Things I've Learned from Being a Patient

[Spinach Dip]

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*Inspired by a tangent from another thread on this board*

I wont pretend to be the most informed person on this forum. In fact, I am grateful that there is a place where lowly almost-med students like myself can come around and learn from the residents and attendings above us. Viewpoints available from every corner.

Anesthesia is the residency path I have been considering since high school. I am keeping my mind open to other options (cardiology interests me...), but I have the most knowledge and interest in anesthesia.

This knowledge comes from a variety of sources... shadowing, lit review and research, and the sedation and monitoring of experimental animals (from pigs to mice).

To date I have been under general anesthesia a few times. I have been under procedural sedation a few more times. And the majority of the things I have learned have come from my own experiences as a patient.



1. There are 2 kinds of anesthesiologist. The no-nonsense-do-things-my-way kind, and the flexible kind actually capable of listening to a patient and adjusting their anesthesia protocol accordingly. Both will get you through surgery, but only the second will make you feel like a human being.

2. Prop-sux-tube is effective, but should only be performed when there is a shortage of lidocaine.

3. No one on Earth is capable of generating an effective mask seal during pre-oxygenation. This applies especially to the bridge of the nose, which results in every exhale going straight into the patient's eyes.

4. Cuff pressure may mean nothing to you, but a 10-second check could mean the difference between your patient feeling fine or hours of post-op tracheal pain.

5. Some patients know their own airway anatomy. (ie. "Yes, I'm an easy intubation.") The majority, however have absolutely no desire to know; as if knowing this information somehow makes them liable for something.

6. A patient can fire their anesthesiologist, especially if said patient has to visit the same ward time after time. This could lead to some odd looks and a comment or two on what the schedulers are thinking today.

7. Last for now... The most important thing you can do for your patients outside of providing them a safe anesthetic is talk to them when they wake up. Let them know that someone is still there and looking out for them. They are just getting out of surgery, which is a scary f*cking time. They want some reassurance. They want to know they're not alone.



Assuming I do an anesthesia residency, these 7 things (and more which I won't go into now) will effect my own practice and how I act around my future patients.

I never wanted to go through this year-long saga, but it has allowed me to gain some insight. Another point of view; one which cannot be given. But, I would argue, it is the most valuable point of view of all.



Comments and/or additions to the list are welcome.

 

[pgg]

2. Prop-sux-tube is effective, but should only be performed when there is a shortage of lidocaine.

Why do you say that?

3. No one on Earth is capable of generating an effective mask seal during pre-oxygenation. This applies especially to the bridge of the nose, which results in every exhale going straight into the patient's eyes.

I disagree with that. Regardless, the seal doesn't have to be perfect in order to effectively pre-oxygenate patients.

5. Some patients know their own airway anatomy. (ie. "Yes, I'm an easy intubation.") The majority, however have absolutely no desire to know; as if knowing this information somehow makes them liable for something.

Not sure what to make of this. Sure, many patients have no desire to know anything about the procedure. I don't think concern about liability (?) has anything to do with that however, just anxiety and a desire to get the procedure over with and remember as little as possible.

6. A patient can fire their anesthesiologist, especially if said patient has to visit the same ward time after time. This could lead to some odd looks and a comment or two on what the schedulers are thinking today.

Patients can fire any doctor. I'm not sure what you mean here either.

 

[KLPM]

1. There are 2 kinds of anesthesiologist. The no-nonsense-do-things-my-way kind, and the flexible kind actually capable of listening to a patient and adjusting their anesthesia protocol accordingly. Both will get you through surgery, but only the second will make you feel like a human being.

This really applies to people in general not anaesthetists exclusively. This goes for surgeons, internists, general practitioners, dermatologists etc.

2. Prop-sux-tube is effective, but should only be performed when there is a shortage of lidocaine.

Why is that? I don't think I have seen people use that much lignocaine when intubating.

