As the current Speaker of the House of Delegates, I probably should be writing an article about parliamentary process or governance issues in our society. I have done just that many times before, and I will probably do it next year. But this year, I decided to write a more personal story. I hope you find it interesting and that it moves you to congratulate yourself for the incredible work you do every day.
It was the same.
Actually… no. It was totally different. I have personally given, or supervised the administration of, over 30,000 anesthetics during my career. But this one was going to be different, because the patient was me.
I woke up and went into the hospital early that Saturday morning. I was on OR call and had a full schedule of “emergency” cases to do. I started having some abdominal discomfort mid-morning but did not think much of it. However, by mid-afternoon, the pain was significantly worse and getting worse quickly. I called a surgeon friend and she ordered a stat CT scan that showed appendicitis. I confirmed that my friend (who was not on call) had not been drinking and was in fine shape for performing laparoscopic surgery. After the shock of realizing that I was going to need emergency surgery and a general anesthetic, I reached out to one of my anesthesiology partners to cover the rest of my weekend’s call schedule, and to anesthetize me. The anesthesiology coverage was great. My family support was atypically sparse. My wife was on an international trip, and my in-town daughter and her husband were also out of town. I called my out-of-state daughter and her husband, who booked the next flight, which would arrive in time to take me home the following morning.
“After over 30 years in the business, I am humbly reminded from my personal experience that what anesthesiologists do is really, really special. We have the opportunity, and the privilege, to care for people during one of the most vulnerable times in their lives.”
Of course, I’ve seen the pre-surgical and pre-anesthesia process so many times that nothing should have surprised me about what I was going through. However, I was indeed very surprised by many things. The hospital gown is very thin and uncomfortable. It doesn’t fit well. It doesn’t cover much, and it sort of rides up on your neck. The hospital gurney feels less like a bed and more like a wheeled version of the examination table in my internist’s clinic. And even though I knew all the hospital preoperative staff, it was weird to have them taking my vital signs, drawing blood, and asking the myriad of medical and social questions that become part of every patient’s database. But my surgeon came to my preop room. She had a big smile on her face and made me feel comfortable and good about the experience that I was about to have. I had the same wonderful experience with my anesthesiologist. I knew that she was very good, and she was so pleasant and relaxed that it put me immediately at ease and gave me great confidence.
Patients tell me all the time that after I give them midazolam, they remember nothing about the perioperative experience until they awaken in the postanesthesia care unit. I received the same preop midazolam, but I actually remembered the whole process of being wheeled into the OR, moving from the stretcher to the OR bed, placement of the monitors, and preoxygenation. To say that it was surreal doesn’t really do it justice. I would say that it was as close to an out-of-body experience as I’ve ever had. I remember taking some deep breaths. Sure enough, the propofol stung a bit as it entered the I.V., but it was not particularly painful. I remember my hearing becoming increasingly distant and my vision closing in around me.
I must have had the surgery, because the next thing I knew, I was in the recovery room. There had been no dreaming. In fact, there was no sensation of any time passing. From my point of view, I did not know if I had been out for one hour or 10 hours. Waking up from general anesthesia was like turning on one of those old cathode ray tube televisions of my youth. The picture started out dim and fuzzy and increased in brightness and clarity, slowly and gradually, eventually reaching full intensity and sharpness.
I highly doubt that my experience was unique or materially different from the thousands of anesthetics I have been involved in – from the other side of the ether screen. But some experiences in life are so profound and emotion-provoking that they become indelibly stamped on your mind. This was one. What I will remember most about the process is how vulnerable and “small” operative patients feel. Hospitals are full of intimidating machines and technology. The whole perioperative process is disconcerting from the patient’s viewpoint. Don’t eat or drink anything after midnight. Be sure to arrive while it is pitch dark and find your way through the maze of corridors and elevators to the proper place. Take off all your clothes and put on this gown with the opening to the back. The processes that exist for patient safety and consistent quality can feel intrusive and confusing to those who don’t see it every day… and even to those who do.
What did this anesthesiologist learn about the process of receiving operative care? The antidote to the preoperative morass is the confident, reassuring manner and easy smile of the physician. Above all else, that is what tells the patient that everything is going to be all right. After over 30 years in the business, I am humbly reminded from my personal experience that what anesthesiologists do is really, really special. We have the opportunity, and the privilege, to care for people during one of the most vulnerable times in their lives. Most patients will never know the amount of scientific and professional education and personal sacrifice it takes to become an anesthesiologist, but they will remember the art and the humanity of a caring physician.