On These Pages Are The Stories Of Our Family We Go Together ! Welcome To The World As Viewed Through Our Eyes
Lynette .......... Caedmon .......... Libby .......... Tom

Wednesday, December 17, 2008

Anesthesiologist On-Call

What is being on-call as an anesthesiologist like?. I thought I would try to journal a bit of a 24 hour call shift for me. Sometimes I get to do my own cases, but a large part of my practice is coordinating the operating room and medically directing certified registered nurse anesthetists (CRNAs). Well, here is this day, albeit, a somewhat slow day for me compared to my usual call days/night...

0435 : Wake up, shower, eat bowl of cereal.

0500 : Out the door.

0550 : In hospital (10-15 min added to drive due to icy roads. Usually my drive into Dallas takes me about 35 minutes.), make coffee in office.

0600 : In OR, check entire OR schedule, readjust anesthesia MD & CRNA line-ups for the day.

0610 : Start interviewing & examining patients, filling out chart paperwork for my supervised CRNA cases. I am supervising 4-5 CRNAs at a time today.

0650-0942 : 45 year old female with fibroids & menorrhagia for vaginal hysterectomy.

(As each case is subsequently started, I go and begin the process of interviewing and examining the next set of patients. I also deal with any OR issues, move OR cases around to facilitate flow of cases for the day, deal with surgeon complaints, help my fellow anesthesiologists if they need an extra pair of hands with their patients, keep track of my partners who are doing cases at other hospitals/offices to make sure they are going to be back at our main hospital in time for cases later on in the day, deal with emergencies around the hospital, deal with office issues, etc.)

0752-1118 : 41 y/o male who had a kidney transplant whose original non-working kidney now was found to have a mass in it, patient also has hepatitis C. The original non-working kidney is removed without complications.

0955-1304 : 61 y/o male with end stage renal disease (ESRD) requiring placement of a dialysis access graft in the arm and also placement of a central venous catheter (Permacath) in the chest. During placement of the Permacath, the patient develops a rapid heart rhythm (Supraventricular tachycardia) which is refractory to medical treatment, he stays in it for the remainder of the case. All attempts to treat it fail. At the end of the case, the patient is woken up, his breathing tube is removed, and after a few minutes suddenly his heart stops (asystole). Resuscitative drugs are given and before CPR can be instituted, his heart rhythm comes back. He is stabilized in the OR, and after consultation with a cardiologist he is taken to the ICU for further management. Whew!

1025-1546 : 74 y/o male who is otherwise healthy is found to have colon cancer and goes in the OR for colon resection. He has no family and a young female friend is the only person who comes with him to the hospital. She tells me he has no one to be here with him during this time in his life.

1045-1254 : 39 y/o male otherwise healthy for laparoscopic cholecystectomy

1247-1820 : 65 y/o female with history of diabletes, hypertension, and chronic kidney disease for repair of a shoulder and hip fracture sustained from a fall.When she is already under general anesthersia and, positioned for surgery, her blood pressure falls to 50 and her poorly working IV is accidentally disloged. She has no ther good veins to place a peripheral IV. She is quickly repositioned supine and a central venous line is emergently placed into her chest by me for IV access and her blood pressure is returned to normal with drugs. The case is done without any complications.

1305-1536 : 46 y/o male with history of morbid obesity and HYPOtension goes for a dialysis access graft placement in the leg.

1538-1750 : 58 y/o male with history of diabetes and HYPERtension goes for a dialysis access graft in the arm.

(~1500 : I sneak up to office for lunch. It is a special occasion as the office orders lunch in honor of my birthday tomorrow. Usually I don't have a chance to eat lunch at all. Because I'm coordinating the OR and supervising the CRNAs, most of my partners have already eaten while I have been working.)

(From here on I release my partner physicians as they wind up the cases for the day. The only people left eventually are the 2 other call team MDs who are doing their own cases.)

1815-2003 : 55 y/o female for removal of a malfunctioning Peritoneal Dialysis catheter and placement of a Permacath.

(The last call team MD leaves and now I am left covering the OR and Labor & Delivery, and basically the rest of the hospital if any patient requires any emergency airway intervention.)

2005-2137 : the 46 y/o male with morbid obesity and HYPOtension history who had the dialysis acess graft placed in the leg earlier is brought back emergently for post-op bleeding. His operative site is re-opened and explored, his femoral artery is found to be bleeding and require repair.


1850-2025 : 44 y/o female with multiple psych issues for percutaneouls removal of kidney stone.

2050-2234 : 29 y/o female in labor all of a sudden has fetal distress. She has an emergency Cesarean Section.

2138-0016 : A 37 y/o female with a life-threatening abnormality of the placenta (placenta accreta), who 1 day prior had a Cesarean Section successfully and was being cared for in the ICU, suddenly begins to hemorrhage to near death. She is brought emergently to the OR for a hysterectomy. I begin the process of placing the hospital on divert for any trauma cases since this type of case requires massive manpower and support during the daylight hours - now, at night as the sole anesthesiologist with a CRNA, this is even more challenging. I activate the hospital's massive transfusion protocol. 3 OR nuring teams/scrub techs and an anesthesia tech are required and directed by me to somewhat stabilize the patient before the operation can begin. The patient had lost 2/3 of her blood volume already and already in hemorrhagic shock. She is dying in front of our eyes basically. Her systolic blood pressure was 50 and falling, heart rate in the 150's, she felt cold, could barely speak, and did not have the strength/awareness to open her eyes any longer. IV tubing from a rapid transfusion machine is connected to her and blood transfusion is begun. During the case the surgeons note that the placental abnormality was even more severe (placenta percreta). Because of the great efforts by the entire OR team, the patient is saved and taken back to the intensive care unit on a mecanical ventilator. Yay team!

