I don’t know much about anaesthetics; they give the white stuff followed by the gas stuff followed by the paralysing stuff and then sit on their backsides and play on their iPads for the rest of the day. Pausing only to go and get more coffee and tutting loudly as it approaches 1630 and we aren’t close to closing up.
What I do know about it is that much like airplane travel, very little goes wrong and they have few complications. Which is good and correct and very clever of them.
Operating on the citizens of Bighospitalburgh is different to giving them a cocktail of drugs and then reversing them. Let’s take the operation of a very low anterior resection (coloanal anastomosis). This carries a leak rate of up to 20%. 1 in 5 will have a leak. That’s all comers of course, if you look at obese smokers with diabetes you will have half of them getting a leak.
If someone suffers a complication during an anaesthetic it is usually because they have failed to rescue a deteriorating patient. If my 72 year old, BMI of 36, smoking, alcohol abusing locally advanced rectal cancer man leaks it is because he was always going to.
It gives me one view of complications: some are inevitable, can be impossible to prevent and are not related to bad surgery that is at odds with how anaesthetists see them: someone’s fault.
One anaesthetic colleague of mine is quick to point the finger of blame every time we have someone unwell with some entirely predictable and expected post operative complication. This person does not understand that cutting people open, removing parts, rejoining them and closing up again is not without its risks.
This attitude of “you incompetent bozos have half killed someone else” radiates from him. A few months ago I was performing a potentially life saving and completely necessary operation on a pregnant women. The operation lasted about an hour longer than we had predicted but it went well.
This anaesthetist went on and on about how the baby was going to die, which I found rather distracting actually and quite unhelpful. Would he have preferred that I let her die of appendicitis and lose the baby in the process because of massive intra-abdominal sepsis? Does he think that we are psychotic murderers who randomly haul people off the street to remove body parts from for our own gratification?
I operate and as a consequence, unfortunately some people have a less than perfect outcome. I deal with that awful responsibility by walking away from the operating table knowing that even if they experience a post/operative complication, there isn’t a single stitch or clip that I would want to change given the opportunity to do so.
You cannot lie awake wishing you had left a drain/de functioned them/transfixed instead of tying a vessel or wondering if you tied that stay suture….That is how to make yourself a stressed out nut case.
Patients will get complications, we go to great lengths to minimise the risks, we prepare the patient properly and we proactively hunt for them before they make you really sick. But they happen and they happen to everyone.
To continue the airline analogy, which for some reason the anaesthetists like, they are just like airline pilots and we, the surgeons, are like astronauts. There is the constant risk of it all going tits up.
Astronaut with the constant risk of death, disaster, flying bits of space rock, aliens, shuttle exploding, breaking up on re-entry, engine failure…and some happy laughing Easyjet pilots with a 1 in 47 million chance of it all going horribly wrong.