There is an interesting phenomenon specific to medical school graduates, they are taught that everything is a competition and that they have always to demonstrate that they are better or smarter than their peers.
This silly game is probably helpful when you are a student but most mature people get over it or at least manage to control it when they start practicing.
Unfortunately there is a small percentage of physicians that can not reach that maturity and although they are a minority they are dangerous because they are the ones who point fingers and accuse their colleagues of malpractice only because they feel the need to do that in order to satisfy their childish desire to be better.
Although I'm not entirely convinced that the physician you reference is doing this, I do believe that many people in medicine are guilty of this personality disorder. It's a double edge sword to play this game. If you play it, make sure you NEVER make a mistake, have a complication, or have a bad outcome cuz all those people you sh*ttalked about will be ready to pounce.
Back to the case, I thank my lucky starts that when I was in training an attending told me that the only reason the anesthesia record existed was to be used as evidence against you. He taught me that you have to explain your thinking and document thoroughly. So when I get a low reading 1) I treat it 2) I document that bp was 79/95 and treated immediately and returned to whatever MAP with pressors 3)I document the duration of the bp i.e. "79/95 ifor 1 minute and then resolved with a bolus neosynephrine"
I do this so I don't get into the game of how long was the hypotension for? i.e. in this case where everyone assumed that it was for the longest duration i.e. between the boxes of 10 minutes or so.
Laurel, it sounds like your colleagues were downright good people. Those are the types you want to work with. They've got your back. But I always protect myself against the other type of people. Those that look to blame...point fingers etc. AND to protect yourself, document like a motherf*cker. I break out the progress note paper and write a Tolstoy novel. THis way no one can comeback and f*ck me.
I think we are missing the forest for the trees in this case discussion. What does everyone expect to happen to a sick as ****, ASA 4/5 E, old Fart? It's a sad fact that we sit here mentally masturbating and monday morning quarterbacking the fact that a bad thing happened to a sick old lady after surgery. Do we honestly think that sbe would get out of surgery and be playing sudoku after surgery, recovering like she just had a cataract?
If we lived in any other country but the good old USA (where lawyers outnumber engineers), we would have chalked this result up to what it was...an old sick person going to surgery and still remaining an old sick person who got sicker. Was the 79/65 the straw that broke the camel's back? ....was it that there was a thrombus that embolized? was it inflammatory cascade that is stirred up with the tissue trauma of surgery that makes you hypercoagulable? I have no idea. But I do know that this was a high risk surgery on a high risk patient that guess what led to a complication. Big F*cking Deal. Remember what type of camel we are talking about, this was an old camel, with a messed up heart, missing a leg, that just got run over by a semi, and we are acting like it's some surprise that it didn't do well.
Would I accept blame. H*LL no. I find it interesting that Mil you lamblast anesthesiologists for not accepting blame for complications. I don't buy that argument, one second of the week. I think that we accept too much blame these days. Do the ICU guys accept blame when their patients are hypotensive for minutes/ hours in the unit? I go by the ICU everyday and watch how long it takes for an order for whatever vasopressor to be transcribed, pharmacy to get the order for levoo, phenylephrine, epi...make the drip...have the nurse check the drip...actually hang the drip...titrate the drip...and this takes years compared to what an anesthesiologist does. So did more myocardium or neurons or nephrons get damaged during this time...probably. Who was in charge at this time? The intensivists, so is she or he responsible for not treating the hypotension? In some sense, yes. So why wasn't he/ she sitting there like I do in the OR and giving bolusses? B/C it's impratical and nuts. So why should the standard really be that much different in the OR? Do surgeons take the blame, when the patient has an anastamotic leak b/c they didn't suture perfectly. Hell no, they chalk it up to the patient's poor protoplasm..etc. And beleive me surgeons hardly ever step up to the mike and take the blame. Do the obstetricians take the blame for a lowered apgar b/c they took forever to do the c/s. Hell no. They talk about how technically difficult it was to get to the uterus. Why should anesthesia be any different? We nit pick in our specialty and honestly it's just BullSH*T. We've been the whipping boy too long. It sickens me when we end up doing it to ourselves as well. When I hear of anesthesiologists openly dissing other anesthesiologists about care, all I want to do is B*tch slap that punk A $$ motherf*cker. Cuz you know what, these people are idiotic syncophants that just don't have the balls to be real men. Respect your own specialty and hold your head up. These guys can only puff up their own self esteem by putting others down. Do it the honorable way and just concentrate on your own care.
Somehow we tend to think that in the OR it's a magical place...we can manipulate every single goddamn variable and get a patient back to the "avoid hypotension...avoid Hypoxia" scenario. Well we can most of the time, but not ALL of the time. We kill ourselves when we buy into this myth. Hell I would argue we have a harder time than in the ICU. In the ICU the patient is just lying there. They don't have someone cutting on them with a chainsaw, doing their darndest to kill them.
We live in the real world...sick people live...sick people die...sick people come in F*ed up and some of them still leave F*ed up.
On another tip, I am with Plank here. I don't talk **** about my colleagues and I back them 100% Even when I think that I would have done differently. Why? Purely for selfish reasons. When you divide a group, you lose power. It is an us against them world. No one is going to back you more than your own colleagues. I always advise the new people to our group to remember that fundamentally...you are there to get the work done...you aren't there to make friends...to play kumbaya. I tell them that the surgeons..some of your colleagues (the ones that plank references in the quote above)willl sacrifice you in a second when **** hits the fan. This thread is a wonderful testament to this sad fact about medicine.
It's a dog eat dog world....hopefully you run in a good pack that doesn't eat it's own.
Peace
