhere else so far.
I hand my notes to a really sweet-looking fellow, do a hand-over in my best, broken greek, help get the old lady settled, and sink down into the nearest chair ... just for a minute or so...
The sweet-looking fellow, with the first, truly friendly, face I 've seen around here, offers me a cup of coffee. He seems shocked to hear that I've survived the day without any form of nourishment whatsoever. ( Secretly, I'm quite surprised too, but hey, they don't need to know that!) Two seconds later, a mug of steaming coffee in my hands, he earnestly explains where all the restrooms / tearooms are situated. Obviously he feels about these places, as an air hostess would about the exits marked in red on board an aircraft.
I don't bother telling him that I'm totally rigting-bef*%. That I would, only with time, find the watering holes myself, but let him ramble on. He definitely doesn't fit into the chauvinistic mould that the majority of males on this island seem to be cast from! I'm really surprised! Pleasantly so!
With every subsequent ICU visit (have I mentioned my probation?), I get to know him better.
Each time over a cup of coffee, that's been made for me exactly the way I like it, nogal by a cypriot male.
I realise that things are really not that bad, as long as I keep an eye out for that silver lining.
Not only have I been working since the crack of dawn, which was about 12 hours ago, but my patients have all had some element of risk, resulting in 12 hours of continuos, low-level, stress-hormone release from my poor adrenals. I'm not unable to work for so long, but thanks to "operation relocation", my career-fitness level has taken a bit of a dive...
Also with no real friends around, no coffee-break, no lunch (ag shame), the day somehow feels longer and lonelier. Reminds me of those blokes on the street corner with the cardboard signs around their necks ... You know, from my previous life ...
Anyway the last patient, is a lady that's about 95 in the shade, femur fracture, cardiac disease, cancer, and a fanatical family of ten children. Need I say more... Her induction is shaky, her intubation a nightmare resulting in 2 dislodged front teeth, (an anathema to any anaesthesiologist by the way), and her bloodloss substantial for her age. Other than that, her surgery is successful. Very importantly, the metal is in the bone! We even manage to wire her teeth back into place!! Decent damage-control I'd say!
So off we go to ICU, for some TLC.
It's my virgin flight to ICU, so I haven't met the staff yet, but I expect my reception to be much the same as everywhere else so far.
I hand my notes to a really sweet-looking fellow, do a hand-over in my best, broken greek, help get the old lady settled, and sink down into the nearest chair ... just for a minute or so...
The sweet-looking fellow, with the first, truly friendly, face I 've seen around here, offers me a cup of coffee. He seems shocked to hear that I've survived the day without any form of nourishment whatsoever. ( Secretly, I'm quite surprised too, but hey, they don't need to know that!) Two seconds later, a mug of steaming coffee in my hands, he earnestly explains where all the restrooms / tearooms are situated. Obviously he feels about these places, as an air hostess would about the exits marked in red on board an aircraft.
I don't bother telling him that I'm totally rigting-bef*%. That I would, only with time, find the watering holes myself, but let him ramble on. He definitely doesn't fit into the chauvinistic mould that the majority of males on this island seem to be cast from! I'm really surprised! Pleasantly so!
With every subsequent ICU visit (have I mentioned my probation?), I get to know him better.
Each time over a cup of coffee, that's been made for me exactly the way I like it, nogal by a cypriot male.
I realise that things are really not that bad, as long as I keep an eye out for that silver lining.
Wednesday, February 3, 2010
The mega colon.
It's freezing out, and I'm on my way to work.
Doing a laparoscopic total colectomy, and expecting a slow and quiet day. Today's surgeon has, in my humble opinion, already got one foot in a retirement village. He seems to know it too cause some hotshot surgeon has been especially imported ... yes from another country, so God help us ... to assist/do the procedure. I have no great expectations for the day and I'm almost sure it's gonna be long, slow and hopefully very boring. Brought my sudoku along just in case ... oh and quitely slipped a mills & boon into my bag when no-one was looking. (Yes, we all have our skeletons ...)
I don't make a habit of "relaxing" in theatre, but on a long 7 hour haul, with proper preparation, the course mapped out on auto-pilot, and everything going smoothly, even a control-freak like myself can relax for about 15 minutes. Bear in mind that I sit in a little spot squashed between the patient and the DATEX, within arms reach of any resuscitation stuff. Super-sensitive ears listening to the blips of the heart from start to finish. My species can detect any changes just by listening ... even in our sleep.
