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Blog: The Biggest Mystery in Medicine
The Biggest Mystery in Medicine
“Sarap nga ng trabaho mo e. Injectan mo lang tapos batsi ka na.” In one very humid Sunday afternoon, over a cup of coffee, my wayward friend teased me. Dumbfounded, I couldn’t react quickly. I felt like my neighbour’s dumb cat staring at an oncoming car’s headlights. In between discussing financial instruments as a hedge from the current economic crisis and the hyperdynamic Electronic Air Suspension of Range Rovers, this short-sighted eunuch just made a crack at my specialty. Was this guy insulting my profession? This heat and humidity is getting to me. Why, I ought to knock some sense into this misguided fool. How dare...
Here’s the thing. A major misconception among the general population regarding our work is that we inject some magic drug and then off we go to the mall. Wish such a wonder drug truly exists. One that we can just so mindlessly inject intravascularly, allow for surgical analgesia without affecting the body’s cardiovascular, pulmonary and homeostatic mechanisms, and then be off and be done with it. One that can handle the vagarities of pulmonary function alterations from intra-abdominopelvic organ manipulation, not to mention the necessary surgical retraction, occasional hepatic palpation, and the inevitably jammed lap pack. And – here’s the kicker – the effect ought to last the duration of the OR, accounting for inadvertent delays, unexpected surprises, and the unwelcome but all to real exsanguination. Lastly, and this must be the best part of this diatribe, have this drug’s effects magically terminate just at the close of the operation, whatever time in this green earth that may happen to be.
No doubt this belief was fuelled in no small part by seriously misguided media people, some misinformed internet savvy hack posting fallacious flights of fiction online, or some gossip around the rumor mill among people too bored to think responsibly while sucking on their cigarettes. Pop culture is rife with hoaxes that underscore much of these beliefs. Ever heard of the drunk horndog who wound up in an ice-filled tub sans his kidneys? While it makes for good forwarded messages, it likewise manages to perpetuate the myth that hey, you can have both your kidneys removed so easily. As any post-nephrectomy patient will attest to you, the sad reality isn’t as easy as a mouse click. There’s the post-operative nausea, vomiting, and inspirational splinting to contend with.
The truth cannot be any farther from the fantasy. The anesthesiologist arrives at the operating room ahead of the surgeon and sometimes – despite today’s high-speed elevators and Nike air running shoes – even ahead of the patient. We’re there making sure there’s oxygen in the pipeline, no leaks in the breathing circuit, no meds missing, and no monitor unavailable. We ensure that life-saving vasopressors are always on standby, that plasma expanders are stocked, and that laryngoscope batteries are always juiced. Some take the extra time to utter a short prayer, psychologically preparing him/herself for the oncoming battle, placing him/herself in the right frame of mind.
We sometimes rush to the operating room in the dead of the night or the heat of the afternoon, through the traffic jammed streets of the metro, braving the occasional flashfloods during the typhoon season, or the throngs of humanity fighting for their cause during Labor Day when the stat word is mentioned. In spite of the customary parking difficulty, we arrive ahead of the surgical team, physically, mentally and emotionally ready to defend the patient against whom the bell tolls.
Then, and this I emphasize with certainty, we are the last to leave the operating room. As an intensive peri-operative specialty, Anesthesia doesn’t end when the gauze has been affixed over the incision. There’s the intricacies of fluid redistribution, oxygen carrying capacities, gag reflexes, residual opioids, central and peripheral acute pain control, recurarization, homeothermic mechanisms, glomerular filtration, and, if you’re just truly unlucky, anaphylaxis. We obsess over your comfort, and constantly worry about that golden hour when anesthetic ligands finally uncouple from their chosen receptors, congregate someplace more appealing to them, and hopefully venture onto the welcome arms of the myriad cytochrome P-450’s of your liver. The first 24 hours is always crucial, relieved only by the sight of your smile on our first post-op visit (or okay, a grunt will suffice).
No, the unfathomable truth is that we as anesthesiologists are in fact, the first to arrive and the last to leave the OR. Perhaps the erroneous concept generally held by the general public is testament to how we have mastered the science and art of the specialty through time. Its how we can manage to smile and maintain an even keel in spite of the persistently shrieking monitors. Its how we can talk about the weather when the elderly patient on the table replete with uncontrolled diabetes, wayward hypertension, and unspeakable angina has her innards exposed for all the glorious evaporative losses to take hold of. And its how we continually keep our disposition and composure when, in the face of liters and liters of ongoing blood loss, our dear fellow surgeons may have invariably lost theirs.
Ultimately, there appears to be some shimmer of truth to what my misguided cretin of a friend just said. And while you’ll need a deeper understanding of life and existence to see the silver lining (as well as a great deal of patience and wisdom), it lends credence to one simple, glaring but compassionate truth: anesthesia is the biggest mystery in medicine. As truth be told, perhaps we, as anesthesiologists, wouldn’t have it any other way.
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