Floating calmly on top of the water… but kicking your legs like crazy under it, so you don’t sink!
Preparation is key. A long time ago in a HIPAA-compliant hospital far away (as always, names/sex/surgery/dates/specific clinical situation changed so the meaning is the same, but the situation is not identifiable), in the operating room I had a fun, fast and super smooth day. Now, if you’re a private practice anesthesiologist, this may be your every-single-day. However, in academics, we aren’t so smooth. It’s hard to time fast wakeups to medical student suturing, and it’s a fine balance to encourage an early resident to prepare and plan for a smooth wakeup, while also keeping the patient’s muscles relaxed and optimizing the environment for our surgery colleagues. But yesterday? Yesterday was different. I was working with an experienced anesthesiology resident and we were doing great work. The last procedure was a laparoscopic cholecystectomy in a healthy, young woman (again, all identifying information has been randomly changed). We safely extubated, and soon after, she developed a life-threatening condition called Laryngospasm. This is the very serious, and if not caught can cause a patient to go into cardiac arrest or develop negative pressure pulmonary edema – where they breath so hard against closed vocal cords that their lungs are severely injured. This is also life threatening.
Thankfully, we were watching closely. We caught the problem early and intervened quickly – escalating when the first two steps failed until things turned the corner. Everything went great. I definitely tried to be calm on the outside, but my mind was racing, anxious and hoping I wouldn’t miss anything. We call this “The Duck:” calm on top of the water, but your legs kicking like crazy underneath!
Ahhh, Anesthesiology. It is so amazing to be able to use skills and experience quickly to help save someone, or help someone wake up comfortably or even go to sleep calmly. I absolutely love managing patients in shock and making sure “the blood goes round and round” (my simplest way of explaining what I do in the intensive care unit!). What is most satisfying to a good anesthesiologist, importantly, is a plan so well prepared that when unexpected near-disaster happens, it looks “boring” and we handle the problem fluently and easily, without racing around anxiously.
What is so funny about anesthesiology is that no one knew what was happening. The surgeon’s thought it was a slow wake-up, and the nurses weren’t sure why I wasn’t moving to the hospital bed, until I told them what was happening. It reminds me of a severely medically compromised patient who everyone – me, the surgeons, their primary doctor – were worried about their ability to recover from (and survive) anesthesia. I was anxious but ready and prepared, and was running infusions, transfusing and cautiously holding or giving fluids. The resident surgeon, partway through the case, leaned over the drape and said “Cool, we thought this would be a hard case for you guys, I’m glad it’s easy!” …Nope. Not easy. Just prepared, ready and enacting a plan … and acting like Duck’s behind the drape!