Laparoscopic procedures are minimally invasive to the patient, but usually quite difficult. Imagine removing an entire colon, with minimal bloodloss, using 4 little holes, and your hands never actually inside the abdomen!!! Never seizes to amaze me how these guys seem to know exactly where they are, exactly what they are looking at, and how they manage to orientate themselves. No wonder they sometimes think the sun stops shining when they sit down...
What does all this mean to me??
Well if all goes according to plan and nodody screws up, it means that the fluid-shifts and losses are minimal, which is very good (less calculations for me). Also the postop recovery is much easier and less painful. But intra-op, besides the standard basic anaesthesia rules, lung ventilation is a little more tricky as a whole lot of extra pressures come into play. The patient is put into a head-down position, with her abdomen blown-up by CO2 gas to resemble that of a term pregnant tummy. So the poor little lungs get squashed up nice and tight, and among other things, its my job to ensure normal gas exchange throughout, using a few ventilation tricks and a couple of drugs.
With the milk of amnesia administered, the endotracheal tube secured, and the desired "altitude" attained, we are ready for surgery to begin.
Today I have decided to take the bull by the horns. Time to chuck that bloody chip off my shoulder! Been the new kid on the block for long enough! Time for the old, spunky, me again... and to hell with everyone else.
I boldly introduce myself to the freshly imported, just about shake his arm out of its socket ( I love seeing the shocked look on people's faces when I do that) and act very much in charge. He doesn't look shocked though, but smiles warmly ... WOW... strange surgeon smiling at me ... thats a fresh change from the last 6 months! He instantly gets a new fan.
Surgery is slow, but precise. The guy is brilliant, its obvious that he loves what he does.
On my side we are cruising steadily on auto pilot. No troubles thank God. I quietly pull out my M & B, and enjoy a few pages behind the screen,( with my ears on the monitor of course), when WOW calls my name. Oh shit, within seconds I asses the situation and find nothing amiss ...
Patient is correctly positioned, fully relaxed, vital parameters normal with enough fuel on board, so what's wrong??
Yes?, I ask. He says something in rapid greek. My own language once again makes me look like an idiot. Excuse me but could you repeat that slowly please? Then, in perfect english, comes the sentence that finally knocks all remnants of that chip, forever off my shoulder.
Thank you for the perfect anaesthetic, I am very very happy with your anaesthesia.
Well blow me over!!!!!!!!!! Don't know what I expected, but that was certainly not it! That little sentence, set me free! I finally escape from the cage in which I have both locked myself in, and allowed others to imprison me. Can't explain the soaring feeling....
I wish all God's blessings upon the lady, now minus her megacolon, for facilitating the brief crossing of this man's path with mine. Although I never strictly doubted myself or my capabilities, his words soothed ... no, cured, an injured soul.
Didn't know I was quite so easy to "fix".
Doing a laparoscopic total colectomy, and expecting a slow and quiet day. Today's surgeon has, in my humble opinion, already got one foot in a retirement village. He seems to know it too cause some hotshot surgeon has been especially imported ... yes from another country, so God help us ... to assist/do the procedure. I have no great expectations for the day and I'm almost sure it's gonna be long, slow and hopefully very boring. Brought my sudoku along just in case ... oh and quitely slipped a mills & boon into my bag when no-one was looking. (Yes, we all have our skeletons ...)
I don't make a habit of "relaxing" in theatre, but on a long 7 hour haul, with proper preparation, the course mapped out on auto-pilot, and everything going smoothly, even a control-freak like myself can relax for about 15 minutes. Bear in mind that I sit in a little spot squashed between the patient and the DATEX, within arms reach of any resuscitation stuff. Super-sensitive ears listening to the blips of the heart from start to finish. My species can detect any changes just by listening ... even in our sleep.
Laparoscopic procedures are minimally invasive to the patient, but usually quite difficult. Imagine removing an entire colon, with minimal bloodloss, using 4 little holes, and your hands never actually inside the abdomen!!! Never seizes to amaze me how these guys seem to know exactly where they are, exactly what they are looking at, and how they manage to orientate themselves. No wonder they sometimes think the sun stops shining when they sit down...
What does all this mean to me??
