It has been a long time since I have written. I’m a bigger and bigger fan of trying to prioritize the important things in life. This summer, that means I’ve been trying to pound it out at work, and get home in time to take my girls swimming and read to them and play around in the evening. In other words, not blog. I am thankful that I have the choice – that I can work in a way to still be a very present father. It’s been a blast. After a ton of preschool-level drama (take a reality TV show, then turn it to 11), my oldest now wants to live underwater in the pool. She’s jumping off the edge, spinning under and diving for toys at the bottom. Anyone without kids will just remember the good times of doing the same thing as kids – parents will know how cool it is to watch the dramatic, super anxious kid take big steps on their own and make real progress.
A long time ago, in a HIPAA compliant hospital far away (and as always, names/sex/location/time/clinical incident changed to be of equal meaning, but totally not identifiable), I was performing the anesthesia with a resident physician for some routine cases in the operating room. The second one looked like it would be straightforward, and I ran through my typical Airway Checklist – the same one I do for emergencies and boring cases. It always has me ready in case anything goes wrong. And this time, it did.
We pushed our typical medications and our patient had immediate, refractory bronchospasm. We couldn’t move air at all – I assumed the resident had “goosed” the airway (put it down the esophagus by mistake), so I took out then replaced the tube, but again – no air movement. We announced the problem to the room and immediately started preparing emergency medications. And though if you walked in the room you would’ve thought everything was calm – I was incredibly anxious and thinking a million thoughts at once — what happened? Can I fix it? What am I missing? Will it work? We call it “floating like a duck”: calm on the surface, but feet kicking a thousand times a second below the water.
We gave epinephrine – both down the breathing tube and in the IV – albuterol, steroids, diphenhydramine and other therapies for what I was worried most about: anaphylaxis. As we started treating him, his EKG changed and suggested cardiac distress. His blood pressure dropped precipitously. It was organized chaos for 90-minutes, but after what felt like a million supportive medications and multiple drips of epinephrine, norepinephrine and others, doing a bronchoscopy, putting an echo probe into his throat to look at his heart, and placing catheters into his artery and in his neck pointing towards his heart, we were able to break the bronchospasm and stabilize his heart and blood pressure. We transported him to the intensive care unit on drip support for his heart and – thankfully – he recovered and is now doing well.
What a day. We always tell our patients that “serious complications from anesthesia are rare.” And they are. But they are rare because we show up and prepare for every anesthetic like it may be life threatening. And every once in a while – they are.
Great reminder. And great job. 🙂