Satisfaction

I call a patient the night before his surgery to walk him through the anesthetic. "Every time I have anesthesia, doc, I get horribly nauseous. I've had seven surgeries and it's been the same each time." A challenge. This, in itself, is not an insurmountable one. In residency, I encountered plenty of patients with severe post-operative nausea and vomiting. With the right combination of ondansetron, dexamethasone, propofol, and scopolamine, I can achieve a comfortable anesthetic.

But then during surgery, a second challenge presented itself. The surgery he was having is not expected to having bleeding, but unfortunately, altered anatomy lead to a sheaf of blood vessels right where the surgeon was working. He got into a bleeder and couldn't get control. Over half an hour, we lost almost a liter of blood. I went into active resuscitation mode; no longer able to attend to the propofol drip, I turned on anesthetic vapors. In between placing additional IVs, sending a type and cross, and managing the blood pressure, I worried that this case could end quite badly. We had to get an extra surgeon to control the bleeding. At the end, the patient was quite swollen after being prone three hours longer than expected.

I stayed late to make sure he recovered from anesthesia and surgery adequately. Stopping by the recovery room, my hair mussed from my surgical cap, my feet weary from standing all day, he said, "I have no nausea. I feel great. Good job, doc."