Sometimes, though, I run into patients who are so obnoxious, crass, rude, or otherwise unpleasant that I can't wait to push an induction dose of propofol just so they'll shut up. (Not often, but sometimes.) And sometimes it's not the patients, but the patients' families or friends who try my patience.
I recall one such family member whom I met about two or three months into my CA-1 year (first year of clinical anesthesiology training after completing internship). She was the mother of a 10-year-old boy who had broken his radius and ulna, requiring operative repair. My attending and I went to the preop holding area to meet them.
"Hi, I'm Dr. Sutton," I said, shaking the patient's hand. "How'd you get hurt?"
"Skateboarding," came the reply. Boys will be boys.
I ran through the rest of the preop questions with the patient and his mother. Pretty predictable answers: completely healthy kid, no prior surgeries, not taking any medications, allergic only to shellfish. His mom signed the consent form, but then said she had a couple more questions. My attending asked me to stay behind and answer them; meanwhile, he was going to take the kid to the OR and start getting our monitors on.
As the patient and my attending left the holding area, the mom turned to me. "Is Cardiology standing by in the OR in case he arrests?" she asked without preamble, appearing very anxious.
This caught me by surprise. Why was she concerned about cardiac arrest? I had just done a preop eval and she had told me her son had no history of heart problems.
"No," I said, "Cardiology doesn't handle things in the OR. Why are you concerned he might arrest?"
"Well, people can arrest during anesthesia!"
"It is a risk, but in a normal patient with a healthy heart it's an extremely remote risk. And you said your son has no history of heart problems or known birth defects, right?"
"But he's just a kid!" she persisted.
"Ma'am," I told her, "he was at higher risk for being in a car accident on the way to the hospital today than he is for an anesthesia-based complication."
She looked a bit sheepish but persisted: "But you need to be ready for emergencies!"
By this time, I was a bit frustrated but still composed. "We are ready for emergencies, ma'am, but that doesn't include making a Cardiology team waste their day sitting around waiting for complications that are exceedingly rare. My attending and I are acute care physicians. We are perfectly capable of running codes by ourselves, and in an emergency situation in the OR there isn't anything Cardiology could add to our management. In the OR, we are the cardiologists and the pediatricians! It's what we're trained for."
She looked skeptical. "But you're not a cardiologist. You're an anesthesiologist."
"That's true, ma'am," I replied, "but I practice acute care much more regularly than cardiologists. Part of anesthesiology is managing crises when they arise. As I said, there is nothing a cardiologist could add to my management of an intraop crisis."
She still seemed very nervous, but appeared ready to concede the point. She then reached into her purse, saying, "Well, OK, but let me give you his EpiPen, just in case."
"That's true, ma'am," I replied, "but I practice acute care much more regularly than cardiologists. Part of anesthesiology is managing crises when they arise. As I said, there is nothing a cardiologist could add to my management of an intraop crisis."
She still seemed very nervous, but appeared ready to concede the point. She then reached into her purse, saying, "Well, OK, but let me give you his EpiPen, just in case."
I stopped her. "Ma'am, I have epinephrine in the OR. I'm all but certain we won't need to use it, but we can give it IV if we do." What do you expect me to do, I didn't ask, jab it in his thigh and wait for five minutes?
"But what if he has an allergic reaction?"
"Again, ma'am, I can give concentrated epinephrine IV in the OR. It will work faster and more effectively than intramuscular injection."
I was very frustrated at this point, needing to get into the OR to get the case started lest the orthopedist yell at me for delaying his case. The patient's mom wasn't ready to let me go yet, though.
"Well, will you make a list of all the medicines you give him in the OR? I'll need to review it afterward."
That kind of statement does not make doctors particularly happy. It practically screams "lawsuit-happy." However, it's the right of every patient to request a copy of his/her medical records. I assured this extremely anxious (and I suspect rather litigious) mother that we record all intraop medications and vital signs for every procedure and would be happy to provide her with a copy of the record after completion of the case.
Finally, she was satisfied. "I know I must seem crazy to you," she said. "You'll understand when you have your own kids." I was a bit put-off by her presumptuousness. I do have kids, I thought, and you're right, you do seem crazy to me. I reached my hand out and she shook it. "It's just, I watch a lot of medical shows, so I worry a bit."
I smiled pleasantly, but I couldn't resist giving one bit of unsolicited advice. "Ma'am, you may want to reconsider watching those shows, for your own peace of mind." And your kid's, I didn't add.
And to think, when I was a teenager I used to think my mom was neurotic.
Loved your post particularly on getting to meet some great older service people.
ReplyDeleteOnce I was an exercise which had an observer. He rode the extra seat in a huey to see 6 of us slide off the floor into the darkness at 1200 ft (parachute.) What made it special and a privilege was getting to meet and ride with a man who had be awarded the Congressional Medal of Honor. In my opinion the Tuskegee Airmen are in a similar class of men, I would love to meet him as well.