An Informal Introduction to the Anesthetist
“Sir! Please get the patient under.”
Faces of people sitting in the room displayed apathy. The senior most of them, with a feigned smile, started the inquisition,
“Is the patient fit for surgery? Have you acquired consent from her attendants? Do we have her latest lab reports? Are there any co-morbidities?”
This barrage of questions was enough for the young and eager surgeon to rush back in a hurry to ensure that all the requirements were fulfilled. There was a collective groan from the people inside the room, though they had somehow managed to buy at least 15 more minutes.
Scene 2: Adjacent to the labor rooms, there is a particular room on the door of which the following instructions are written, in bold letters,
Prerequisites for knocking on this door:
1. Passed 2 large bore IV lines
2. Checked fresh labs
3. Preloaded with fluid
4. Arranged blood
5. Checked if instruments are complete
6. Asked OTAs if they are prepared
7. Called surgeon who is going to operate
P.S: Do not irritate.
The first scene is not an isolated one and is repeated day and night, night and day, in public hospitals, in private hospitals, in developing countries and in developed countries. In short, it occurs at any place where a surgery has to take place under anesthesia. The second scene depicts exactly how much friendly/annoyed the Anesthetists are with the rest of medical fraternity.
I initially thought of anesthetists as losers. It was a time when I was still in medical school and had to visit operation theaters as part of our clinical teaching. I always found them sitting there, in clothes different from everyone else, playing games on their mobile phones or generally giving apathetic vibes. One of our surgery teachers once proclaimed that the person least interested in your surgery is the anesthetist.
We considered them freeloaders, slackers and useless voyeurs. During my own House Job, I got the chance to work at a surgical unit and there was a widespread antipathy towards the anesthetist. He would always made life difficult for us by rejecting patients whom we had prepared for surgery. By a cruel stroke of luck, though, I myself ended up working in the anesthesia department eventually.
Surgeons hate anesthetists. Anesthetists hate surgeons. Regardless of this mutual disdain, both can’t survive without the other. On the very first day of my job, our senior informed me that Surgeons can never be your friends, and never to trust them. My experience in the last few months has proved him right.
Giving anesthesia to a person is like taking off and landing a plane while the surgeons are in control of the flight. We have to keep an eye on three different monitors simultaneously as well as the intravenous infusion drips and the patient himself. This can of course be classified as voyeurism but as the axiom goes, ‘It is easier said than done’.
The life of a patient undergoing surgery is dependent on the anesthetist. Any minuscule alteration in oxygenation, blood pressure or heart rate can be catastrophic in consequence. Surgeons tend to think of themselves as artists, but most of them forget to give any credit to the person who holds up the canvas for them.
Anesthesia, in its modern and effective meaning, is a comparatively recent discovery with traceable origins dating back 160 years. In January, 1842, William C Clarke, a medical student, gave ether anesthesia for a dental extraction. The field has grown a lot since then, becoming safer and safer with new additions.
Anesthetists are supposed to be in the operation theatre earlier than anyone else and leave after everyone else. Patients are handed over to us in living state and are supposed to be returned in the same state. If anything untoward happens in the interim period, the blame is left with the anesthetist.
Thus, there is a generalized caution, bordering on reluctance, to give anesthesia to patients for surgery. The unwritten rules are clear: Every case is important; every case is a potential disaster. It is pertinent to mention here that the very first cases of medical negligence under investigation at the newly formed Punjab Health Commission target Anesthetists. The remuneration received by anesthetists is paltry as compared to surgeons. Even in the developed world, anesthetists receive 1/3rd of what surgeons get.
In Pakistan, things are even worse. In major cities, anesthetists are getting less than 1/10th the amount paid to surgeons. This is in spite of the fact that demands for anesthetists are omnipresent.
In all the ‘First World’ countries, anesthetists are in high demand. This is mostly because of the fact that very few doctors in those countries are willing to spend their lives in this field as there is just too much responsibility involved. A patient under anesthesia is entirely dependent on the anesthetist for vital functions.
All in all, the relationship between surgeons and anesthetists is akin to a South Asian saas-bahu affair and is one of the continued mysteries of medical science.
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