Well if all goes according to plan and nodody screws up, it means that the fluid-shifts and losses are minimal, which is very good (less calculations for me). Also the postop recovery is much easier and less painful. But intra-op, besides the standard basic anaesthesia rules, lung ventilation is a little more tricky as a whole lot of extra pressures come into play. The patient is put into a head-down position, with her abdomen blown-up by CO2 gas to resemble that of a term pregnant tummy. So the poor little lungs get squashed up nice and tight, and among other things, its my job to ensure normal gas exchange throughout, using a few ventilation tricks and a couple of drugs.
With the milk of amnesia administered, the endotracheal tube secured, and the desired "altitude" attained, we are ready for surgery to begin.
Today I have decided to take the bull by the horns. Time to chuck that bloody chip off my shoulder! Been the new kid on the block for long enough! Time for the old, spunky, me again... and to hell with everyone else.
I boldly introduce myself to the freshly imported, just about shake his arm out of its socket ( I love seeing the shocked look on people's faces when I do that) and act very much in charge. He doesn't look shocked though, but smiles warmly ... WOW... strange surgeon smiling at me ... thats a fresh change from the last 6 months! He instantly gets a new fan.
Surgery is slow, but precise. The guy is brilliant, its obvious that he loves what he does.
On my side we are cruising steadily on auto pilot. No troubles thank God. I quietly pull out my M & B, and enjoy a few pages behind the screen,( with my ears on the monitor of course), when WOW calls my name. Oh shit, within seconds I asses the situation and find nothing amiss ...
Patient is correctly positioned, fully relaxed, vital parameters normal with enough fuel on board, so what's wrong??
Yes?, I ask. He says something in rapid greek. My own language once again makes me look like an idiot. Excuse me but could you repeat that slowly please? Then, in perfect english, comes the sentence that finally knocks all remnants of that chip, forever off my shoulder.
Thank you for the perfect anaesthetic, I am very very happy with your anaesthesia.
Well blow me over!!!!!!!!!! Don't know what I expected, but that was certainly not it! That little sentence, set me free! I finally escape from the cage in which I have both locked myself in, and allowed others to imprison me. Can't explain the soaring feeling....
I wish all God's blessings upon the lady, now minus her megacolon, for facilitating the brief crossing of this man's path with mine. Although I never strictly doubted myself or my capabilities, his words soothed ... no, cured, an injured soul.
Didn't know I was quite so easy to "fix".
Sunday, January 31, 2010
My grand reception.
Tuesday evening, 7pm, finds me freshly showered, and frowning at my closet. What to wear? What to wear???
I'm not usually the type of person to disturb my equilibrium over such, semi-mundane matters, especially since my body has long since lost its former glory. (Thanks to a fair number of offspring!). But, damn, why didn't I go on that f%^#&$* diet????
Hospital admin was kind enough to arrange a sort-of, informal, get- to- know- the- new- doper, meeting at 8pm. Must say I felt rather chuffed at the idea of meeting all the surgical colleagues at the same time. I could therefore spare myself the agony of going from doctors rooms to doctors rooms, handing out my snazzy little business cards, and feeling like a glorified call girl/ rep/ idiot.
Eventually, I look at my reflection and think, not bad... not bad at all. I don my killer heels, that don't actually show beneath my pants, but make me feel like some exotic chick with hidden powers, kiss my family goodbye, and present myself to my favourite receptionist (yep the very one I mentioned in a previous post) with 5 minutes to spare.
With a confused, yet sympathetic, "they are not here, but perhaps they are late", she continued whatever she was doing. Should of known then that something was up.
I am strictly punctual, but this is an island ... and apparently you can only call yourself a true islander once you have proudly mastered the art of being late... Very late...
Exactly one and a half hours later, my mood something akin to soured cream, I get a call. "Sorry got caught up with something." No kidding. " It's quite late so maybe you should come to my rooms, just outside the main hospital, to the left." Piss off. By now I just want this joke of a meeting over with so I follow the directions, and come up with... wait for it.... nothing.
Back to the receptionist who explains that said rooms are to the left of the hospital, but that Dr Prick forgot to mention that they were about a kilometer down the road!
My mood now resembling curdled cream, I stomp down the road, expecting at least one hell of a stiff drink for this minor inconvenience, and very worried about my heels. Island pavements seem to be as twisted as island doctors.
