A Case Of Mine That Made It All Worth It

[jetproppilot]

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I was reading a post from PowerMD on another thread about some of the better parts of his anesthesia life....made me reflect on mine.

As with other jobs, medicine, most days, is justa job.

Its Monday morning.

I've just blasted a stikka propofol into a talkative, 19 year old ASA 1 kneescope dude's IV with just a pulse-ox and BP cuff on since the versed made his comments a little inappropriate and I didnt care to hear any more about how hot he thought the circulator was.

He finally stops talking, and becomes apneic.

I'm thinking about how I'm gonna blast my legs on Tuesday, which is religously my leg day......Smith machine squats!!! Hell yeah!!! I'll ease up to 405 and if my codgers don't hit the floor at the bottom the rep doesnt count and I'll start over.....

I slam a pre-inflated LMA #4 into dudes mouth. No gloves needed with the jiggle technique.

Now we'll put on the ECG pads.

Blah blah blah.

Easy cases.

Fun banter in the room. Circulator's head now bigger. Not commensurate with her beauty but thats OK. Dude made her day.

But Power is right.

Medicine affords us humanistic priveleges every once in a while that makes all the s h it we go through worth it.

One of my most memorable was at previous gig....circa 2001 or 2002. The lead singer of the group that sang at the catholic church I attended was a great guy....helped modernize my church experience with his songs....great voice, great attitude, great wife and kids....I spoke to him frequently after Sunday mass since he had such an impact on me.

Dude was in his late forties. Athletic. Didnt smoke.

Found by a rushing-home-wife one day after a phone call to her by him....

Ashen, diaphoretic.

Rushed to the ER.

Stabilized in ER with medical management.

Subsequent cardiac cath shows that dude has coronary artery disease best managed via CABG.

😱

HUH? Singer dude at church, the athletic guy with a cute wife and teenage daughter needs heart surgery?

Bad genetics, folks. It'll getcha every time even without Marlboro Reds in a box.

Somehow someone contacts me and lets me know whats going on. I go into the ICU on my day off. He looked like he always did.

Spoke with him for a while.

Spoke to his wife.

Told him I'd take good care of him during his surgery in the morning. Assured him the surgeon doing the case was a stud and we'd be done in three hours.

Come into work the next morning. That was back in the day where we had a holding room nurse that did everything, something I don't have anymore at new gig.. (thanks, Theresa. You made our lives very easy.). Dude was precedex sedated when I walked into holding at 0630. Everything I needed was in place. Popped in a 9.0 cordis and an A line. Theresa had already placed a 16" peripheral.

In the room at 0650. Had a soul-searching talk with the CRNA (Paul G., Trin...remember him?)

Jet: "Healthy guy, Paul, other than the obvious. Good ventricle. We're gonna extubate him when Knoepp is through with him.

Paul: "OK, Dude."

Case goes well. We fly off bypass since dude is healthy and Dr Knoepp had a very short pump run.

Sternum is wired, Knoepp has popped off his surgical attire, PA is closing the skin, Dude is breathing on his own, great tidal volumes, hemodynamically stable, 5 red blood cells in the pleur-a-vacs combined.

PA finishes, we pull the tube.

Breathing on his own. On the table.

Great case.

Dr. Knoepp: "Bill, why don't you go speak with the family since you know them. Meetcha in the ICU."

Great gesture by a great heart surgeon.

I walk over to the surgery waiting area and ask the cute little old lady volunteer to summon Dude's family into the conference room, which she does.

I walk in. Dude's wife and teenage daughter I've seen in church for so long are sitting there......eyes wide open.....distraught.....

Jet: "Hey! Doin' fine. We're done. He's very stable and on his way to the ICU."

Both of them wept.

Not like you cry at a movie.

Like you cry when you find out your wife's breast cancer is gone. Or like when your child gets hit by a car and emerges from a coma after 24 hours and say's "Daddy, I'm thirsty!"

Or like when your husband/dad emerges from highly invasive surgery unscathed.

Wife and daughter hugged me. Thanked me over and over. Thanked me for saving their loved one's life.

I'm smart enough to know I didnt save Dude's life.

It just wasn't his time to go. God makes those decisions. Dr Knoepp, myself, Paul G., and supporting staff just made sure he got over this huge bump in the road.

Dude made a full recovery.

And came back to sing for a while at church, before a professional opportunity took him to Baton Rouge.

That case was a poignant moment in my career.

Made me feel it was all worth it.

Sprinkled between all the mundane cases, you too will experience poignant moments in medicine.

That will tell you you are contributing.

And that it was all worth it.

