Friday, July 2, 2010

A Patient's Need To Know

As I walked into Preop Holding, the nurse comes up to me and whispers, "Your next patient is really nervous about anesthesia."  "Okay," I reply. "Thanks for the warning."  When I see the patient she is wringing her blanket in her hands, shaking slightly, and staring with saucer-like eyes right at me.
"Are you my anesthesiologist?" she asks.
"Yes.  I'm Dr. Z.  Your nurse tells me you are very nervous about anesthesia.  May I ask why?  Did you have a complication from anesthetics in the past?"
"Uh huh.  My previous surgeon told me to tell anesthesiologists that I need extra drugs to keep me asleep. In my last operation I woke up in the middle of the procedure."
"My goodness.  No wonder you're anxious.  What did you do?"
"The surgeon said that I was moving during the operation.  He had to tell the anesthesiologist to give more drugs before I was put back to sleep."
"Do you remember waking up during the operation?" I ask skeptically.
"Do you recall any conversations in the operating room or feel any pain?"
"Did you talk to the anesthesiologist afterwards?"

Oy, I thought.  This poor patient has been psychologically traumatized, but not by the anesthesiologist.  Why did her surgeon have to tell her that she "woke up" during her operation?  She had absolutely no recall of her surgery.  Her muscle relaxant had worn off and she started to move but that is not the same thing as "waking up" even though surgeons always yell, "Anesthesia, patient's waking up!" when the patient twitches a single muscle fiber during the case. It was really unfair of the surgeon to say this to the patient without consulting with her anesthesiologist.  How would the surgeon feel if the anesthesiologist told the patient after the surgery that the surgeon lacerated an artery and she hemorrhaged 1000 cc's before he finally got it under control?  I bet the surgeon would not appreciate the patient knowing that detail.  If the patient's outcome was unchanged because of the movements, does the patient need to know the information? I just don't understand the disrespect that surgeon had for the anesthesiologist.

"I can understand your anxiety," I assured her. "It is okay to be nervous before surgery.  That's perfectly natural." She seemed to calm down a little. "I've never had a patient wake up during an operation.  All our operating rooms are equipped with monitors that track your brain waves.  These machines help us determine if the anesthesia is becoming light so that we can give you more if necessary. Do you feel better?"
"Yes. Thank you doctor."
"You're welcome."


  1. Love it when I hear "Patient's awake!". Especially when a medical student is in the room and they look at me with wide, panicked eyes. I usually think something along the lines of F-off, but instead I just check twitches if needed, increase me anesthetic, and keep amiable.

  2. Love the piece. You nailed it when you said that the surgeon simply didn't respect the anesthesiologist. The uneven expectation about the sharing of untoward intraoperative events that you outlined is a reflection of the uneven relationship between surgeons and anesthesia. The sorry state is that surgeons in general have no real respect for the specialty of anesthesia; just think about the occasional solicitous surgeon who gets you and your work. We may be happy, but we think of him as an oddball! If the surgeons give any thought about anesthesia at all, they think of it as an OR service like wall suction or lighting: if it doesn't work it's a mess and it grinds down the surgical work pace; if it does work, there's no need to think about it. I don't have an answer for this lack of respect. Someone help me.