(0030 : I zip back up to a now empty office and microwave some left over food from the lunch the office ordered earlier. This is my dinner for today or was that yesterday?)

As I sit and write this, I realize that the midnight hour has passed several hours ago and I have now turned another year older. It is my 41st birthday today. I actually asked for this call shift so that I can be home all day when I leave at 0700. When I walk out the hospital I will have been up for over 26.5 hours and I'll then have to drive home without falling asleep at the wheel. I'll get to spend the day with Lynette, Caedmon, and Libby. If I can stay awake this morning, I'll go to Caedmon's swim class to watch my little boy swim. In this busy practice that I am a part of, many times I go to work and feel like the work is such a chore and a burden. It is just a job. I can't wait to get done and go home to Lynette, Caedmon, and Libby. I can't wait to eat a whole meal. I can't wait to put my feet up and veg in front of the tv and not have to think. I can't wait to just lay down and sleep. Yet it is cases like these today that remind me of why I so much enjoy what I do. Life and death in the balance at any given moment in the OR. It is a great privilege to take care of patients and keep them safe and alive during these most scary and difficult times in their lives. They don't always live, sometimes they die. I'm used to it. Sometimes too used to it. Today there were a few bumps but no one died. Every morning before I leave for work, Lynette wakes back up and says a prayer for me. In her prayers she prays for the Godly things I should be thinking of and the Godly actions I should be doing in order that I may shine the light of Jesus and that others may be encouraged. In the midst of the busyness, I must admit that I don't much think of God, nor do I often see God in my work. My actions, thoughts, and words are not Godly at times... many times they are not. I act like sinful man. However, I realize that it is only through Him that I am able to do what I do. He has given me the ability to be a physician. I am only an instrument through which He operates. The art and practice of Medicine is not just a job, it is so much more. I am good at what I do. However, my family is still my priority. At the end of the day, I so look forward to being greeted by my wife and children when I pull into the garage and walk through the doors. I can't wait to enjoy a homecooked meal when the day is done. I await a well deserved rest and mindless veg'ing time in front of the tv. Today is my birthday and I will be tired, but that's ok. May God continue to use me to help those in need. And... may He mold me into the Godly husband and father that I want to be and should be.

2 comments:

  1. Dear Tom,

    I am a junior anesthesia resident and I appreciate your insight in this post. I'm actually at a crossroads in my career. I do enjoy the practice of anesthesia, the pharmacology and procedural aspect of the practice is what attracted me to the specialty in the first place. However, I am at the point of my training where I'm doubting whether this specialty is the best for me and my family. I am recently married and would like to start a family in the near future. However, I have found it difficult balancing time with my wife, spending quiet time with God and serving at my church, at the same time trying to keep up with my readings and clinical duties; with an understanding that life as a staff member will still be filled with call and long hours. That being said, I am considering switching to family medicine to have more control over my professional life and to allow more time for family and God. Being a physician is a privilege and I feel that I would also be happy doing family practice, developing relationships with patients and managing diverse medical conditions. I'm definately at odds with this decision and would appreciate any further insight and advice.

    Thanks,

    Jeff

    ReplyDelete
  2. Jeff,

    I commend you on recognizing that the priorities for most in the world are wrong (even among Christians, myself included) - you are on the right path. Yes, the practice of medicine is a great privilege... one not to be taken lightly. You have been gifted and granted an opportunity to serve in a unique way. I would tell you that the decision will truly lie not just with you and God, but instead with you, your wife, and God... and through great soul searching and prayer... lots of it. There is great power in prayer and I know I personally don't do enough of it. Medicine has become so specialized and compartmentalized that I certainly don't feel like a complete physician any longer at this stage of my career. You know like how when we were medical students, interns, and young residents... we had so much textbook knowledge in our heads and beginning clinical training only broadened our knowledge. Somewhere through the years, the reverse happens. Your skills hone down specific to anesthesia, and a lot of the broadness of medicine is lost. Now, that is not to say that you won't feel competent. It is just different because then your skill set will be totally different, because you'll be an expert in what you do. I guess that's how I see anesthesia for myself at this time.

    However, in general, a career as an anesthesiologist will be more financially rewarding than one in family practice. I realize that that also is not necessarily a good thing because with wealth comes great responsibility. It is the rare person that can give up / share wealth willingly and be a wise and faithful steward with money. I have felt great comfort as a provider that (God willing) my family will be ok financially if I continue in my current path. From another angle though, I see family practice as opening up great opportunities of service/missions for you. You will be a more complete physician, able to open up shop on your own (if you wanted), be a great asset in the missions field locally & internationally. though you may not be a specialist, you'll be able to meet & treat people in a broad sense. I sometimes wish that I had that ability to just pick up and go and practice as a family practitioner or internist with much greater freedom than as an anesthesiologist. The opportunities are much greater than just being able to give anesthesia... you know what I mean? You are blessed that you have a choice. I love that you are hearing and understanding the call to your priorities to God, family, church, role as a provider. I don't think you truly expected me to be able to solve this for you. I will tell you what I have been up to this past summer. Every month I've been going through Psalms and Proverbs (5 Psalms, 1 Proverb per day) - I plan on doing this until the year is over. I had taken a basic seminary class about a year and a half a go and it indeed changed my life. I learned so many things. This was one exercise that my professor said to try because it will change your life. He said to try it for 3 months - I thought I'd need twice as long since I'm a layperson! I'm on the 4th run through now and I do see that God is changing my heart and mind... slowly, oh so slowly, because I am so thickheaded and obstinate. His word is giving me perspective and in fillling my mind with his wisdom perhaps the decisions I make in reagrds to the future will be his decisions. I hope this helps... Tom

    ReplyDelete

Blog Widget by LinkWithin