At last, Dr Prick in the flesh, lounging against the streetlamp, having a smoke and chatting to Dr X.
"You guys are late and where is everyone else?" I ask. "Two minutes please" is the reply. WTF!!!!!
I'm ashamed to say that I actually granted them their precious two minutes. I was so flabbergasted, that even if I had come up with some acid one-liner to shove them back into the creepy hole they had crawled out of, it would have eluded me at that moment.
What happened afterwards is barely of any consequence, suffice to say that my first impression had been well and truly cemented into my brain. These people sucked!! And I had to work with them!!
Well ... I can always still diet.... doubt whether much can improve for them, poor sods...
I'm not usually the type of person to disturb my equilibrium over such, semi-mundane matters, especially since my body has long since lost its former glory. (Thanks to a fair number of offspring!). But, damn, why didn't I go on that f%^#&$* diet????
Hospital admin was kind enough to arrange a sort-of, informal, get- to- know- the- new- doper, meeting at 8pm. Must say I felt rather chuffed at the idea of meeting all the surgical colleagues at the same time. I could therefore spare myself the agony of going from doctors rooms to doctors rooms, handing out my snazzy little business cards, and feeling like a glorified call girl/ rep/ idiot.
Eventually, I look at my reflection and think, not bad... not bad at all. I don my killer heels, that don't actually show beneath my pants, but make me feel like some exotic chick with hidden powers, kiss my family goodbye, and present myself to my favourite receptionist (yep the very one I mentioned in a previous post) with 5 minutes to spare.
With a confused, yet sympathetic, "they are not here, but perhaps they are late", she continued whatever she was doing. Should of known then that something was up.
I am strictly punctual, but this is an island ... and apparently you can only call yourself a true islander once you have proudly mastered the art of being late... Very late...
Exactly one and a half hours later, my mood something akin to soured cream, I get a call. "Sorry got caught up with something." No kidding. " It's quite late so maybe you should come to my rooms, just outside the main hospital, to the left." Piss off. By now I just want this joke of a meeting over with so I follow the directions, and come up with... wait for it.... nothing.
Back to the receptionist who explains that said rooms are to the left of the hospital, but that Dr Prick forgot to mention that they were about a kilometer down the road!
My mood now resembling curdled cream, I stomp down the road, expecting at least one hell of a stiff drink for this minor inconvenience, and very worried about my heels. Island pavements seem to be as twisted as island doctors.
At last, Dr Prick in the flesh, lounging against the streetlamp, having a smoke and chatting to Dr X.
"You guys are late and where is everyone else?" I ask. "Two minutes please" is the reply. WTF!!!!!
I'm ashamed to say that I actually granted them their precious two minutes. I was so flabbergasted, that even if I had come up with some acid one-liner to shove them back into the creepy hole they had crawled out of, it would have eluded me at that moment.
What happened afterwards is barely of any consequence, suffice to say that my first impression had been well and truly cemented into my brain. These people sucked!! And I had to work with them!!
Well ... I can always still diet.... doubt whether much can improve for them, poor sods...
Saturday, January 30, 2010
The DIRE emergency.
It was my second on-call in greener pastures.... The first one had gone off without a hitch, but yet a mixture of anxiety, fear and excitement was twirling around inside me. What would the day bring my way, and would I cope? Not only was my comfort zone very far away, it was quite frankly, totally shot to hell! Nevertheless I acted as though all was well and butter wouldn't melt in my mouth....
As expected, the inevitable call came. A DIRE emergency!!! Theatre stat!!! Shit!!!
All I could get out of the receptionist (due in part to a language deficiency on my side, and an information deficiency on her side) was... MVA (motor vehicle accident), emergency, get here immediately.
Well that was enough to unleash the formula 1 driver in me. Man it was so cool!! I put on my hazards and made a twenty five minute journey in about eight minutes. They didn't call me Villeneuve back in varsity for nothing!! All the while mentally reciting adrenalin dosages, c-spine considerations, the protocol for low tidal volume ventilation blah, blah, blah.
I screeched to a halt, as only a woman driver can do, and dashed into the hospital, making a beeline for said receptionist...
"So where is he? Still in the ER or in ICU?"
"Oh he is waiting for you up in the ward doctor."
"No not that one, the one you called me about, you know...the DIRE emergency!!! Where is that one?"
"I just told you, he is up in the ward waiting to see you."
