Tuesday, 4 June 2013

Nerves

It never ceases to amaze me what patients will allow me to do to them under the influence of anaesthesia.  I have to take you apart, fix you, and put you back together again, Humpty-Dumpty style.  That's nerve-wracking stuff, as I'm sure you can imagine.  There are countless things that can go awry, and one wrong move can literally mean the difference between life and death.

So why aren't more people deathly nervous before surgery?

It's a question I can answer from personal experience.  When I had appendicitis (over 20 years ago), I wasn't nervous at all before going under the knife.  All I knew was that this pain was excruciating, I felt like dying, and I just wanted to get this goddamned thing out of me RIGHT NOW.  It wasn't until years later during my training, assisting with my very first appendectomy, that I actually got scared.  Is the incision in the right place?  Is the skin bleeding?  Did I cut the fascia in the right plane?  Is the muscle bleeding?  Did I poke a hole in the bowel on my way in?  Did I tie off the appendix tightly enough?  Is it too tight?  Did I irrigate enough?  Too much?  Did that suture fall off?  Is there an abscess I missed?  Did I forget something?  Will there be a skin infection? 

You get the idea.  Interestingly, even though most of my patients don't seem particularly nervous, I've had a few of them ask me if I'm nervous before operating on them.  My standard answer:

"Yes."

A look of combined panic, terror, and "GET ME THE HELL OUT OF HERE!" universally ensues.  As the patients are probably locating the nearest exit and simultaneously mentally reviewing their lawyer's phone number, I give them a warm, reassuring smile and explain my response. 

I always get nervous before every operation, no matter how simple or routine it may seem, from a mole removal to an appendectomy to a pancreas excision.  I'm constantly reviewing the steps in my head, even if I've done it 1000 times (which I have), and I'm constantly thinking what could go wrong at every stage of the procedure.  Being nervous keeps me on my toes.  When a surgeon loses that edge, he gets complacent. And complacence is what causes mistakes to happen. 

As I go carefully through my explanation, their look goes quickly from "SHIT I'M GOING TO DIE!" to "I think this guy might know what he's doing" and then finally to "Ok, I'm in good hands".  Only when I see that look do I allow the anesthesiologist to proceed. 

If your surgeon isn't nervous, you should be. 

16 comments:

  1. My biggest fear about surgery may or may not be rational - waking up in the middle of the procedure. I've read that children, seniors, and heart surgery patients are the most likely to have this happen. Is this true?

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    1. Well that would probably scare the crap out of most doctors.

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    2. I've also heard of at least one case where the patient could not move but was completely aware of everything, mostly including the pain of having his stomach cut open. Sued the hospital, of course. How does this happen?

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    3. It's called anaesthesia awareness. It's extraordinarily rare, but it does happen. When patients are asleep, they get medications to keep them asleep (usually inhaled), to keep them still (paralytic), and to keep them pain-free (usually a narcotic). Sometimes one or more of these medications don't work properly or for long enough. If the paralytic agent is active but the sleeping agent isn't, the patient will be awake but paralyzed.

      You may be surprised that redheads are at increased risk for some reason. They usually require more anesthesia than blondes and brunettes.

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    4. Great, I'm a former redhead gone gray. In the last proceedure that I had done I was aware when they tested the defibrillator. I thought that I had dreamed it because I am so nervous about the thing ever going off. Now I'm afraid to ever have anything done again...ever...Thanks.

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    5. Yeah so is this like extremely rare or like winning at a slot machine rare…?

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    6. It's about 1 in 1000. Very unusual, but you have a much worse chance of winning the lottery.

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    7. This is why I always tell my doctors that I'm a natural redhead and that I almost always have to up my medication from it's original doses. There is no way I want to wake up.

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  2. I don't know but I would not be surprised if children and seniors were more likely to wake because the anaesthetists are probably even more than usually careful not to put them too deep. Being an anaesthetist must be a tough job - all the stress of being a surgeon without the glamour.

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  3. I'm totally okay with surgery. I've had my appendix and gall bladder out, and three or four laproscopies for endometriosis. All my endo surgeries are done by my regular gyno and she is pretty much the best doctor ever. (Excluding maybe you, Doc, and my neurologist.) I, too, have the fear of waking up during surgery, but I'm pretty confident my insides are not going to be fucked up. She is the most reassuring woman ever. Hopefully there will be no more surgeries (the new method I'm trying seems to be working; I can elaborate if anyone wants me to, but ladyparts afflictions aren't always something everyone wants to read about ;) )

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  4. I don't have the fear of waking up...I have fear of the anesthesiologist more than anything. As a vet tech, I'm pretty familiar with how anesthesia works, and my job required I handle anesthesia on a daily basis, but maybe knowing the risks more intimately is what makes me nervous? I'm not sure I can explain it that well. Too bad for me that the military wants my wisdom teeth removed.

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  5. Today, at 6 PM, my grandfather's ventilator was turned off. His lung damage due to chicken pox (he was immune-suppressed from the chemo) was too severe for him to breath on his own. For lack of a better word, it really sucks for my family (especially my now fatherless mom), friends, and the doctors whom I will always be thankful for.

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    1. I'm sorry for your loss and your sadness and the general suckiness your family is going through.

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  6. Hey SkyGuy32, I just read your profile and realized that I, at 14 years old, am not the youngest reader of this blog (you might be). I am currently in an unspecified location in Texas, and I like to play flight simulators in my free time. By the way, you should upgrade to Microsoft Flight (it's free) and try out Orbiter Spaceflight Simulator.

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    1. i am 12, so yeah.... I AM THE YOUNGEST!!!!!!!!!!

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  7. I've had several surgeries, I was never nervous with my big abdominal surgeries (colon removed, rectum removed, ileostomy) but for some strange reason, I was extremely nervous when I had to have my wisdom teeth pulled out, but luckily it wasn't bad at all, so I worried for nothing, it's odd though that is what made me nervous! Lol

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