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The Secret Life Of An Anaesthetist: If Surgeons Are The Blood, We Are The Brains

Discussion in 'Anesthesia' started by Hadeel Abdelkariem, Jun 12, 2019.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Golden Member

    Apr 1, 2018
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    During an operation, your life is in our hands. But despite the highly sensitive role we play, we are all but invisible to our patients

    You have to get used to being invisible as an anaesthetist. A large percentage of the public has no idea that we’re medically qualified. I’ve been asked how many GCSEs you need to be an anaesthetist. In fact our training is as long as that of a surgeon. It takes seven years of specialist studies after you’ve already completed two years of basic general training; and that’s after five or six years at medical school.


    Patients always remember the name of their surgeon, never that of their anaesthetist. But it’s still a hugely rewarding job. We’re everywhere in the hospital. In theatre obviously, but also in intensive care, on the wards, in the emergency department, and in the pain clinic, with those who are really suffering. We assess people’s fitness for surgery, how likely they are to suffer complications, and support them through the operation itself and into the postoperative period.

    When you first start anaesthetising patients early on in your career it’s terrifying. You know that if you get it wrong you might kill someone. Our drugs stop people breathing and it’s our job to take over that function. Even after nine years I still get a frisson of nerves in some situations. I hide it though; it’s an important part of the job to stay calm at all times. If there’s an emergency during an operation the team looks to the anaesthetist for leadership, as the surgeon is often too focused on fixing the immediate problem. If you panic, it spreads and the team loses the ability to function efficiently.

    Anaesthesia is a very safety-oriented speciality; we’ve led the way in reducing patient harm by looking at human factors, using simulation training and reporting “near misses”. By sharing episodes where a patient has nearly come to harm, we hope to address the causes and prevent actual harm from occurring in the future. We’ve embraced ideas from aviation and other high-reliability industries about how a team functions effectively. We try to flatten the hierarchy in theatre so that the least qualified individual can raise concerns without feeling intimidated. This makes it especially frustrating when patients come to harm after they leave your care because the rest of the system is struggling to cope.

    There are so many gaps in rotas of doctors, nurses and the wider healthcare team, and the proposed junior doctor contract changes will only make this worse. The outlook for patients who suffer complications after surgery is determined not by the presence of the complication, but by how quickly it is picked up and dealt with. This simply can’t happen when workloads are too high.

    I look after one patient at a time. This ability to offer a premium level of care is one of the reasons I became an anaesthetist in the first place. On the wards each doctor will be responsible for up to 30 people a day, and even more at night. I can see with each heartbeat what the patient’s blood pressure is in the operating theatre; on the wards, it might only be checked once every four hours.

    The speciality is a broad church, so there is room for all personality types. But given the precision involved there is perhaps a tendency to obsessive traits. I’ve worked with colleagues who have a 10-minute ritual for putting in an intravenous cannula that had to be completed in the correct sequence. Our postgraduate exams are renowned for being tricky but they are really a test of commitment. We’re experts in physiology, pharmacology, and physics; we have to know about everything from cellular respiration to how our drugs work, to the internal workings of a defibrillator.

    Patients are usually nervous when they arrive in my anaesthetic room. It’s an exercise in trust to place your whole life in the hands of others. Every anaesthetist will have their spiel, some small talk to distract the patient from their imminent surgery. I ask them about family, talk about their favourite place to visit, what they do for a living. I modify my “going to sleep” talk depending on the small talk that’s gone before. If they love travelling, I’ll talk about a white sandy beach, with crystal clear waters, a gentle breeze. The more nervous they are, the longer they take to go to sleep. Many young, usually male, patients have commented as the drugs take effect that it feels just like a Saturday night. I’ve also been asked if I liked to have sex in a vest – I decided not to pursue what he meant by that when he woke up.

    Every anaesthetist has a secret weapon when working in the operating theatre. We always work with an assistant, who might be a nurse or an operating department practitioner (ODP). The very best of them could do my job without thinking twice, but they choose even greater anonymity than the anaesthetist enjoys. Many a time I’ve had my bacon saved by an astute ODP. Some appear to have powers of extrasensory perception; I turn to ask for something and there it is in my hand.

    I’ve also worked with many theatre colleagues with a wicked sense of humour. Before my first unsupervised operating shift, I confessed to the ODP that I’d never worked alone before. He paused and stuttered that neither had he, it was his first day at work, being newly qualified. I spent the entire day terrified that some disaster would befall us, and we wouldn’t be up to the challenge. At the end of the day he came clean – he’d been doing the job for 20 years.

    Frustrations creep in to the job when the system fails. I often arrive at 7.30am (30 minutes before my shift begins), so I can find space on the pre-op ward to see my patients in private, find out their history and take the time to address any concerns. It’s then immensely distressing when operations are cancelled due to lack of beds, or lack of notes, or the surgeon’s been double booked, or you are moved to another job at short notice. Anaesthesia can also become routine; it’s a far cry from the early days of the speciality when unpredictable drugs were used without monitoring. If the patient is fit, it’s rare for them to come to harm from a general anaesthetic.

    It is important to have other interests to distract from the stresses, strains and occasional boredom of the job. In my spare time I’m a volunteer doctor for the ambulance service. Being under a car in a ditch in the rain at 2am is very different from the bright lights of the operating theatre. Some of my colleagues are real polymaths. There are painters, musicians, novelists, as well as some quite serious sports people. The coffee room in the morning is the preserve of the middle-aged man in lycra. We see every day the damaging effects of too little aerobic fitness, so we’re staving off our own mortality.

    The best bits? Reassuring nervous patients, rendering labouring women pain-free with the magic of epidural analgesia and, of course, merciless surgeon baiting. I’ll ask if they need me to Google instructions for the operation, or if they’ll be finished before new year. We say there’s a blood-brain barrier between the surgeon and the anaesthetist: they’re the blood, and we’re the brains.


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