Ok I was not getting anywhere with this poppie, and besides she was looking at me like I was half mad and I had just wasted about five minutes! The pixie dust in the golden hour-glass was seriously running out...
I ran up to the ward only to be told that the particular patient was in room 226. Nobody seemed very stressed by the situation and I was getting more and more worried. What the hell was going on here? Surely I was missing some vital part in the equation??
Revved-up and ready for whatever was awaiting me, I entered room 226.
Imagine my surprise when I found an old man, grinning from ear to ear, and hardly able to contain himself as he excitedly relayed the events of a few hours ago leading to his badly fractured humerus. Oh and he reckoned that he was absolutely starving and yes his whole body was sore, and were we going to sort him out now?
Well, I felt myself deflating faster than a pair of silicone boobs on a concorde! For a few blinding seconds the disappointment threatened to overwhelm me... Then I smiled, did the old toppie's premed and continued with the dire emergency, saving my little giggle for later.
As expected, the inevitable call came. A DIRE emergency!!! Theatre stat!!! Shit!!!
All I could get out of the receptionist (due in part to a language deficiency on my side, and an information deficiency on her side) was... MVA (motor vehicle accident), emergency, get here immediately.
Well that was enough to unleash the formula 1 driver in me. Man it was so cool!! I put on my hazards and made a twenty five minute journey in about eight minutes. They didn't call me Villeneuve back in varsity for nothing!! All the while mentally reciting adrenalin dosages, c-spine considerations, the protocol for low tidal volume ventilation blah, blah, blah.
I screeched to a halt, as only a woman driver can do, and dashed into the hospital, making a beeline for said receptionist...
"So where is he? Still in the ER or in ICU?"
"Oh he is waiting for you up in the ward doctor."
"No not that one, the one you called me about, you know...the DIRE emergency!!! Where is that one?"
"I just told you, he is up in the ward waiting to see you."
Ok I was not getting anywhere with this poppie, and besides she was looking at me like I was half mad and I had just wasted about five minutes! The pixie dust in the golden hour-glass was seriously running out...
I ran up to the ward only to be told that the particular patient was in room 226. Nobody seemed very stressed by the situation and I was getting more and more worried. What the hell was going on here? Surely I was missing some vital part in the equation??
Revved-up and ready for whatever was awaiting me, I entered room 226.
Imagine my surprise when I found an old man, grinning from ear to ear, and hardly able to contain himself as he excitedly relayed the events of a few hours ago leading to his badly fractured humerus. Oh and he reckoned that he was absolutely starving and yes his whole body was sore, and were we going to sort him out now?
Well, I felt myself deflating faster than a pair of silicone boobs on a concorde! For a few blinding seconds the disappointment threatened to overwhelm me... Then I smiled, did the old toppie's premed and continued with the dire emergency, saving my little giggle for later.
Friday, January 29, 2010
Blood-brain-barrier.
One thing that I learnt very early in my training as an anaesthesiologist, and that still baffles me to this day (10 years later!) is the almost irreconcilable differences between us and the surgeons. Allow me to make it very clear from the start, that this is by no means a generelization. All surgeons are gems, but some are certainly more polished than others. It's the unpolished, rough diamonds I wish to get off of my chest today. So all of you brilliant cuts out there, just sit back, relax and let me vent.
We survive in a symbiotic environment whereby surgeon needs anaesthetist and vice-versa. Yet when in close proximity of a "roughy" as I like to call them, one would swear that we and only we, are the parasites! As a registrar I mistakenly believed that this attitude problem was due to the torture the poor surgery registrars had to endure, both physically and emotionally.
Couldn't wait to get into private practise and enjoy decent, fun and equal relationships with the gems ie discussing the patients together, cracking the odd joke in theatre (across the blood-brain-barrier) and most importantly trusting each other.
Luckily or unluckily for me, I am a cross between an idealist and a realist. So everytime my parade gets pissed on, I just clean it up and start again! But sometimes even my mops get saturated and this is where my story actually begins...
I am a recent expat... That in itself is quite a challenge. So here we are... new country, new life, new hospital, new job, new colleagues, but (thank God for small mercies) same DATEX machines. Due to my above-mentioned personality flaw, I really thought that the transition period between "new" colleague and "regular" colleague would be difficult, but manageable.
