|Giving an anaesthetic is a bit like flying an aeroplane: the take-off (induction) and the landing (waking up) are the two periods of tension, with a bit of autopilot in-between, says Dr Lindi Snyman ...
Anaesthetists as a group are often considered to be ‘OCD’: particular, pedantic and precise.
To our colleagues we are the ‘go to people,’ the specialists other physicians turn to when things are going wrong or a patient is very ill. To the public, our practice is a bit vague, not yet glamorised by the likes of House, ER, or Grey’s Anatomy. Yet on an average day, providing an anaesthetic service is a pleasing combination of patient interaction, delving a little into the unknown, and practising the art of medicine.
I don’t bother much with dressing up for work – part of the joy of being an anaesthetist is the thought of comfy scrubs and a hat to hide the hairdo. Combine that outfit with a stethoscope around the neck and a pen in the pocket and I have my armour donned to face the day ahead.
My day begins with the ritual drawing up of anaesthetic drugs and a mechanical check of the machines. This is followed by a careful perusal of the day’s list and a discussion with the consultant to put an anaesthetic plan in place for each of the patients.
Patients coming in on the day of surgery are visited on the day ward to discuss their health, their surgery and the planned anaesthetic. A lot of patients presenting for surgery have their first contact with an anaesthetist at this stage. While they are mentally prepared for the surgery, frequently they are frightened of the prospect of having an anaesthetic: of what happens when they are being ‘put to sleep,’ or else they’re afraid of not being put to sleep enough, or of feeling pain. Although there is calm in the room, with just the rhythmic beating of the pulse oximeter in the background, everyone is on full alert.
I spend a few minutes with each patient obtaining a pertinent history, performing a focused exam, and reading through the chart gleaning important information ranging from previous anaesthetics and admissions to current blood results and investigations. All the while I’m building a rapport with the patients, calming their fears, explaining what we anaesthetists do and reassuring them that they will be well looked after and safe.
It’s back to theatre then and the list starts. Giving an anaesthetic is almost like flying an aeroplane: the take-off (induction) and the landing (waking up) are the two periods of tension, with a bit of autopilot in-between. The first patient arrives and gently drifts off to sleep as the ‘white stuff’ is injected. Although there is calm in the room, with just the rhythmic beating of the pulse oximeter in the background, everyone is on full alert.
Every surgery is different and every patient is unique, so although there is a ‘formula’ of what to do and when to do it, it is tweaked to suit each situation. The surgical period is dotted with periods of joking interaction between the staff, re-analysis of the anaesthesia and minor adjustments of drugs or fluid to accommodate what’s happening. As the surgery nears the end the surgeon looks up and questions the room: ‘Has the next patient been sent for?’ The preparation to wake the first patient begins as I start preparing for the arrival of the next one. Being an anaesthetist exposes you to a range of experiences, from performing an epidural for pain relief for a woman in labour, to the excitement and adrenaline rush that comes with being on the team of a patient receiving a heart transplant
The surgeon finishes the surgery and leaves the room. I wake the patient, transfer them to the care of the recovery nurses making sure that they are calm and comfortable, and return to the next patient in theatre.
Thereafter, the day could almost be copy, paste and repeat. The day is interspersed with visits to the recovery room to check on postoperative patients, visits to the ward to review patients planned for surgery, and doing preoperative visits for the next day.
Being an anaesthetist exposes you to a range of experiences, from performing an epidural for pain relief for a woman in labour, to the excitement and adrenaline rush that comes with being on the team of a patient receiving a heart transplant. There are repetitive days where it’s all about getting through the list: one case after yet another, and there are days where one case will take up to ten hours. There are days in ICU where you manage sick patients, and see them get better; or know that you’ve done your best if they don’t.
In Ireland, some of the larger hospitals offer intern rotations in anaesthesia. However, if you go through medical school and your internship year only interacting with anaesthetists when you ring them for a cannula, then there are many six-month SHO posts where you can be exposed to anaesthesia to decide if it is a career you wish to pursue. Any experience will stand you in good stead for the future, whether you choose anaesthesia as a career or not.
Anaesthetists are enthusiastic teachers and the practical skills learnt will boost your confidence to deal with any clinical situation that you may encounter.
Dr Lindi Snyman is an Anaesthetic Registrar (SPR 1) at Letterkenny General Hospital