Working with Surgeons II

The optimal team has mutual respect between the surgeons and anesthesiologists. Last week, I had a patient requiring a brainstem surgery for a vascular malformation. These surgeries require central venous access for administration of vasopotent medications such as nitroprusside, esmolol, and phenylephrine. We decided to place a subclavian central line, but this became quite technically challenging, taking twice as long as it usually does. Last night on call, a patient presented for facial surgery, but the surgeons had difficulty identifying the facial nerve. They called in a second attending from home to dissect out the nerve to prevent it from being damaged.

In both these cases, one team took much longer to accomplish their task while the other team waited. But in both circumstances, the surgeons and anesthesiologists treated each other with respect and patience. The surgeons didn't hurry us as we troubleshot the central line, and when the ENT surgeons called in a backup physician, I knew it was the right decision for the patient.

But the truth is, such collegial relationships don't always exist. In part, we don't fully understand the difficulty of what the other person is doing. When I look over the drapes, I can't appreciate how much focus, effort, and precision the surgeon has; I only see the amount of blood loss and the time taken. It's easy for me to be frustrated with how the case is going. Intubating a young, healthy, thin patient takes ten seconds; if a surgeon sees the anesthesiologist struggle with a challenging airway without understanding why it's difficult, he may become exasperated at the delay. It's easy to discount what we don't know. But as we become further specialized in our fields, we also learn to respect other practitioners as experts in their domain.