03 November 2010

I used to do this to fruit flies, and sometimes I forgot*

I’m in anesthesia now (the rotation1). It’s alternately seen as the your-patients-are-asleep specialty, the knock-them-out-quickly specialty, the bring-people-close-to-death specialty, the more-drug-addicts-than-any-other specialty, the control-the-level-of-consciousness specialty, and, as one resident said to me, the anti-death specialty.

It is surreal. Which is more like playing god? The sterile, scrubbed, blue-gowned ones on the body cavity side of the blue-sterile curtain (now: blue equates to sterile. It does in the OR. Synonymous), the ones who are cutting through skin – the ultimate violation – and putting their hands in and manipulating another person’s internal organs.
Or. The ones on the non-sterile side of the blue curtain, the head side (usually), who put a tube down that person’s throat and connect it to a machine to breathe for them, who tightly control drugs (by feel, actually, more than by dosage) to keep them awake/not in pain/not remembering/not alive/not. Yes, the machine plugged into the wall is playing god2.

You’re going to go to sleep soon, I tell the patient. You’re not going to remember any of this.
And they don’t.

1(Though – note on that – dinner with friends the other night. Friend of Y’s showed up, and Y asked me something along the lines of “didn’t you have anesthesia today?” or “weren’t you on anesthesia today?” Her friend looked at me kinda funny… I guess I looked fairly alert for someone he presumed to have recently had surgery. I raised my glass at him. “AND then I drove over here!” Oh, medicine….)

2 Being a skeptic, I may overuse this phrase to the point of meaninglessness. Apologies.

*(to take them out of the freezer). I’d take them home sometimes … forget exactly what I did to them there, separated them, maybe I could tell wing shape or color or what have you. And the way you anesthetize them to get them to stop moving is to put them in the freezer. Quick and dirty. And yes, sometimes, I forgot to take them out. In the lab, in college (freezer was high school experiments – maybe it was just taking them home to babysit as no one would watch them over the weekend?) we used CO2 to put them to sleep. And sometimes you use too much. And it’s fruit flies, which, though they have taught us so much of what we know about genetics, we can shrug over and move on. It’s a 10 day reproductive cycle. Born to reproduce. More or less, cross them again, again, again.

Today I put (read: rammed carefully and deliberately) a tube down a woman’s throat to help her breathe. Successfully.
For the sake of argument, I’m going to compare myself to Obama for a moment (because… well that’s nice).

The woman had a disease, not life-threatening at all, a little uncomfortable, and she came in for elective (doesn’t mean, like, plastic. Just means it was planned and not emergency surgery) surgery. She’s basically very healthy. People out of my control and out of her control started to give her drugs through her IV:
one to make you feel like you’ve had a few too many cocktails (Versed/midazolam)
one that is numbing medicine (lidocaine)
one that will sting a little. This one will put you to sleep (Propofol)
and one that will help with pain (fentanyl).

All together, they depress her drive to breathe. She is no longer able to breathe on her own; her brain can’t interpret the signals that she’s filling up with CO2. Now, these people/actors on the economy… are not totally malicious. Before giving the drugs to make her go to sleep, they put an oxygen mask (tight, uncomfortable, pressed down) over her mouth and nose and have her take deep breaths of oxygen. This too makes her light-headed and sleepy.

And as soon as she’s out. “Ms X? Ms X?” Touch her eyelids. “Open your eyes, Ms. X.” Nada.

And Obama enters the office and tries to do something for…the economy. Everything.

The mask stays on awhile longer. I’m holding it as tight as I can – harder than it sounds – gripping under her jaw bone and thrusting her chin up. Forcing oxygen through a balloon into her lungs. But I can’t do this forever. It’s a several hour surgery. I’ll get tired. My hand could – and will – slip from the mask, from the balloon, over this period of time. Besides which, we have millions of dollars of machines next to me, beeping.
 Then -
The mask comes off. And out come the instruments to ram down her throat. I look. Try not to break her teeth as I pull UP with the laryngoscope, finally see the vocal cords, and thread the tube down them. I attach the oxygen to the tube now jutting out of her throat and continue to squeeze in air, for awhile, while we check it’s in her trachea and not in her esophagus (… as it was the first two times I tried this week. Oxygen to stomach? Not. Helpful). And then I flip the big switch to the ventilator and the accordion does my job – up, down – and the people who put her to sleep and paralyzed her and made her stop breathing in the first place add inhaled anesthetic to the oxygen. Keep her drugged.

Paralyzed. Unable to breathe. And I help by placing a tube in her throat at this time.
There’s nothing more helpful to do, yet.

And sedation?
American voting public, perhaps.
My resident was confused about why I asked to come in late so that I could vote (ie, polls open at 7, can’t get to the OR at 6:30). In planning for the next day, he said, “oh, yeah, you’ll be coming in later because of your “voting thing.” Yup, it’s pretty kooky of me to want to vote on election day. Very original idea.

Change parties, cause, yeah, it takes time and work to revive someone brought to the brink of death and paralysis (making someone not be able to breathe or move?) Long-term and short-term.

And/or sedation to not caring.

Politics. Medicine. And it’s November, so there are words flying….everywhere.


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