Space Cadet; anaesthetic view of why complications happen

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.

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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.

Pics from http://www.lovethesepics.com and http://www.plane-mad.com.

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6 thoughts on “Space Cadet; anaesthetic view of why complications happen

  1. The age- old anesthesiologist- surgeon aversiveness can never be fully extinguished!

    They believe they do the magic of taking the patient to the brink of death and then bring them back. They believe they keep the patient alive while we are the back- slapping, loud, histrionic bunch who gets all the credit.

    We constantly comment on them sitting idle and their coffees and magazines. And them warming their chairs for hours at end… And relentlessly nagging us (especially if the newbie- resident has been asked to close) to finish-up.

    And yet, I have two sets of ‘anes- surg couple’ friends whose marital bliss seems to be unaffected by their professional issues.

    • Yes so do I, one even is the anaesthetist for her husband’s list. I have to say of the 3 couples I know, he is the surgeon and she is the anaesthetist, never the other way round. I love our anaesthetists almost all the time and think they are genuinely quite excellent. This one person is tiresome with their “oh no, how did that happen” histrionics. It has filtered down to their trainees as well and they pick up on this attitude that we are incompetent. If you could see the state of some of the people we operate on, it’s a miracle that they survive such is the deprivation and general ill health.

      • Yes. It’s always the case isn’t it? She = Anesthetist and He= Surgeon… I do some anesthetist buddies, fellow residents…great guys. Then there are the nasty ones, and the flirts…

    • Most of the time there isn’t. We take the piss a bit about them sitting about, they don’t have the responsibility for the overall care of the patient that we have, but most of the time we get along well. I’m just fed up with to individual acting like every time someone has a recognised complication from high risk surgery that someone must be to blame. It is unusual and it permeates down to their juniors as well, who then that mismanagement has occurred when it hasn’t.

      • They only get to comment on my low anterior once they have actually performed a low anterior themselves. Until then- not a word!

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