Anesthesiologist Quotes

Imagine someone is racing intentionally towards his own destruction and you can save him - do you go ahead and save him? Imagine there's an operation, and the patient is a drug user and the drugs are incompatible with the anesthetic, but the patient is ashamed of being an addict and does not want to tell the anesthesiologist - do you talk to the anesthesiologist? Imagine a trial and a defendant who will be convicted if he doesn't admit to being left handed - do you tell the judge what's going on? Imagine he's gay, and could not have committed the crime because he's gay, but is ashamed of being gay. It isn't a question of whether the defendant should be ashamed of being left-handed or gay --- just imagine that he is

The second reason caregivers may be silent about the dark side of epidurals is that they generate big bucks for anesthesiologists and hospitals. Epidural charges range from $500 to $2500. A hospital consultant explained to me that hospitals have to maintain staff anesthesiologists around the clock to handle obstetric emergencies. In order for these doctors to make what they consider an adequate income, the hospital has to maintain something like an 80 percent epidural rate. Given this, how strongly do you think medical staff would resist the notion that epidurals are not always a good thing and most women can cope without them?

A good anesthesiologist is essential to any important surgical effort. Without one, the greatest surgeon in the world is helpless. With one, relatively untalented surgeons can look good.

The surgical ICU had its surgeons and anesthesiologists, doctors who wrote the shortest and most indecipherable notes. The notes reminded me of haikus, and because I wasn’t a literary person, I called my time in this unit difficult poetry.

As a result of its investigation, the NIH said that to qualify for funding, all proposals for research on human subjects had to be approved by review boards—independent bodies made up of professionals and laypeople of diverse races, classes, and backgrounds—to ensure that they met the NIH’s ethics requirements, including detailed informed consent. Scientists said medical research was doomed. In a letter to the editor of Science, one of them warned, “When we are prevented from attempting seemingly innocuous studies of cancer behavior in humans … we may mark 1966 as the year in which all medical progress ceased.” Later that year, a Harvard anesthesiologist named Henry Beecher published a study in the New England Journal of Medicine showing that Southam’s research was only one of hundreds of similarly unethical studies. Beecher published a detailed list of the twenty-two worst offenders, including researchers who’d injected children with hepatitis and others who’d poisoned patients under anesthesia using carbon dioxide. Southam’s study was included as example number 17. Despite scientists’ fears, the ethical crackdown didn’t slow scientific progress. In fact, research flourished. And much of it involved HeLa. 18

To my surprise, I discovered that anesthesiologists are a bit in the dark themselves. “How anesthesia works has been a mystery since the discovery of anesthesia itself,” writes Michael Alkire, an anesthesiologist at the University of California at Irvine School of Medicine, in the new Encyclopedia of Consciousness.

Among medical specialties, anesthesiologists benefit from good feedback, because the effects of their actions are likely to be quickly evident. In contrast, radiologists obtain little information about the accuracy of the diagnoses they make and about the pathologies they fail to detect. Anesthesiologists are therefore in a better position to develop useful intuitive skills. If an anesthesiologist says, “I have a feeling something is wrong,” everyone in the operating room should be prepared for an emergency.

But there is also some empirical evidence that sheds light on the relationship between quantum principles and consciousness. Anesthesiologist Stuart Hameroff claims to have found evidence that anesthesia arrests consciousness by hindering the motion of electrons in microtubules, minute tunnels of protein that serve as a kind of skeleton for cells. Hameroff speculates that microtubules could be a possible site for quantum effects in the brain,17 and his speculations have led mathematical physicist Roger Penrose to endorse the hypothesis.18 Attempts to develop models of consciousness based on quantum mechanics have also been made by neuroscientist John Eccles, and physicists Henry Stapp and Evan Harris Walker.o Walker and the experimental physicist Helmut Schmidt (the latter responsible for many of the micro-PK experiments described earlier) have also proposed mathematical theories of psi based on quantum mechanics.19 These theories rest upon two propositions that are now supported by experimental evidence: that mind can influence random quantum events, and that influence can occur instantaneously at a distance.p

Declan Lynch was a liar. He'd been a liar his entire life. Lies came to him fluidly, easily, instinctively. What does your father do for a living? He sells high-end sports cars in the summer, life insurance in the winter. He's an anesthesiologist. He does financial consulting for divorcees. He does advertising work for international companies in English-speaking markets. He's in the FBI. Where did he meet your mother? They were on yearbook together in high school. They were set up by friends. She took his picture at the county fair, said she wanted to keep his smile forever. Why can't Ronan come to a sleepover? He sleepwalks. Once he walked out to the road and my father had to convince a trucker who'd stopped before hitting him he was really his son. How did your mother die? Brain bleed. Rare. Genetic. Passes from mother to daughter, which is the only good thing, 'cause she only had sons. How are you doing? Fine. Good. Great. At a certain point, the truth felt worse. Truth was a closed-casket funeral attended by its estranged living relatives, Lies, Safety, Secrets. He lied to everyone. He lied to his lovers, his friends, his brothers. Well. More often he simply didn't tell his brothers the truth.