 

[DrDre']

I love that story. I think u have told it before? Still Squat to Dre MD?

I was reading a post from PowerMD on another thread about some of the better parts of his anesthesia life....made me reflect on mine.

As with other jobs, medicine, most days, is justa job.

Its Monday morning.

I've just blasted a stikka propofol into a talkative, 19 year old ASA 1 kneescope dude's IV with just a pulse-ox and BP cuff on since the versed made his comments a little inappropriate and I didnt care to hear any more about how hot he thought the circulator was.

He finally stops talking, and becomes apneic.

I'm thinking about how I'm gonna blast my legs on Tuesday, which is religously my leg day......Smith machine squats!!! Hell yeah!!! I'll ease up to 405 and if my codgers don't hit the floor at the bottom the rep doesnt count and I'll start over.....

I slam a pre-inflated LMA #4 into dudes mouth. No gloves needed with the jiggle technique.

Now we'll put on the ECG pads.

Blah blah blah.

Easy cases.

Fun banter in the room. Circulator's head now bigger. Not commensurate with her beauty but thats OK. Dude made her day.

But Power is right.

Medicine affords us humanistic priveleges every once in a while that makes all the s h it we go through worth it.

One of my most memorable was at previous gig....circa 2001 or 2002. The lead singer of the group that sang at the catholic church I attended was a great guy....helped modernize my church experience with his songs....great voice, great attitude, great wife and kids....I spoke to him frequently after Sunday mass since he had such an impact on me.

Dude was in his late forties. Athletic. Didnt smoke.

Found by a rushing-home-wife one day after a phone call to her by him....

Ashen, diaphoretic.

Rushed to the ER.

Stabilized in ER with medical management.

Subsequent cardiac cath shows that dude has coronary artery disease best managed via CABG.

😱

HUH? Singer dude at church, the athletic guy with a cute wife and teenage daughter needs heart surgery?

Bad genetics, folks. It'll getcha every time even without Marlboro Reds in a box.

Somehow someone contacts me and lets me know whats going on. I go into the ICU on my day off. He looked like he always did.

Spoke with him for a while.

Spoke to his wife.

Told him I'd take good care of him during his surgery in the morning. Assured him the surgeon doing the case was a stud and we'd be done in three hours.

Come into work the next morning. That was back in the day where we had a holding room nurse that did everything, something I don't have anymore at new gig.. (thanks, Theresa. You made our lives very easy.). Dude was precedex sedated when I walked into holding at 0630. Everything I needed was in place. Popped in a 9.0 cordis and an A line. Theresa had already placed a 16" peripheral.

In the room at 0650. Had a soul-searching talk with the CRNA (Paul G., Trin...remember him?)

Jet: "Healthy guy, Paul, other than the obvious. Good ventricle. We're gonna extubate him when Knoepp is through with him.

Paul: "OK, Dude."

Case goes well. We fly off bypass since dude is healthy and Dr Knoepp had a very short pump run.

Sternum is wired, Knoepp has popped off his surgical attire, PA is closing the skin, Dude is breathing on his own, great tidal volumes, hemodynamically stable, 5 red blood cells in the pleur-a-vacs combined.

PA finishes, we pull the tube.

Breathing on his own. On the table.

Great case.

Dr. Knoepp: "Bill, why don't you go speak with the family since you know them. Meetcha in the ICU."

Great gesture by a great heart surgeon.

I walk over to the surgery waiting area and ask the cute little old lady volunteer to summon Dude's family into the conference room, which she does.

I walk in. Dude's wife and teenage daughter I've seen in church for so long are sitting there......eyes wide open.....distraught.....

Jet: "Hey! Doin' fine. We're done. He's very stable and on his way to the ICU."

Both of them wept.

Not like you cry at a movie.

Like you cry when you find out your wife's breast cancer is gone. Or like when your child gets hit by a car and emerges from a coma after 24 hours and say's "Daddy, I'm thirsty!"

Or like when your husband/dad emerges from highly invasive surgery unscathed.

Wife and daughter hugged me. Thanked me over and over. Thanked me for saving their loved one's life.

I'm smart enough to know I didnt save Dude's life.

It just wasn't his time to go. God makes those decisions. Dr Knoepp, myself, Paul G., and supporting staff just made sure he got over this huge bump in the road.

Dude made a full recovery.

And came back to sing for a while at church, before a professional opportunity took him to Baton Rouge.

That case was a poignant moment in my career.

Made me feel it was all worth it.

Sprinkled between all the mundane cases, you too will experience poignant moments in medicine.

That will tell you you are contributing.

And that it was all worth it.

