Notice that I didn't say blame the anesthesiologist... just blame the anesthesia. The adage in the OR is: "it's always the fault of the anesthesia...." I jest (not), but I frequently find myself blaming the various side effects that patients experience after a surgical procedure on the anesthesia. These can include nausea and vomiting, headaches, muscle aches, lethargy, constipation, sore throat and a general feeling of malaise, not to mention the pain from the procedure itself.
When a post-op patient comes in, complaining of various little ills, I nod slowly, and in my most "knowing" and empathic tone, I will say: "yes, it's all because of the anesthesia." I can usually get away with this for up to three weeks after the surgery. And it's a no-blame situation. It's certainly not the fault of the anesthesiologist who usually does a stellar job, it's just this *nebulous* entity know as "the anesthesia".
I suspect the anesthesiologists don't know we surgeons do this (well, now they do), but it is quite convenient for us. I must thank them for the thankless job they do. They put the patient to sleep effortlessly, they have to converse with surgeons and deal with our tantrums on a daily basis, and they are the first ones to be called to adjust the OR table. We are constantly asking them the raise the table higher, lower, in trendelenberg, reverse t-berg, flex, reflex and the very special treat when they work with a urologist: managing the kidney rest.
I do draw the line when it comes to blaming the pain from the surgical incision and I do take responsability for that. But that is all....
Friday, December 08, 2006
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9 comments:
Do your patients a favor and tell them to tell the anesthesiologist that they puke when they wake up...my doc did that and they gave me a WONDERFUL combination of drugs and I woke up feeling wonderful...well, the morphine helped ;)
I am most definitely one of those patients who will become violently ill post-op if they don't do some kind of pre-op anesthesia planning.
The ED gave me morphine when I became ill with my 1st kidney stone a couple of years ago.
Kidney stone pain worse than any child birth labor and I had the back pain with the contractions, which meant that it intensified as the contractions subsided and I never got a break from it. Kidney stone pain trumps that!
So,I kept saying more morphine please and I couldn't open my eyes and could hardly speak, but the pain was so intense. I kept vomiting, non stop for hours. It was a combination of the stone and the morphine. I have since found out that I can't handle dilaudid either.
I believe patients need to be proactive in their healthcare and speak up when they know how something will work for them.
A couple of days ago I had another ureteral stent put in me and I told the anesthesiologist that this other Dr. gives me a great anesthesia cocktail that prevents me from getting sick and he said that was his recipe. Always the patch, never morphine/dilaudid and whatever else they use in that magic cocktail works like a charm for this girl! Anyway, as I was just beginning to get a bit woozy, the anesthesiologist let me know that he had just given me my marguerita cocktail!
Dr.Keagirl, it is interesting how similar surgeries/procedures can leave a patient feeling so differently post-op.
In July, I had a larger stent taken out and a smaller one put back in. I was quickly sitting up and feeling breezy and ready to go home from SDS. The smaller stent was taken out 4 days later in the doctor's office.
Conversely, A couple of days ago I had the same smaller stent put in and when I woke up in post-op was having the most intense bladder spasm or so the nurses thought. From experience - I know this can happen, but I REALLY felt I needed to use bathroom or have a foley cath put in. The nurses said I didn't want that (inferring the foley cath would make me feel worse), said the DR. drained my bladder and that I should try to not be so anxious. My discomfort level was exacerbating "to a 12!"but I stayed quiet as tears from the pain were silently streaming down the sides of my face. Thank God my urologist came back in when he did! He came over to me and asked me what was going on and asked me if I wanted a foley and I hesitated because of what the nurses said (which he din't know)but then I said yes. The nurses gave me something for spasms but after he inserted the foley I quickly put out a thousand ccs and had RELIEF! Needless to say my doctor was my hero for the day and hopefully those nurses (who were nice) will not be so assuming with their other patients.
I am astounded that I felt so much worse post-op from the very same procedure, in which the doctor did less. I stayed over night because of the discomfort level as opposed to last time, the staff couldn't believe how good I looked and how well I was doing. I guess there are different variables affecting our bodies at different times and is why such things aren't really predictable.
I am just grateful that I do have a cutting edge urologist who actually listens to me and takes me seriously.
Dr.Keagirl, I am sorry if this got a bit off track. I'll blame the percocet!
Six! My comment is in there 6 times! I am a fairly new blogger and I didn't think it was going through as I thought it was a glitch in my computer system. Sigh...
I'm with you keagirl; but I'd not stop at incisional pain: hey, you woke up violently and strained the incision. I did all I could to hold it together.... Worth a try...
Seaspray:
Don't worry, I fixed the problem... :)
Blogger can be a bitch sometimes. Make that many many times....
Sorry about your kidney stones. I've never had them personally, but I've seen tiny 1 mm stones bring grown men to their knees...
Thank you Dr. Keagirl!!
This past year it's been about a ureteral stricture caused by scarring from the big stone that I had a couple of years ago. I know from the procedure the other day the opening is staying open, so I am feeling optimistic and waiting on more info from the Doc. :)
Thanks for the laugh! Brings back fond memories of my surgical internship year before switching to EM
Looks like it's nt only in this part of the world that "anaesthesia" gets blamed. Haha.
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