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Comments on Notes of an Anesthesioboist: Epidurazilla





Updated: 2017-12-14T15:13:38.901-05:00

 



Mitch, your explanation was so eloquent and spot-o...

2007-07-25T22:01:00.000-04:00

Mitch, your explanation was so eloquent and spot-on. Thank you very much for making up for the gaps in my narrative. It's so easy to lapse into insider-speak, for which I apologize, Lyss!

I just meant to convey very quickly and concisely to the nurse working closely with me that, as Mitch suggested, the patient's physiology was extremely precarious, and we had to be super-ginger with almost every step of the process - a sort of "Let's get this right, ok?" rallying call.

One might ask, why do a surgical procedure at all in someone for whom just walking around poses a risk and exacerbates heart failure? The answer is, he REALLY needed the procedure done, and we just had to do our very best to make sure he came through.

Hope this clarifies things a bit, and again, sorry if I failed to convey all the above initially!



you just know that some people aren't likely to be...

2007-07-25T20:56:00.000-04:00

you just know that some people aren't likely to be resuscitatable; that doesn't mean you won't try-it just means you're pretty sure it won't work. So you make decisions about your anesthetic technique that do not push the patient's physiology in certain ways that you might ordinarily consider. Normally, this is a trade-off between safety and comfort. For instance, if I am not sure I can easily breath for a patient once they are unconscious (anesthetized patients don't reliably breath for themselves), I may elect to place a breathing tube in their windpipe while they are still awake; an unpleasant procedure, but potentially more safe. We don't do this for/to everyone, because it is unpleasant. This is what I took as a fellow anesthesiologist from t's comment. The nuts and bolts of medicine are pretty stark; there are no "do-overs" in the OR. That breeds a certain practical-mindedness (bloody-mindedness?) about things that isn't harsh-just real. Fire fighters, paramedics, radiation divers, combat soldiers, cops; they've all got it, too. Fire fighters call burn victims "crispy critters" amongst themselves, but will sacrifice their lives for those same people. Compassion is pretty complicated up close.
sorry t to wax on on your blog; feel free to delete this comment if it doesn't suit...

Mitch



"FYI - if he codes, he dies." To the non-medical p...

2007-07-25T19:51:00.000-04:00

"FYI - if he codes, he dies." To the non-medical professional, that sounds kind of harsh. (Did he have a DNR or something?)



I wish you well, Rebecca, and I have no doubt you ...

2007-07-25T17:04:00.000-04:00

I wish you well, Rebecca, and I have no doubt you will be sweet with or without painkillers!



I check in to the hospital tomorrow for a 3 night ...

2007-07-25T15:23:00.000-04:00

I check in to the hospital tomorrow for a 3 night stay (breast cancer w/tram flap) and I look forward to being totally sweet to everyone so that they will be sweet right back. At least I hope I am when under the influence of whatever pain killer they give me ;)