Anaesthetics

I’m still constantly amazed by the new stuff that I’m exposed to as a doctor. Take anaesthetics for example. This week is the fourth week I’ve been on it for, and yet I still really don’t know how to use that damn anaesthetics machine well yet. It’s got a lot of fancy knobs, 3 (yea, three!) monitors that displays lots of numbers and pretty graphs, and lots of buttons that I could press, but I’m afraid to.

My job as a resident anaethetist appears to be the most relaxing job I have done to date. I don’t have to hold a phone, and I don’t get pestered much by nurses (they’re all too fantastic at looking after recovering patients to give me a call 🙂 My job is to put oxygen on the patient. Well actually, it’s more involved than that, but putting on the oxygen seems to be what I do a lot of. As well as putting in cannulas, and taking a brief anaesthetic history of the patient.

I must admit, anaesthetics seems like an extremely cool specialty. For one, it is the only specialty so far that I have seen that gives allocated breaks (yea, another person actually comes to relieve the anaesthetist so that they can actually eat lunch). Next, it is the only specialty that surgeons can’t bully. If an anaesthetist says that a surgical procedure can’t occur, then it can’t occur, and the surgeons have to stand there looking dumbfounded that they’ve just been told that they can’t cut up their guinea pigs er.. I mean patients. In fact, one of the anaesthetists that I was with felt it was too unsafe to perform surgery on a patient, given the arrangement of the theatres – the theatre was too small, the equipment was way too far away from the patient, and the theatre was horrendously understaffed (the anaesthetist was not pleased that all the nurses had left at the same time, meaning the anaesthetist had to be the orderlie staff, the anaesthetist, and the nurse – yea, not fun to be 3 people at once.

I find it funny that I have learned more about operating theatre procedures, and have spent more time in theatres than I have in my 20 weeks of surgical rotations. I have actually felt like I’m learning new skills for once, rather than just using the pen. I have put in numerous laryngeal masks, and have successfully today intubated my first patient without any consultant intervention. It’s a great feeling.

But, I must say however, that I can’t imagine myself doing this long term. It’s as boring as hell. From what I’ve seen (largely elective cases, exclusions including emergency anaesthetics, paediatric and obstetric anaesthetics) the majority of cases go smoothly (95%), while only 5% provide you with some adrenaline pumping action. So it’s either goes very smoothly (boring) or extreme adrenaline action (stressful). I don’t think I’d really want a job that swings in between these two extremes. And perhaps I don’t feel like it’s very rewarding. Just sitting for hours monitoring a patient’s vitals, and occassionally giving some more drugs doesn’t seem to be a particularly rewarding job to me.

Did I learn much from anaesthetics? Yea, I learnt quite a bit, and got to do a lot of procedures. Was the rotation enjoyable? Not a great deal to be honest (I was told that I was supernumerary – yea, like a spare tire), given that I didn’t feel I was doing too much. Despite all this, I still respect the jobs that anaethetists do, although I feel like it isn’t something that would suit me.

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Pocket of Air

But I couldn’t have done it, could I? My mind swirled with chaotic panic, as I desperately looked through the internet, looking for any bit of information that could alleviate my fears.

I punched in key terms “lethal” and “air embolism” on Google. Definitions and the pathogenesis of air embolism were explained on various sites. Still, they didn’t provide the answers that I desperately needed. I scrolled through pages of the search results, and then bam – there it was.

Air Embolism

Reading through the article, I was immensely relieved. The panic, and the chaos in my mind instantly subsided. This article was to keep me sane, for in it, it states that it takes about 200-300 mL of air injection to kill someone. Why am I so thankful for this piece of information?

It all starts back to earlier that day. Earlier that day, I had been in ED, practicing my cannulation skills on patients that needed a cannula. It had been perhaps a good 3-4 months ago since I had inserted a cannula, and I was really rusty in my skills. On one pretty stoic gentleman, I popped the tourniquet up, producing some bulging veins. This would be easy, and I inserted and successfully advanced a cannula. Removing the needle, the plastic part stayed behind, and blood slowly trickled out of the cannula. I was happy I was in a vein. With that in mind, I grabbed my saline syringe flush. Connecting it in to the cannula, I depressed the plunger. It didn’t budge. I tried harder, and it advanced a small bit. This is certainly strange I thought to myself. So I kept on going, and probably advanced about 1-2 mL of the saline flush in, and decided to give up. That’s when I noticed there were some pockets of air in my syringe.

I started to panic. Had I given this patient an air embolus? It certainly wouldn’t kill him would it? I prayed dearly that nothing would come of it. Too scared to tell anyone, I kept a close eye on him that morning at ED. Nothing happened to him, but I was scared for my life. Thoughts raced through my mind, coroner’s reports, news reports about the negligent medical student who gave an air embolus to a patient. Maybe I should quit medical school before they find out? Maybe nothing won’t occur. Maybe….  I need some reassurance.

Reading through the internet article, I was relieved that it would take 200-300 mL of air to kill someone. It was a close call, but I like to think that the air would be reabsorbed by the patient’s body. I sincerely hope nothing bad has happened to the gentleman.

And so, such was an extremely anxious and scary learning experience, coupled with my inexperience during my student years. Yes, I dread the many more days of similar experiences of close calls that are to come as a doctor….