Heart trouble

So, my dad had his heart catheterization yesterday. They found narrowings in at least 3 vessels. That's pretty shocking to everyone considering he had no symptoms prior to his test. Normally that would mean that he would need heart surgery. But one of the main vessels had blockages all the way down the artery. This means that if they were to do a heart bypass there would be no where to bypass the artery. So instead they put in four stents. Four! And then they stopped because they had used a lot of contrast dye to place those four stents. They kept him overnight and they want him to come back in two weeks and they want to put some more stents in. Yikes.



Anyway he had an uneventful night in the hospital. And we picked him up at the hospital after being dumped on by 8-10 inches of snow. It sucks. I shoveled the driveway at home and after an hour I had to shovel another 2 inches off... what gives.

Mortality

Nothing like mortality to bring you down to Earth. I see life and death situations most days at work, but you work through it because if you don't someone dies. It's different when something happens to family.

Yesterday my dad called me and told me had a positive stress test. That means that there is a high likelyhood that he has some blockage in some of the arteries of his heart. Tomorrow he's going in for a heart catheterization. They will place catheters in his groin, fish them up to the heart and then shoot dye into the arteries of the heart. If there is are blockages they may stent them open, or maybe he will need heart surgery, or maybe none of the above if the blockages are minor. All of these procedures carry their own risks. Likely tomorrow everything will be fine... but I've seen with my eyes bad things happen. Maybe I know too much. I rarely see the results at work of "normal" tests.

This brings somethings into perspective. Here I am. 29 years old. A physician. single. overweight. i don't exercise, i eat poorly. I think I need to make some changes. I've always known better. I just never had a reason to change.

kitty litter

So the other day, I'm helping out in the cardiac room. They're done with the cardiac cases. it's a rare light day. So there's an add on case that needs to be done urgently. A woman has an infection in her abdomen. I let the anesthesia attending know i was going to work on a presentation for a conference since there wasn't another cardiac case. My curiosity gets the best of me and I start looking up this next lady on the computer to help the resident in the room out. So the chart says she got the infection from being scratched by one of her two cats... now i'm thinking that this must be some dirty cat, or some really dirty woman. So i'm going through the notes. In the admission note... there are describing this poor woman's case.... scratched by cat blah blah blah... then they get to the physical exam. General appearance -- usually something about the patient's in no apparent discomfort, well nourished etc. -- this chart said "smells like kitty litter" So I warn the anesthesia attending. He's wondering if that should be in the chart at all... it's not a medical description. I argue that it's a fact... not a opinion so it deserves to be in the chart. He goes and sees the patient. I see him in the hall later. and ask him if she smells like kitty litter... He answers "little bit..." I couldn't help but bust out laughing...

Yay

As I said yesterday today was my first day as cardiac anesthesiology attending. As I said yesterday I have bad luck on first days.... long story short... I didn't kill anyone today. Yay.

I'll tell you about my other first days later.

First Days

Tomorrow I'm staffing my first case as a cardiac anesthesia attending. That means I call the shots... and "the buck stops here". I'm worried.. not because I don't think I can do the job, but more because I've had lots of bad first days. I'll tell you about it sometime. Not tonight.

Awareness under anesthesia

Last night I saw a special on Discovery Health about awareness under anesthesia. Awareness is when people can remember some or all of what happens during a surgery under general anesthesia... usually this in combination with being paralyzed so they are unable to tell anybody about it. i wonder how many people saw that special. I wonder if more people will be worried about it. I know it happens... it has never happened to me, as far as I know.I can't say it's because I'm a better anesthesiologist than anybody else. I think it's because I've been lucky.

Most awareness situations occur due to drug error, which is easy enough because of all the different medications that we use. I've made drug errors, anyone who says they haven't is a liar. luckily nothing serious or life threatening has happened because of this, and I try to be careful.

As for awareness, most times it happens in trauma situations and cardiac anesthesia. During traumas, people don't always get a complete anesthetic for the reason that people are worried about keeping them alive. I say that I'd rather have some awareness and be alive then the other way around. As for cardiac anesthesia, I should be worried about thi more since that's my speciality. I think this is a result of the historical perspective of cardiac anesthesia. We tend to now use a much different combination of drugs then we did just five, ten years ago so I think this is less of a problem.

