Saturday, January 9, 2010

Anesthesiology Is Such A Thankless Job

Not only is anesthesiology one of the hardest jobs in America, it can also be one of the most thankless. I suppose that's another similarity we have with nuclear plant operators. I saw a patient in preop that was a total nightmare. His H+P ran nearly ten pages single-spaced small type. Needless to say he was an ASA Class 4.

While giving the informed consent, which by necessity involved explaining the risk for an MI or death with the procedure, he became extremely agitated and outraged. He accused me of being unprofessional. He said he was well aware of his medical conditions and for me to emphasize his morbid conditions was totally out of line. I was taken aback by his animosity. I apologized for making him feel so angry but he would not be placated. Any attempt at a conversation came to a complete stop. He would only give one word answers and most of the time just stared at me with the evil eye. In the meantime he was cheerful as he could be with the rest of the OR staff.

Of course thanks to expert anesthesia care the patient did well during the procedure. The patient suffered no cardiovascular calamities. He had survived the surgical procedure without any evident sequela. But did I get any credit for his life? Hell no. He continued to give me the evil eye in postop. He wanted my card so he could write a letter of complaint to the hospital administrator about my conduct.

At first I felt badly about how this situation had turned out. You never want the patient-doctor relationship to turn into a battle. But then I thought, "Screw it, and him." I did my job in a professional manner and the proof is that he is not lying in the morgue in the basement of the hospital right now. If he is so shortsighted and selfish that he cannot see what a miracle it is that he is still alive then f*** him. Let him write his letter. I don't care if he says I have poor bedside manners. I have had thousands of other patients who will say otherwise. That's always the problem--only the complainers are ever heard from. The people who are thankful for your care rarely write letters to compliment you. I am not going to let this one petulant irritating man make me feel I've given bad anesthesia care. They can review my record all they want. Everything is pristine and by the book. In other words, F.U.

P.S. I talked with a family member afterwards. He was very nice and understanding. I explained that the patient was extremely angry with my care when I was explaining the informed consent and the need to be very specific because of his multiple medical problems. He said not to worry. He can be overbearing at home too. The family member then thanked me for my anesthesia care and gave me a fist pump. I felt just a bit of my self respect return with that one kind act.

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