I said to myself, This is going to be quick. I also thought: I’ll take the epidural now! Because the contractions were starting to demonstrate what the pain of birth is all about. The obstetrician came in. I smiled, ready for my shot. “I don’t know how to tell you this,” she said. “Your platelets are really, really low.” “Okay,” I said. I knew what platelets were-blood cells whose job it is to stop bleeding-but I had no idea why that was significant. “So, my epidural?” “You can’t have any medications.” “Come again?” “No drugs, no medications,” she said. “No epidural. I’ve called around to different anesthesiologists, and no one will touch you.” “No epidural?” “Nothing.” There are girls from third-world countries who do it with no drugs, I reminded myself. My mother elected for natural childbirth. How bad can it be? I got this. It started to hurt. I thought to myself, I am not going to cuss. Hell no! I am about to be a mother. I am bringing our baby into a positive environment and must be a good role model. Wow! The contractions built up quickly. My pristine vision of perfect, calm, quiet childbirth disappeared. A banshee snuck into the room and took over my body. Arrrgggh!!! No cursing! There was a rocking chair in the birth room. I went over and sat in it and began moving back and forth. Chris put on a CD by Enya that we’d brought to listen to: peaceful, pleasant music. I took a deep breath. Jeez, Louise! That one was a monster! Then, a breather. I’m doing goooooood! Breathe. Breathe… Wow! Then I said some other things. The banshee had a mind of her own. “I’m sorry, I’m sorry, I’m sorry!” I apologized to the nurses as I recovered from the surge of the contraction. “It’s okay,” said Chris. The pain surged again. Dang! Jiminy! And other things. Chris would watch the monitor. Suddenly he’d turn to look at me. “What?” I asked. “That was a strong one.” “Uh-huh.” The funny thing is, the stronger the contractions were on the monitor, the less they seemed to hurt. Maybe when things are really bad you focus more on being tough. Or perhaps my brain’s pain mechanism simply went on strike when the agony got too much.

In recent years, a trend toward a more restrictive approach to transfusion therapy has emerged.9,10 For example, as per the American Society of Anesthesiologists Task Force transfusion guidelines, RBC transfusion is rarely indicated when the hemoglobin (Hgb) concentration is above 10 g/dL and is usually indicated when the hemoglobin is less than 6 g/dL.2

Dr. Charles Carrico was the first doctor to examine Kennedy as the President was being wheeled into the hospital. Carrico observed two wounds: a small bullet wound in the front lower neck and a large, gaping wound in the President’s head.3 He also noted that Kennedy “was blue-white or ashen in color, had slow, agonal spasmodic respiration without any coordination; made no voluntary movements; had his eyes open with the pupils dilated without any reaction to light; evidenced no palpable pulse; and had a few chest sounds which were thought to be heart beats.”4 No less than twelve doctors were soon at work on the President and Governor Connally. This group included four general surgeons, four anesthesiologists, the hospital’s chief neurologist, a urological surgeon, an oral surgeon, and a heart specialist.5

I joked with the anesthesiologist for a while, and then a nurse handed me a baby.

The day of Mia’s first surgery was not only a big day for her; it was a big day for me, too. Handing my three-month-old daughter to the anesthesiologist and watching her walk away with my baby was one of the most heart-wrenching things I have ever done. I knew that Mia was in someone else’s care and that I had absolutely no control over what happened to her until after the procedure. I tried my hardest not to cry, but after the anesthesiologist walked through the secure doors, I broke down in Jase’s arms. He was very emotional about the situation, too, but the two of us handled our intense feelings in different ways. I went to join our family in a large foyer area, where about fifteen of them had gathered to support us, and Jase headed outside to a small grove of trees near the parking lot. As I mentioned earlier, being outdoors makes Jase feel closure to the Creator, who he knows can do mighty things. That grove of trees, which was surrounded by such a large concrete jungle, became a special place for Jase, a place where he said many heartfelt prayers.

