An anaesthetist’s day
The night before, I look through the theatre list of patients I will be meeting on the day of surgery. I make a note of what medical conditions I have to be aware of for each person, what potential issues I may encounter for each one, and specific surgical requirements I need to take note of in order to support my surgeon so that optimal outcomes can be achieved. On the day of surgery, I arrive early to prepare, which means drawing up all the necessary drugs in advance, the anaesthetic machine is adequately checked and making sure I have all the equipment and anything else I might need to execute a safe and effective anaesthetic plan.
In theatre, we work in teams. This involves communicating plans to the nurses and technicians who help make the operation possible. These key people need time to prepare their workstations as well. There are many moving parts that need to be in alignment.
Today’s is a list of adults requiring general anaesthesia. Each patient is consulted with before their anaesthetic, and an intravenous cannula is placed before the patient enters the operating room. Airplane take-off and flight metaphors are often used to describe what happens next: a sequence of events that every specialist anaesthetist has trained to do safely and effectively many-times over, individualised to the age, physical status, health condition of the patient. It looks easy, and because of how we have been trained, we make it look easy. If this is done right, and the right mix of drugs are selected accounting for patient, surgery and anaesthesia factors, the case is able to run without a hitch. I am constantly on alert while the operation is happening as the patient is unconscious, watching monitors and being aware of communication in theatre. While the surgeon operates, I am also anticipating a plan for the patient’s immediate post operative recovery: how much pain relief the patient will need, and crafting a plan on the drug chart, how much intravenous fluid to keep going, for how long, what medications to continue or stop...I am used to making all these micro-decisions. All the time, the mood in theatre is kept light, some banter, a bit of background music - after all everyone performs their best when relaxed. All the time, I am aware of what is at stake.
Throughout all this, the surgeon is able to operate under perfect conditions. When the last stitch is thrown, the medically-induced coma needs to be reversed (the plane brought in for landing) - again, this too takes experience and skill to perform well. The most critical periods are at the start and end of anaesthesia. Blankets are tucked around the patient to ensure he is kept warm. A quick glance at the monitors, constant oxygen delivery to the patient is ensured via a mask, and the patient is transported to the recovery area.
Once there, I handover the patient’s clinical status to the recovery nurse following a systematic approach I am used to repeating, highlighting any pertinent events that might have happened during the case that could impact the ongoing care of the patient. I linger by the bed observing the patient’s airway, the rise and fall of their chest, their colour, their disposition, make my final notes and changes to the drug chart, quick glance at the monitor and it is back to meet the next patient and prepare for their anaesthetic. A quick stop for a loo break and a swig of coffee on the way.
During the course of the next few patients, the baseline sequence of events remains similar, but I treat low blood pressure, an unexpectedly erratic heart rate, an airway crisis, unexpected blood loss which the surgeon takes a bit of extra time to control. I have to adjust the anaesthesia to meet this need. At some point, I am called back to recovery to optimise post-operative pain treatment and chart an extra anti-nausea drug. A patient is assessed as requiring a nerve block - my anaesthesia nurse and I pivot to accomodate this.
Surgery is dynamic. Anaesthetists are trained in anaesthetic delivery and to cope with rapidly changing events. I often quip that I am a glass half empty sort of person, which makes my patients laugh, but I think it’s a good mindset to have as an anaesthetist.
By list's end, it’s 7pm. After a day of operating, I bid my theatre team farewell and express my gratitude for a good day. I go back to the recovery room to check on my last patient and make sure the nurses are happy before I leave. I update the surgeon to let them know all is well before heading down to the tea room for a quick break before the drive home. I lust love catching up on the daily news on ABC.
*the above is a creative re-telling of a day in a life account as an anaesthetist. Some technical details and events have been compressed to preserve the flow and readability of the blog post. Attempts have been made to remain as generic as possible yet preserve the overall factual nature of the work that is carried out. The patient/patients mentioned are fictitious.