I was even almost excited (amidst my fear) and couldn't wait to do my beloved job again!
Enter roughy...
"so...you are the new one..." Yes, that would be me, pleased to meet you. "everytime they get a new one, I get stuck with all the problems. I've tried them all around here and not one can give me what I need. Let me tell you that in my long and prestigious career, the 3 sole haematomas I've had where unmistakeably due to the anaesthesia" Really, I'm sorry to hear that. "It's always up to me to tell them what drugs to give, where to position their tubes and even where to stick the tape. What am I going to do with you?" Well you could give me a try and if you find me lacking, no need to use me again, how about that hmm? I actually adore my job, and am quite good at it too, so I might even be okay. What do you think? Should we give it a shot and see what happens?
Exit roughy...
I kid you not, he just looked at me with total contempt, shook his head, turned around and walked off mumbling under his breath. He had never seen me before and this entire session took place in the recovery room in full view and hearing of half the theatre staff.
Out came the mops in full force!! Mop, mop, mop!! Mop, mop, mop!! Mop, mop,mop!
I am a firm believer of the saying, "how someone treats you is their karma, how you react is yours" ,by Dyer. So now I have a bit of a dilemma... Do I lower myself to his unpolished standards? Do I follow my gut feeling and tell him to go get screwed? Bear in mind that he is about my dads age and honestly I still do have respect for my elders! Do I just keep mopping my parade clean and smile? Do I dope for him and prove myself as a worthy anaesthesiologist? Do I swear on my life never to share a theatre with a common little rough pebble like that?
Perhaps I should fall back on the age-old concept of the blood-brain-barrier! Roughy the blood, me the brain and the screen draped over the patient, the barrier...
We survive in a symbiotic environment whereby surgeon needs anaesthetist and vice-versa. Yet when in close proximity of a "roughy" as I like to call them, one would swear that we and only we, are the parasites! As a registrar I mistakenly believed that this attitude problem was due to the torture the poor surgery registrars had to endure, both physically and emotionally.
Couldn't wait to get into private practise and enjoy decent, fun and equal relationships with the gems ie discussing the patients together, cracking the odd joke in theatre (across the blood-brain-barrier) and most importantly trusting each other.
Luckily or unluckily for me, I am a cross between an idealist and a realist. So everytime my parade gets pissed on, I just clean it up and start again! But sometimes even my mops get saturated and this is where my story actually begins...
I am a recent expat... That in itself is quite a challenge. So here we are... new country, new life, new hospital, new job, new colleagues, but (thank God for small mercies) same DATEX machines. Due to my above-mentioned personality flaw, I really thought that the transition period between "new" colleague and "regular" colleague would be difficult, but manageable.
I was even almost excited (amidst my fear) and couldn't wait to do my beloved job again!
Enter roughy...
"so...you are the new one..." Yes, that would be me, pleased to meet you. "everytime they get a new one, I get stuck with all the problems. I've tried them all around here and not one can give me what I need. Let me tell you that in my long and prestigious career, the 3 sole haematomas I've had where unmistakeably due to the anaesthesia" Really, I'm sorry to hear that. "It's always up to me to tell them what drugs to give, where to position their tubes and even where to stick the tape. What am I going to do with you?" Well you could give me a try and if you find me lacking, no need to use me again, how about that hmm? I actually adore my job, and am quite good at it too, so I might even be okay. What do you think? Should we give it a shot and see what happens?
Exit roughy...
I kid you not, he just looked at me with total contempt, shook his head, turned around and walked off mumbling under his breath. He had never seen me before and this entire session took place in the recovery room in full view and hearing of half the theatre staff.
Out came the mops in full force!! Mop, mop, mop!! Mop, mop, mop!! Mop, mop,mop!
I am a firm believer of the saying, "how someone treats you is their karma, how you react is yours" ,by Dyer. So now I have a bit of a dilemma... Do I lower myself to his unpolished standards? Do I follow my gut feeling and tell him to go get screwed? Bear in mind that he is about my dads age and honestly I still do have respect for my elders! Do I just keep mopping my parade clean and smile? Do I dope for him and prove myself as a worthy anaesthesiologist? Do I swear on my life never to share a theatre with a common little rough pebble like that?
Perhaps I should fall back on the age-old concept of the blood-brain-barrier! Roughy the blood, me the brain and the screen draped over the patient, the barrier...
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