How much do you use your hands?

[IrishTwins]

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I am pre-med, so I haven't done any actual rotations, and I am curious as to how much you use your hands in anesthesiology? More specifically, what kind of dexterity and precision is required, especially from the non-dominant hand?

I ask because I have some nerve damage in my left, non-dominant, hand. I have about 95% mobility in it, just a little stiffness and irritation in my last two fingers, which can be highly intensified on rare occasion from exertion (i.e. holding a crappy can opener that you have to really clench down on with a lot of force) ... my hand will sometimes cramp up in these situations, which is paralyzing for a few moments, until I can massage it out - usually lasts about 10 seconds at the most.

This only happens ... maybe once every few months. But, I am almost certain that this kind of unpredictable disability and unreliability excludes me from even thinking about surgery - would it eliminate anesthesiology as an option as well?

I do a lot with my hands, though, I even play piano, and I hardly ever notice any manifestation of the nerve damage at all. My family has told me I shouldn't give up on surgery, yet, that I could still possibly rehab my hand or get some reparitive surgery, that could restore my hand function to 100%, but I'm just not willing to commit to med school if I'm left with suck fields to choose from. Granted, I may end up loving one of those fields when I actually got to rotations ... but I don't feel comfortable staking years of my life, and loads of student loans on it. Any help?

 

[Noyac]

I wouldn't count on any type of surgery to repair your hand to 1oo%. I also wouldn't necessarily say that surgery or anesthesia is out for you. But I will say that there are times when my hand may even cramp without any nerve damage. Mostly, when trying to mask ventilate someone with a difficult airway. This is were you will notice your injury the most and were it will become dangerous for the pt. I'm sure you can overcome all the other dexterity issues required in anesthesia but this airway management one will be tough to overcome and could possibly be a real risk to a pt.

 

[IrishTwins]

Well, that was pretty much what I expected to hear. 🙁 And, like you said, the uncertainty of the success of rehab or surgery is a factor, and I'm just scared to death of finding out years into this endeavor, that I'm not going to be able to continue, because I'm a risk to a pt.

So ... I guess that leaves me with ... how do I know where to go from here? Should I seek a physical therapist before making a decision? Or ... could you compare the airway management to some other task I could do to try to test myself?

Is hand cramping during airway mangement typical?

 

[Noyac]

I wouldn't say that hand cramping is typical during airway management but it is possible. I experience it much less frequently as I continue to get better and better at it. And there should always be an extra set of hands around to help when you are faced with a bad airway. And another thing, if your impaired hand is your right one then it would be less of an issue just because of the way anesthesia areas are setup. Anything can be overcome, well almost. I suspect this can be overcome.

I'll say this, anesthesia is a speciality were we use our hands a lot. Surgery as well but in surgery you can typically rest your hands if they are cramping. This is not always the case in anesthesia. If you are struggling to ventilate someone and your hand begins to cramp, you may not be able to take a break. I wouldn't go as far as to say anesthesia is out for you but there are many other interesting specialties in medicine were your hands are not as important.

 

[IrishTwins]

That's hilarious. I was just reading that thread earlier.

You know, its not really tempting to me, after having worked in a cube for two years in a position that paid me way too much, considering my lack of experience and education ... But it was complete hell, and I couldn't imagine sitting behind a screen for the rest of my life. Thats why I started looking into services. Give me social work, medicine, teaching --- anything but the tiny little prison cell existence of a desk job. Ugh.

And its encouraging to hear about the one-handed graduate, even though he did go into family practice. My husband says - go pathology! You can't hurt anyone that way! 🙄

Oh well, I suppose I could just hope for the best and continue with med school anyway, I just hate the fact that I don't have a plan anymore. And the thing is, I just have no idea what is even a real possibility for me now, short of posting on every forum and seeing how improtant the non-dominant hand is. I mean, obviously radiology and pathology. Possibly IR. Not interested in peds or ob. Argh, I'm rambling. Thanks for the info, anyway.

 

[IrishTwins]

Not to mention that the corporate world is completely dismal and two-faced and nasty just as Cop described the medical field. Except, in a corporate job, I don't know if there's any real sense of satisfaction or altruism. I dunno. Just seemed pointless and boring to me. Ultimately, I think we're all a part of the rat race in one way or another, but at least you're really using your mind and doing good things in medicine ... Maybe that's just the naive pre-med perspective, who knows.

 

[powermd]

Ultimately, I think we're all a part of the rat race in one way or another, but at least you're really using your mind and doing good things in medicine ... Maybe that's just the naive pre-med perspective, who knows.

I don't think you're being naive.

At the end of the day I can usually think back over several things I've done that were personally satisfying. It may have been helping a colleague with an issue related to a patient, choosing a particular anesthetic technique that worked really well, getting a difficult line or intubation, putting a patient's mind at ease about surgery before taking them to the OR, heading off a problem in the ICU... there's always something. I trade stocks in my spare time and it's fun, but totally meaningless. I couldn't imagine doing a job that didn't involve actively solving problems, being creative, and interacting with people. I suppose I could get that from certain types of business careers, but not what I see most people doing. Ultimately I think I want to be some kind of entrepreneur. I guess it's convenient I'm headed for pain medicine!

I did an anesthetic today for a patient undergoing a Whipple. Due to circumstances beyond my control, I couldn't do an epidural, or spinal duramorph. My attending wouldn't let me run low-dose intraop ketamine. So I used heavy dosing of fentanyl pre-incision, and throughout the dissection, followed by a moderate dose of dilaudid about an hour from wake-up, along with toradol. She was so narcotized, she needed a few hits of naloxone to breathe enough to extubate. Later on I went back to see her in the ICU (all these patients go to the ICU here... regardless of how well the case goes), and she was very comfortable. The the blood pressure cuff was bothering her more than the surgical wound! I had a good laugh with her family, who were all at the bedside. It was kind of a nice moment. Medicine is full of these. It's these 'human' moments that are the reason I got into medicine.

 

[mdjobexchange]

In anesthesia, the left hand is really only used to hold the laryngoscope. You won't use it for many fine movements. You can get into some difficult airway situations that can really stress your hands. I know during my CA-3 year, I was mountain biking so much I got carpal tunnel syndrome in both hands, especially my left hand which operates the front brake. It really caused me some big time problems because my median nerve was really suffering. My hand was pretty numb and, of course, when it was the worst, I had a string of difficult airways, but I still got through it.

One good thing is now they have the Glidescope. It is a fiberoptic gadget that can easily bypass your problem. You will really end up using your right hand for any real work. The glidescope does not rely on much left hand strength or dexterity. It costs about $10,000, but most training programs should have one and you can buy one once you finish.

Also, you can go into pediatric anesthesia, which requires very little left hand strength. If you need more than 2 pounds of lift to intubate a kid, you are using too much strength. Not to mention peds anesthesia is in big demand and it is only a one year fellowship.

Surgery could be a problem for you, as you will be expected to hold retractors for long periods of time which could aggravate your problem more and make it really difficult to operate.

 

[VentdependenT]

I watched this show on discovery channel where this highly skilled hand surgeon actually got his hands crushed or mangled. He had this dude that he trained reattach what was left and now the guy operates again!

I think you'll be fine. You know you can train yourself to use the larnygoscope with your other hand, you just need the blades with the flange on the opposite side.

There are plenty of 5'2'' little ladies practicing anesthesia out there and they do fine.

As for masking people, thats what the old HEAD STRAP and airway are for. Gives you much more freedom.

 

[IrishTwins]

Really appreciate the insight. I can't tell you how encouraging that is. I'm feeling pretty reassured. 👍