Thursday, 10 January 2008

A bad experience (part 2)

“Michael, you can anaesthetise the next patient by yourself, if you need me, I’ll be in the Departmental Offices.”

“Sure,” I reply and with that, my consultant turns on her heels and disappears round the corner and down the corridor.

I’ve got to the stage now where I feel confident to administer simple anaesthetics by myself. I’d already met the patient, Mrs Romano, before the operating theatre opened and aside from her being very nervous, I found nothing that would suggest I’d have any major problems giving her an anaesthetic.

Mrs Romano is the third patient on the list this morning. She’s having a shortish operation, so I plan to anaesthetise her, use a laryngeal mask airway (LMA) and allow her to breathe for herself.

“Hello again,” I say as she walks into the anaesthetic room. When I met Mrs Romano first thing in the morning, I thought to myself “this woman couldn’t BE more nervous.” I was wrong. Now, Mrs Romano is almost crawling up the walls so I decide the best plan is to get going with minimum delay. She takes a seat on the trolley and Danny, the ODP performs all the safety checks. We are good to go.

I’ve already prepared all the drug that I want to use and I pop a drip into the back of her hand. I then give her the oxygen mask to breathe and start injecting the drugs to render her unconscious. First I give Midazolam to calm her, then Fentanyl as a pain killer and finally, Propofol as the induction drug.

Very nervous people tend to require higher doses of drugs, so I’m a little surprised when Mrs Romano goes out like a light. I gently breathe for her using the oxygen mask and bag, and slip the LMA down her throat. It goes in easily and sits nicely. So far, so good. Danny and I wheel Mrs Romano into the operating theatre where the consultant surgeon and the theatre staff are waiting to start the operation.

Everything goes smoothly, I fiddle a little with the anaesthetic machine halfway through, but at no point am I concerned that Mrs Romano is going to come to any harm.

When the operation is over, I wake her up again and we go through to the recovery area where the nurses make sure that she is OK before sending her back to the ward.

All in all, a pretty uneventful anaesthetic – just the way it should be.

I like to go see my patients at the end of every day. I know a lot of anaesthetists don’t do this, but I like to make sure that everyone is OK and that there was nothing that happened that they were unhappy about.

Mrs Romano is in a bay with three other ladies. She looks up and smiles when she sees me approaching.

“Hello there!” I pipe up

“Hello,” she beams back

“How are you feeling?”

She grabs my hand and says “I feel great, doctor.”

“No pain? No sickness?”

She shakes her head

“Have you had something to eat and drink yet?”

“I’ve had a cup of tea, but all they’ve given me to eat is this,” she gestures distainfully to a single, dry piece of bread with no butter “and I don’t really fancy it.”

“Well, I don’t think the NHS is known for the quality of its cuisine,” I reply and she laughs “but hopefully you’ll go home later on today. Now, can I ask you one more question?”

“Certainly”

“Do you remember anything about the operation?”

“No, nothing at all. I remember coming down and talking to you but that’s it really.”

“So, really, Mrs Romano, the anaesthetic is not as bad as you thought it was going to be was it?”

“Oh no, not at all! Thank you so much. I was petrified about this operation, you know. I almost rang up last night to cancel it because I was so scared, but my husband made me come (I resisted smirking when she said this). But it was fantastic. You know, the reason I was so scared was because I had a bad experience with anaesthetic before.”

“Really?”

“Yes, I was six years old and I had to have an anaesthetic so the dentist could pull one of my teeth out. Back in those days, anaesthetic were very different. They go me in the chair and they had this wire mask with a bit of cloth in it. And what they did was they dripped the anaesthetic stuff onto the cloth and held it onto my face.

“It was horrible. I couldn’t move, the stuff was stinging my eyes and I couldn’t breathe. Do you know what I thought doctor?”

“No.”

“I thought they were trying to kill me. I thought I was going to die. I remember trying to get away, but I couldn’t move. I tried to shout for my mother but I couldn’t. I couldn’t do anything. I know this probably lasted for a couple of minutes, but, to me it seemed to go on forever.”

“Oh. That sounds awful!”

“It was. And remember, I was only six years old. So you see, that was why I was so scared this morning. I know that happened more that fifty years ago, but to this day I can’t stand having masks or anything on my face.”

I take a deep breath and sigh. “Well, you’ve seen for yourself that anaesthetics have come a long way since those days.”

“Oh they have!” She emphasises. She still holding my hand and she gives it a squeeze. “Thank you so much for everything you’ve done for me.”

“You’re very welcome, Mrs Romano. I wish you all the best. Take care.”

- Michael

5 comments:

Micheál said...

Phew! All's well that ends well.

the little medic said...

Awww, a very happy ending.
I was getting worried, its written like there is a twist to come, but I guess the twist is a happy one.

Well Done!

Anonymous 8 said...

That WAS the twist 'the little medic', Mrs Romano is A L I V E!

@ @
$
>-<

steph said...

I've never had any fears around GA's but I was on the edge of my seat for that one!

At least now you'll know how to handle the next 'Mrs Romano'!

A nice twist to the tale.

john said...

I was reading that just waiting for the moment she had a horrific reaction like malignant hyperthermia or something! Glad to hear it all went smoothly