3. No one on Earth is capable of generating an effective mask seal during pre-oxygenation. This applies especially to the bridge of the nose, which results in every exhale going straight into the patient's eyes.

I am not sure I agree with that either and like pgg said, I don't think the seal has to be perfect to be effective.

5. Some patients know their own airway anatomy. (ie. "Yes, I'm an easy intubation.") The majority, however have absolutely no desire to know; as if knowing this information somehow makes them liable for something.

I think patients don't want to know mainly because 1) most people don't seem to know anything about anaesthesia, and 2) they simply don't care. I don't see where liability comes in.

7. Last for now... The most important thing you can do for your patients outside of providing them a safe anesthetic is talk to them when they wake up. Let them know that someone is still there and looking out for them. They are just getting out of surgery, which is a scary f*cking time. They want some reassurance. They want to know they're not alone.

There are other people to talk to too. Like the PACU nurses. In fact, I don't think anyway gets left alone straight after surgery. That had be pretty irresponsible wouldn't it. But agree with the point in general that coming out of surgery and being half awake with a tube down your mouth is really scary.

 

[Spinach Dip]

Did you guys come by just to be contrary?

Anywho,



2: Propofol freakin burns.

3: I was being slightly facetious. Obviously, a seal is possible. But, seriously, the last thing I want right before I go to sleep for my hysterectomy/spinal fusion/other life-altering surgery is something blowing in my eyes.

5: Sorry, there's a long story behind that one. Maybe I'll get into it in more depth later.

 

[Spinach Dip]

2: Propofol freakin burns.

BTW, I'm guessing this is one of those things that can be repeated to someone's ears adnauseum, but doesn't actually mean anything until they are on the receiving end...

 

[WholeLottaGame7]

BTW, I'm guessing this is one of those things that can be repeated to someone's ears adnauseum, but doesn't actually mean anything until they are on the receiving end...

Do you have to have been shot with a gun to appreciate that it hurts?

We appreciate you giving us your patient perspective, but understand that you are an n of 1. A lot of people on this board have performed thousands or tens of thousands of anesthetics. We all know that propofol burns. There are a plethora of methods for trying to decrease the burning associated with propofol, some of which are better than others (and which there are threads on). But unless you want a PICC or a CVL, the risk of it burning will never be zero.

Also, I realize oxygen blowing in your eyes may be traumatic, but so is brain anoxia from a prolonged intubation from your difficult airway because you're having spine surgery. There are alternative methods of pre-oxygenation (also which there are threads on), but the primary consideration is always safety. There are problems, and then there are problems.

 

[norwood]

Did you guys come by just to be contrary?

No, but walking into a roomful of anesthesia folks and announcing that you've discovered the only correct way to give anesthesia will get a response...

2. Prop-sux-tube is effective, but should only be performed when there is a shortage of lidocaine.

I'm guessing you had propofol pushed fast through a relatively small IV. There are various tricks to make it burn less, of which lidocaine is only one.

And yes, I've been on the receiving end of that same aggressive propofol push (through a 22, no less), when I had an minor outpatient procedure under sedation and requested no versed/fentanyl so that I wouldn't be all groggy afterwards. Yeah, it burns. Life goes on. If I had it to do over again, I'd be fine with having the same anesthetic.

It often burns after lidocaine, too. Big lines help more than lidocaine does, but do you really want a 16 for a case with an EBL of 5cc?

3. No one on Earth is capable of generating an effective mask seal during pre-oxygenation. This applies especially to the bridge of the nose, which results in every exhale going straight into the patient's eyes.

It's more challenging for some faces than others, but again, there are ways of making your mask seal a lot more effective.

4. Cuff pressure may mean nothing to you, but a 10-second check could mean the difference between your patient feeling fine or hours of post-op tracheal pain.

Cuff pressure certainly means something to us, because making the tracheal wall ischemic is not something we like to do. The trachea was not designed to have a piece of plastic put in it, and unfortunately this causes a sore throat or scratchy feeling for a lot of patients.

