28 Feb A Day in the Life of an Anesthesiologist-Part Two-My Patients Who Never Woke Up
Over my forty years practicing anesthesia, it has become incredibly safe. In the 1970s and 80s, anesthesia malpractice insurance premiums were out-of-this-world, and for good reason. Since pulse oximetry and other improvements in monitoring, training and medications, our insurance premiums are now some of the lowest of all. That being said, regardless of the advancements, sometimes we put people to sleep, and they never wake up.
I haven’t had anyone die in the operating room in over twenty years, but my early years of doing anesthesia for trauma and heart transplants, it was a different story. When ambulances arrived bearing victims of motor vehicle accidents, shootings or stabbings, they had the potential to bleed out extremely fast. I’ve participated in more than my share of such resuscitations where the victim’s chests were cracked and the ragged hole in the heart closed right there in the ED, and others where they were raced to the operating room before the surgeons started digging in. As you might guess, a fair number of those patients didn’t make it.
While cases like that were exhausting, the patients arrived unconscious and mostly dead, so I never had a chance to establish a personal relationship with them ahead of time. It’s always been much more emotionally draining for me when I’ve had time to get to know a patient and hear their story, before I put them to sleep, only to have them never wake up again. Years ago, when I was still doing cardiac anesthesia, I anesthetized plenty of folks whose hearts were failing and the surgeons were performing some sort of last-ditch effort, usually a mitral valve replacement, to prolong their lives. Knowing we were fighting the odds, I always tried to be reassuring and positive, but in the end, it didn’t always work out. Not everyone woke up. I was humbled that my voice, my smile, my touch were the last human contacts those patients ever experienced this side of heaven. When it became obvious to everyone in the operating room that the patient’s heart was not going to be strong enough to come off bypass, and the surgeon “called it,” I always rested my hand on the patient’s forehead and said a prayer. Each time it happened, and it wasn’t often, it left a reverent mark on my soul. I truly believe that someday, I’ll see them all again.
These days I work at a community hospital where most of the extremely sick get transported out to bigger hospitals. That said, everyday holds new surprises and challenges where it seems like someone is always teetering on the edge separating good from bad. One day it could be a severe allergic reaction. The next helping manage the anesthetic of a six hundred pound appendectomy patient, or a ninety-five-year-old hip fracture who’s been healthy all her life, or young woman who just gave birth and is hemorrhaging. I wonder how many of those people would have died in the old days.
Sometimes, despite our best efforts, bad things happen, but that’s extremely rare. The vast majority of patients going through anesthesia today do just fine. It doesn’t mean they don’t hurt or their stomach’s not upset, but they’re alive. Unless you already have a serious, life-threatening condition, rest assured, you going to wake up from anesthesia.
Next up: Swallowed Razon Blades and other Operating Room Bizarreness