Apnoea Done Wrong

A few weeks back in anaesthetics, I almost killed a patient. Well that’s what it looked like at least.

A patient had just had an operation before,

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….

How Can Anyone Survive In Surgery?

As a medical student, I had a terrifying surgical experience. The general surgery consultant grilled me and a bunch of other medical students rigorously, and expected us to know answers to some pretty tough questions. He was a terrifying man, who only slept for 4 hours every day (according to himself), and who backhandedly disguised a praise to his registrar with a nasty comment (“great presentation Dr X, this is the first time you sound like you know what you’re talking about”).

Perhaps another thing that terrified me, was going to theatre. The scrub nurse would tell me off for not scrubbing up properly, because I wasn’t sterile enough (any more sterile and I’d have been castrated ha!). It was my first time, and the nurse didn’t have to be so mean about it! Perhaps the most terrifying scrub experience, was at a rural location where I was needed to assist in a c-section, but was delayed for a very long time because of the scrub nurse needing me to get the scrub perfectly. The consultant was yelling off “come on, I need you here right now!”. I almost gave up under the pressure, but in the end, I scrubbed up, amidst a ton of pressure.

Fast forward to now, and I still feel terrified of surgery. The consultant gives the impression of friendliness, but I feel as if she’s just as deadly, and I feel she will explode some point in the future with rage, rage at us residents for not doing an extremely brilliant job. She has high expectations I feel, and her offhanded remarks at us at times reflect this. We are all doing our very best, and we can’t help it if everything is so disorganized and chaotic!

There are days where panic just sweeps over me because of the tasks I have to balance simultaneously. Consent, x-ray forms, sorting out a man who has passed about 20 mL in the past 2 hours, patient about to be discharged soon etc. It’s just the constant stream of tasks that we have to balance that is freaking me out now. I am afraid that I’m going to make a mistake because I cannot multitask. Afraid that my memory won’t serve me correctly, because it isn’t photographic in nature, and afraid that I will forget some urgent task to be done, because I would have had 2 or 3 of those I am trying to balance at the same time. And I am afraid that I will get a stomach perforation, because I am constantly having lunch or dinner 2 or 3 hours too late. Perhaps they’ll put me through an x-ray and find free gas under my diaphragm?

So, I am still getting my head around surgery. But I am freaking out here because of the consultant, and the tasks I have to balance. The registrars are too busy to help us residents, so we are left to deal with things ourselves, learning from trial and error. What a horrible way to learn from making mistakes. But what doesn’t kill you makes you stronger right?