5. Some patients know their own airway anatomy. (ie. "Yes, I'm an easy intubation.") The majority, however have absolutely no desire to know; as if knowing this information somehow makes them liable for something.

I don't know the context for this, but since you've commented that you're interested in becoming an anesthesiologist, your anesthesia team might have expected you to know somewhat more than average about this?

I've also never told a patient that he was an easy intubation, unless he asked or was concerned whether he'd have trouble with the intubation. Now if you've been told you're a difficult intubation, then yeah, that's your responsibility to remember. Same as if the team tells you you have a drug allergy.

Does this have something to do with the sore throat in #4?

 

[B-Bone]

Oh man. Are we gonna rehash this again?

http://forums.studentdoctor.net/thr...tice-where-is-the-line.1034608/#post-14505406

 

[Gern Blansten]

Oh man. Are we gonna rehash this again?

http://forums.studentdoctor.net/thr...tice-where-is-the-line.1034608/#post-14505406

Both of these threads violate board rules. This is not the place for a lay person to get medical advice or complain about their medical care. This patient clearly demonstrates lack of knowledge in both threads that discuss the same events. It should be closed and the poster should be given a warning.

 

[urge]

Oh man. Are we gonna rehash this again?

http://forums.studentdoctor.net/thr...tice-where-is-the-line.1034608/#post-14505406

After reading both threads I arrived at a conclusion: the OP is a rookie.

An experienced person would limit themselves to saying that he has GERD and he doesn't like the propofol burn and let the anesthesiologist take it from there. It is better to let people do what they usually do.

 

[deleted162650]

It often burns after lidocaine, too. Big lines help more than lidocaine does, but do you really want a 16 for a case with an EBL of 5cc?

Big lines don't matter, big veins do. A 22g in a big forearm or AC vein won't burn anymore than a 16g in the same place. What hurts is that 22g in the tiny spidery hand vein.

 

[Consigliere]

Hey OP: Here's One Thing I've Learned About You from reading this and your other thread: you're a douchebag.

 

[norwood]

Big lines don't matter, big veins do. A 22g in a big forearm or AC vein won't burn anymore than a 16g in the same place. What hurts is that 22g in the tiny spidery hand vein.

What I honestly think matters most is flow rate. If you have a sufficiently boffo IV that the prop gets diluted with NS or LR on its way in, it will burn less. If not, it will burn more.

 

[Dejavu]

*Inspired by a tangent from another thread on this board*

I wont pretend to be the most informed person on this forum. In fact, I am grateful that there is a place where lowly almost-med students like myself can come around and learn from the residents and attendings above us. Viewpoints available from every corner.

Anesthesia is the residency path I have been considering since high school. I am keeping my mind open to other options (cardiology interests me...), but I have the most knowledge and interest in anesthesia.

This knowledge comes from a variety of sources... shadowing, lit review and research, and the sedation and monitoring of experimental animals (from pigs to mice).

To date I have been under general anesthesia a few times. I have been under procedural sedation a few more times. And the majority of the things I have learned have come from my own experiences as a patient.



1. There are 2 kinds of anesthesiologist. The no-nonsense-do-things-my-way kind, and the flexible kind actually capable of listening to a patient and adjusting their anesthesia protocol accordingly. Both will get you through surgery, but only the second will make you feel like a human being.

2. Prop-sux-tube is effective, but should only be performed when there is a shortage of lidocaine.

3. No one on Earth is capable of generating an effective mask seal during pre-oxygenation. This applies especially to the bridge of the nose, which results in every exhale going straight into the patient's eyes.

4. Cuff pressure may mean nothing to you, but a 10-second check could mean the difference between your patient feeling fine or hours of post-op tracheal pain.

5. Some patients know their own airway anatomy. (ie. "Yes, I'm an easy intubation.") The majority, however have absolutely no desire to know; as if knowing this information somehow makes them liable for something.

