Sunday, November 27, 2011

No Pressure

"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their pressure".


I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from a different vantage point, a place that made her look so vulnerable.

And she was vulnerable.

A few minutes prior to closing her eyes she had been nervously chatting and laughing away as we prepared her for surgery. The dose of propofol and the inhaled sedatives smoothed her face and left her body limp. Now we had injected medication into her intravenous line to paralyze her. Once her muscles were relaxed we could slide a tube down her throat and into the trachea, providing the means to ensure that her airway would remain open and her lungs could be well ventilated with oxygen during the surgery.

I removed the mask to prepare for the intubation. Her skin was pale, the freckles standing out now that the nervous blush had faded from her cheeks and neck. She was perfectly still and we were moving into action. 

It struck me then how explicitly patients trust their doctors and nurses. Of course I have always understood this as a general concept in healthcare but this was suddenly a much more concrete example. Patients literally put their lives in our hands on a daily basis.

Why have I never said to a patient, "Thank you for trusting me with your most precious possession"? Why has a patient never said to me, "Please do not be hurried, or harried, distracted or inattentive, because today you are responsible for my survival"?

I suppose these are silent agreements and understandings that we have in all of our patient interactions. Yet the fact that we don't outwardly acknowledge these understandings means that maybe we've forgotten that at the core, it is an honor to be in this role. I'm not so unrealistic to think that one is thankful when the bleep goes off for the 47th time on a Christmas eve night shift...but I hope that at the end of the day when I am bone tired and flopped-out on the couch in the call room I'll remember this, and take even just a tiny measure of satisfaction from the honor of responsibility. 

No pressure.


Grumpy, M.D. said...

At the end of the day it's still good to believe in what you do.

jberry said...

good reminder. I'm an OR nurse, that moment of intubation with every patient gets me. I even take those slow deep breaths.

Anonymous said...

Well said, as usual. I've never thought about it from the perspective you take here, that this is an otherwise "healthy" patient. In the ED, even though the airway is usually a crash airway and in theory harder and performed under more stress, perhaps there is actually less pressure since we don't have a choice to do it or not, and if we fail, which we do from time to time, the patient would have died regardless.

Anna Elissa said...

Unbelievable. I read this post just after finishing a surgery, and your words describe exactly what I felt when I was in that room.

Albinoblackbear said...

Grump--It is good to have those reminders on the bad days.

Jb--I catch myself doing it as well... :)

ERJ--Thank you. Yes, it is something I haven't been confronted with before either (also having an ED background!) Really does change the playing field...

AE-- :)

Anonymous said...

I think it's almost an implied part of any interaction. The patient is coming to you with the expectation that you're going to apply all your knowledge and training to their illness/issue, and they're going to emerge better from it, same as when I take my car to the mechanic. The difference is that you can't go to the auto lot and pick out a new life should you mess up.

(And see, anesthesia can be cool!)

Knot Telling said...

Good post. This is why I pick my anesthesiologist with at least the same care as my surgeon. The doctor who wakes me up is important to me!

wv: thysin Alternative contraception?

Unknown said...

Just a simple "Amen' to your post. Well said.
*high five*

Unknown said...

What a beautiful post to read as I ready my son for his first long term deployment to Japan in the Navy.

mrossg said...

Having been on both sides of the surgical ambu bag, I found your article very very touching. Thanks for writing it.

mrossg said...

Having been on both sides of the surgical ambu bag, I found your article very very touching. Thanks for writing it.

Helen said...

In the rush to prepare for an unexpected surgery this summer, I didn't even think about the intubation until after it was all over.

I do remember being wheeled into the OR, seeing five or six faces smiling down at me and hearing the calm voice of the anaesthetist, and feeling like everything was going to be fine.

From a patient's perspective, it's good to know you're nervous sometimes, too.