Tuesday, December 15, 2009

Surgery Without Anesthesiologists

Another aspect of the story in the New York Times about a heroic 43 hour surgery really bothers, no angers, me. Besides the enormous expense of this procedure for questionable long term benefits, on a more personal note this article barely mentions the anesthesiologists involved in the care.

Toward the end of the surgery, when the liver was reimplanted, the operating team encountered some serious difficulties:

The liver bled profusely. Transfusions could barely keep up. Over the next few hours he needed 30 pints of blood. But even as the bleeding abated, his blood pressure and body temperature dropped, and his blood turned dangerously acidic. Drugs to correct one problem made others worse. He was sinking into a vicious cycle that could kill him.

Who was there giving all the transfusions, and the pressors, and other life saving maneuvers to try to salvage this 43 hour operation and the patient's life? There is not a mention of the work of the anesthesiologists at this critical juncture in the operation. It's as if all those interventions happened by magic. There is a single quote from an anonymous anesthesiologist in the entire article. Of course he, or she we will never know, is talking about the surgeon, describing him as having "soft hands." Blech.

On the 8th photo of the slide show, they actually described what the anesthesiology team was doing during the operation:

During surgery, anesthesiologists transfuse blood and other fluids and drugs, and monitor the patient's heart, breathing, blood pressure and blood chemistry, in addition to administering anesthesia.

That sounds like a pretty generic job description, something I do every day. That gives no indication of the exhausting work that must have been going on behind the drapes keeping this patient alive. Even the surgeon's PA had a picture and was mentioned by name in the article. But the team actually responsible for keeping the operation going is only shown as a single arm hanging up albumin and PRBC. Anybody can slice and dice a body into pieces. It is up to the skill of the anesthesiologist to make sure the patient survives this "attack" and wakes up afterwards in relative health and comfort. But thanks to writers of the New York Times, the public will continue to be ignorant of the vital roles we play.

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