 

[jetproppilot]

I love that story. I think u have told it before? Still Squat to Dre MD?

Yep, told it before, Dre.

Thanks, Power, for reminding me of it.

 

[Fastrach]

I love that story. I think u have told it before? Still Squat to Dre MD?

I squat to one song, and one song only:

Lady Humps, by the Blackeyed Peas.

http://www.youtube.com/watch?v=WTM7IXEW_Xs

 

[coprolalia]

My boys won't bump the floor in a full squat. In fact, I'm still waiting for them to descend.

Nice story, Jet. Thanks for sharing. I agree. It makes the equally ****ty moments more bearable.

-copro

 

[powermd]

Poignant story, and well told. Thanks Jet. I'm glad these stories are coming out now, on the heels of of Copro's very depressing (but too true) detailing of the trip from boyhood to doctor.

I'm finding that the more often I call patients the night before surgery for a no-time-pressure pre-op conversation, the more satisfying work seems to be. I don't call everyone, but for the bigger cases, or when I just have the time and energy, I do. It feels good when you go to see the patient in the ASU, and the whole family is eagerly anticipating YOUR arrival.

There are other benefits too, like being the first to know if the patient is planning to cancel, or arrive late. Or if there is some medical issue that needs to be worked out prior to surgery. You can also make sure they take the meds YOU WANT THEM TO TAKE the morning of surgery. I've had plenty of patients ask me, "is it okay if I take a xanax before I come in?" Sure, take two!

 

[Monty Python]

.... back in the day where we had a holding room nurse that did everything, something I don't have anymore at new gig.. (thanks, Theresa. You made our lives very easy.). .

Absolutely worth her weight in gold. If those of you in management positions can justify it to the bean-counters (make it an efficiency / room turnover agenda item) a competent holding-room RN makes life so much better

Had a soul-searching talk with the CRNA (Paul G., Trin...remember him?)

.

I was still at the Big Free across the river then, but I'd heard of him.

 

[Monty Python]

(Re-posted from last year) I was doing my Navy reserve drill by passing gas at the local VA hospital. There the pts are brought to the OR hallway, immediately outside their particular OR, before anesthesia sees them. I had just cleaned up the machine from the previous case, and stepped into the hall to pre-op the pt and start the IV.

My pt was a thin, 80-ish African American, with a steady lock-on gaze and a definite air of polite self-confidence. The only military history indicated in his VA medical record was that he was a retired Air Force colonel.

The pt was there for a lap chole, and immediately after I started his IV the circulator informed me there would be a 30 minute room delay. I started to make small talk with the pt and found out, lo and behold, I was talking with one of the few remaining Tuskeegee Airmen fighter pilots.

Introducing myself to him as a novice pilot, I got him to go back in time and recount his days in World War 2. Within a few minutes our conversation had him in the skies over Germany in his P-51 Mustang, escorting our B-17s and fighting off attacking Luftwaffe fighters. His eyes lit up as he described dogfights with German pilots, and his squadron's record of not losing a single bomber they escorted to enemy fighters.

His lap chole was an easy uneventful anesthetic. What was memorable for me was the honor and privilege of caring for this true American hero.

Addendum: Since giving the above anesthetic, I've spent time at the National Naval Medical Center in Bethesda, caring for some servicemen and women greviously wounded overseas. These folks' unspeakable injuries were no longer life-threatening, but they sure as hell destroyed any quality of life these people (some still teenagers) can look forward to. Taking care of them was a true privilege.

Jet's son will now be in my prayers, along with others'.

 

[Ferdie]

I've been told by so many people (none of whom are anesthesiologists) that if I like "people" anesthesia is the wrong field for me. Stories like these just show how wrong the people who say that are.


(and regardless of how much I like people, a lot of times after exchanging pleasantries I like them better asleep. Especially if they're crazy)

 

[Dr Serenity]

I've been told by so many people (none of whom are anesthesiologists) that if I like "people" anesthesia is the wrong field for me. Stories like these just show how wrong the people who say that are.

Too true.

(and regardless of how much I like people, a lot of times after exchanging pleasantries I like them better asleep. Especially if they're crazy)

 

[cfdavid]

Yep, told it before, Dre.

Thanks, Power, for reminding me of it.

Great story Jet. Really cool for us med students to hear that stuff, but I'm sure everyone else as well. Thanks for sharing brother. Can't wait until I can contribute a bit myself...

I have an anes attending buddy (my older bro's childhood friend actually) that I need to get involved here. He's a super cool dude and very bright. I think his input would be another asset to our pool of professionals. He's a private practice partner covering a community hospital in MI. I'll send him an email.