Anyone out there concerned about awareness during anesthesia... it's a valid concern. Awareness is a rare occurrence but it does happen. Talk to your anesthesiologist before your surgery and let them know your concerns. If you have some awareness after your surgery, let your anesthesiologist know! If you don't remember who he or she was, make the department aware of your problem and they should be able to put you in touch with your anesthesiologist. Sweet dreams?!

Doctor aids juror, mistrial declared

Saw this on Fark.com one of my favorite sites.

NORWALK, Ohio (AP) — A judge declared a mistrial in a medical negligence case against a physician after the doctor came to the aid of a juror who passed out during opening statements.

The defendant, Dr. Joseph Carver, told the 74-year-old juror Wednesday that it appeared he had a heart flutter that momentarily prevented oxygen from getting to his brain and caused the blackout. The juror was taken to a hospital for tests.

No new trial date has been set.

Carver, an obstetrician and gynecologist, is being sued for $3 million by a couple who say their newborn daughter was dropped on the floor of a delivery room in 2000 while under Carver’s care.

They say the baby’s fall caused speech problems, seizures and other permanent neurological injuries.

The doctor can't be that bad of a doctor....

I hate my job

I hate my job.

What is my job really. I'm a cardiac anesthesiology fellow. Which means that I've finished training to be an anesthesiologist and that I'm doing speciality training to do predominatly anesthesia for heart surgery. I'm about half way done with my fellowship. This means I'm in the gray zone between being in charge of the case and just following directions.

Anyway, today we were doing a descending thoracic aortic aneurysm repair under hypothermic circulatory arrest. This probabaly requires some explaination. A portion of the biggest blood vessel in the body, the aorta, has enlarged to a size that risks rupture at any time. The surgeon was going to repair the portion of the aorta that comes down through the chest with artificially material. This requires putting the patient on a cardiopulmonary bypass machine (the "heart-lung" machine). The bypass machine does the work of the heart and lung while it is on. For this surgery, once on bypass, the body is cooled to 18 degrees centigrade. The head is than packed in ice to protect the brain and the bypass machine is shut off. This is the circulatory arrest portion. The surgeon then cuts out the diseased portion and repairs it quickly then returns to bypass. While the bypass machine is off, no blood is flowing through the body. The longer the bypass machine is off, the higher the risk of complications to the patient, including death or stroke.

Anesthesia for this surgery is quite complex as well as you can imagine. These patients require complex monitors to watch their status during the operation. These include a big IV, and arterial line to monitor blood pressure, an introducer in a vein in the neck to give lots of blood or fluids through, a pulmonary artery catheter to monitor their heart function during the operation, as well as a double lumen endotracheal tube to isolate each lung so that one lung can be deflated during the surgery. In addition to protect the spine during the procedure, we routinely put in a lumbar drain to take spinal fluid out from around the spinal cord. All in all... before the surgery starts, as anesthesiologists, sometimes we need 2 hours or more to put all the monitors in before the surgery even starts. That is, if all goes well. Sometimes it takes longer. Today it took longer. First of all, the patient had had a difficult intubation in the past. This meant we needed to use a fiberoptic scope to place a breathing tube in the patient. The other monitors went okay until we placed the spinal drain. Suffice it to say instead of a 20 minute procedure, we took almost three hours to place the damn thing. This ultimately included calling another anesthesiologist in, moving the patient to another bed, placing him prone and using xray flouroscopy to place the catheter.... once it was in, we had to move him back to the other bed and place him on his right side, so the operation could take place. Instead of starting the actual surgery at 10ish.(Thursday is a late start day), we started at almost 2pm. About 6 hours of preping this patient before the surgery even started. I wanted to scream.

It amazes me to think that we can do this surgery at all. I'm sure these people must have just died at home somewhere, or in the mall, or at the post office, not ever knowing there was a problem. It amazes me that we can do most of the procedures that it is possible for an anesthesiologist to do before 10 in the morning.

I love my job.

Hello

Hi there. I'm joining the world of the blog. There's a bunch of medical blogs out there, but I haven't seen many in regards to anesthesiology/anesthesia. Sure there are indirect references but not too many specific ones.

I'm not sure anyone understands what anesthesiologists do. Not even the surgeons with which we work every day. Even the title of this blog isn't quite right. Anesthesia isn't just about putting people to sleep. Sometimes it is... not always. Anyway. I have a lot of interesting stories from work. It shouldn't be overly technical or academic, at least not at first. Hopeful this will be an insightful and enjoyable journey. If not, I at least get a chance to vent. Feel free to send or make comments. I'll do my best to address them if anyone actually reads this.