6. A patient can fire their anesthesiologist, especially if said patient has to visit the same ward time after time. This could lead to some odd looks and a comment or two on what the schedulers are thinking today.

7. Last for now... The most important thing you can do for your patients outside of providing them a safe anesthetic is talk to them when they wake up. Let them know that someone is still there and looking out for them. They are just getting out of surgery, which is a scary f*cking time. They want some reassurance. They want to know they're not alone.



Assuming I do an anesthesia residency, these 7 things (and more which I won't go into now) will effect my own practice and how I act around my future patients.

I never wanted to go through this year-long saga, but it has allowed me to gain some insight. Another point of view; one which cannot be given. But, I would argue, it is the most valuable point of view of all.



Comments and/or additions to the list are welcome.

Things I learned from being a patient myself for the first time, after 38 yrs of anesthesia...

Even a big vein can be missed, even three times but so what. People are trying their best.
People like taking care of someone they know and like.
Coming into an operating room full of open instruments after decades of daily masking up when the packs are open is really freaky. I kept saying, "I need a mask, I need a mask."
Fem/sciatic/spinal is a sweet way to have a total knee.
Propofol infusions are sweet.
Don't waste your sedation dreams on a chemistry lecture like I did.
You won't remember much of the first day, no matter how awake you where.
Ask for Oxycontin Q3 instead of Q4, when the sciatic wears off.
Bring Mountain Dew to the hospital.
One can actually sleep in a hospital, at least in a private room. All of ours are, luckily.
Physical therapy is probably more important than anything that happened on the day of surgery.

I am sure there is more, but I wanted to steer this away from "complaining" about one's care, which is, apparently, against the rules. Hopefully complimenting one's care isn't.

 

[pgg]

Both of these threads violate board rules. This is not the place for a lay person to get medical advice or complain about their medical care. This patient clearly demonstrates lack of knowledge in both threads that discuss the same events. It should be closed and the poster should be given a warning.

He's not asking for advice here, he's giving it. 🙂

We let the other thread go because it derailed into some good discussion about accommodating patient requests.

 

[chocomorsel]

Hey OP: Here's One Thing I've Learned About You from reading this and your other thread: you're a douchebag.

agreed 100%. And an idiot who thinks he or she knows something, when in reality is clueless. Don't come to a board and try to tell us how to do our jobs when you aren't even a medical student.

 

[chocomorsel]

Here's what I learned,
Versed is good ****. Don't remember a thing NOT EVEN THE PROPOFOL BURN even though I apparently complained about it as I drifted off to sleep.
I am a wuss when it comes to IV's but I already knew that. Had to get lidocaine after the first failed attempt.
People do like to take care of you when they like you. Agreed. My colleagues and nurses were awesome!!
But they had to cut me off on my "more versed please" request Haha.

 

[Arch Guillotti]

Both of these threads violate board rules. This is not the place for a lay person to get medical advice or complain about their medical care. This patient clearly demonstrates lack of knowledge in both threads that discuss the same events. It should be closed and the poster should be given a warning.

Please use the "Report" button for issues such as this. Thanks.

 

[Spinach Dip]

Hey OP: Here's One Thing I've Learned About You from reading this and your other thread: you're a douchebag.

If this is the way attendings treat people they don't know, in a public place, it's no wonder you are all being replaced by CRNAs. Don't you have some charts to sign?

Also, your capitalization makes my vision blurry.



This thread can be closed. I realize now that trying to learn from my own experiences (good or bad) is something best done in private.

TY.

 

[Consigliere]

YW. Now scram!

 

[Arch Guillotti]

This thread can be closed. I realize now that trying to learn from my own experiences (good or bad) is something best done in private.

Closing. This forum is primarily for anesthesiologists, residents, medical students, etc. Anyone is welcome to post here but realize that this forum has a culture that has evolved over time, sometimes for better and sometimes for worse but almost always the forum maintains itself and (I think) is the most interesting one on SDN.