The reason for this is that in anaesthetics, when things go wrong, they go BADLY wrong and they go badly wrong very quickly indeed. Yesterday, I was shown something that really crystallises this message.
“A mother who spent years undergoing IVF treatment died after a bungled birthand never saw the baby she longed for, an inquest was told yesterday.
Joanne Lockham had a Caesarean operation to deliver baby Finn but her brain was starved of oxygen for up to 30 minutes, it was claimed.
Within moments of the birth she suffered a heart attack and she died two days later after sustaining massive irreversible brain damage."
Reading a bit further into this story we learn that basically, the decision was made to give Mrs Lockham a general anaesthetic for her ceasarian section, after giving her the anaesthetic, the anaesthetist couldn’t put the breathing tube in the right place (couldn’t intubate) despite several attempts. By the time help arrived, she was already dead.
“…problems arose in the operating theatre. The jury heard that three attempts were made by anaesthetist Dr Prasad to insert a tube to give Mrs Lockham oxygen before it was eventually believed to have been successful.
Dr Prasad broke down in the witness box as he told how he repeatedly tried to intubate Mrs Lockham.”
It sounds like several things went wrong here but I’m not going to comment too much about the ins and outs of this case because I wasn’t there and don’t know all the facts, but I will say this. In situations like this, when things start to go a bit wrong, people start to panic. This is ESPECIALLY true on the labour ward. The midwives panic, the obstetricians panic, the scrub nurses panic and everyone starts telling you, as the anaesthetist to hurry up and get the patient to sleep. It’s noisy, the atmosphere is fraught and if the anaesthetist starts to panic, then things become INCREDIBLY dangerous. It sounds like Dr Prasad panicked.
“Dr Prasad said: 'I was doing my job, but I was in a complete state of shock, I couldn't think, I was trying to be useful in anything I could.
'I went in at that point in time with a particular plan and it didn't happen.
'It was completely out of the blue and the equipment was not giving way, so I didn't
know what to do, it completely numbed me, it was not what I was expecting.'"
This is a horrible situation for everyone and highlights the point that I’ve been told several times during my training – always be clear what your exit stratey is. The books say that Dr Prasad should have prevented the obstetricians from starting the caesarian section, woken Mrs Lockham up and waited for senior help to arrive. However, I can see that this is difficult to do when you have the consultant obstetrician and a room full of midwives yelling at you to hurry up and get the mother to sleep because “they need to get the baby out.”
This brings me back to my original point. I’ve not yet been in a situation like the one above by myself, but sooner or later, it’s goint to happen. Things are going to go wrong unexpectedly with one of my patients. At least if I’ve checked everything and know where everything is, when the panic starts to creep up on me, it reduces the amount of “thinking” I have to do and hopefully gives me more of a chance of sorting the situation out long before it gets to the stage that Mrs Lockham go to.
What happened to Mrs Lockham is truly tragic. Dr Prasad would have had to explain to her husband why he now has to bury his wife. What should have been a joyous occasion has become a horribly tragic one. Everybody involved will have to live with what happened for the rest of their lives. A child will grow up never knowing his mother.
My condolenses to Joanne Lockham’s family.