Jase, Mia, and I arrived at the hospital early the next morning to what seemed like a replay of Mia’s surgery one year earlier--same hospital, same preoperative area, and same room setup. Over the next few minutes, her room filled up with people, including Reed and his girlfriend of three and a half years, Brighton, who had both driven in from college. Mia loves being silly with them, and I snapped a picture of the three of them. Mia’s cousins also surrounded her to play a game of Old Maid, thanks to the deck Mamaw Kay pulled out of her purse. Everyone was cracking jokes, taking pictures, and, well, just being themselves. All this activity helped keep Mia, as well as me and Jase, thinking positively and staying upbeat. Mia opted to not take the goofy juice this time. She told me she wanted to be awake and alert so she could tell everyone goodbye as she was being rolled back through the operating doors. Whoa! I wasn’t so sure about this. Jase thought it was very brave of her and that we should let her do it. Reluctantly, I agreed. Dr. Sykes, the anesthesiologist, said he would tell her every single thing he was going to do before he gave her enough gas to first make her silly and then to put her to sleep. She was all for it. However, as Dr. Sykes rolled her away, tears formed in Mia’s eyes. I had to keep myself from shouting my thoughts: Wait! Are you sure about this, Mia? You don’t have to go in like this! Let’s rethink this goofy juice thing! I watched Mia’s face closely to catch the slightest glimpse of her wanting to change her mind. There was none. Even though she was scared, she pushed through, and Jase and I let her. We both followed the gurney with tears in our eyes, but she never saw them.

Damn, woman,” he said as the anesthesiologist left. “That needle was huge.” “Thanks, Ian,” I deadpanned. “But I wasn’t worried.” He winked and slid his hand over mine. “You’ve taken much bigger than that.

Anesthesiologist,” I tell him. “Sì.” He smiles at me. It’s a goofy, toothy grin. His nose is large and his ears stick out, but I like how his thick black hair gets in his eyes when he tilts his head to bite into the pear. He runs a hand through it to push it back, but it doesn’t help. There is a snap as he bites through the pear’s skin, into the flesh, peeling it with his teeth. I watch his throat work as he eats. A bit of juice disappears beneath the collar of his shirt. His mother huffs, pretending exasperation, and gets him a napkin. This is Paul and Hannah’s apartment—Donato and his parents live one building over—but I can tell by how he stretches across the living room couch, how his mother directs my brother-in-law in the kitchen, that they might as well live here too. “Marie’s teaching me how to make a proper cacio e pepe,” Paul calls to me from the stove. The pot of boiling water is making the room muggy. Marie goes to prop open the front door. “You have not seen Hannah since her mamma’s funeral?” Donato asks, watching me from the couch. He has very light brown eyes, fringed with thick lashes and full, almost feminine lips that are slick and shiny from the pear juice. I can feel him assessing me. Taking in the box-dye job, the blunt haircut I managed to fit in between visits to the nursing home and my red-eye flight. It’s shorter than I wanted and feels uneven. It looks exactly the same, Guy assured me before dropping me off at the airport. “Over a year now,” I say, trying not to fidget. He raises an eyebrow, still enjoying that pear. I refuse to feel guilty. Paul had left for Italy soon after the funeral, taking Hannah with him. And I had my mother to think of, her grief was insurmountable. It affected everything. She did not want to go outside, she did not want to eat.

SHIT!” the anesthesiologist exclaimed. “I forgot to put him to sleep!

Teamwork may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise—in the operating room, for example, there is the surgeon, the surgical assistant, the scrub nurse, the circulating nurse, the anesthesiologist, and so on. They can each be technical masters at what they do. That’s what we train them to be, and that alone can take years. But the evidence suggests we need them to see their job not just as performing their isolated set of tasks well but also as helping the group get the best possible results. This requires finding a way to ensure that the group lets nothing fall between the cracks and also adapts as a team to whatever problems might arise.

When she got back to the house, Cora was awake and at the computer and groaning. “Can I get you something?” Grace asked. “An anesthesiologist,” Cora said. “Straight preferred but not required.” “I was thinking more like coffee.” “Even better.” Cora’s fingers danced across the keyboard. Her eyes narrowed. She frowned. “Something’s wrong here.

Suppose a surgeon and an anesthesiologist could not communicate with each other except through a hospital administrator about a patient on an operating table, he said. “Instead of [an] exchange of information [among] people who are attempting to accomplish a result . . . , we have made it virtually impossible.” Olson went on, “In order to connect the dots someone has got to have knowledge of those various different dots.

The surgeons couldn’t take their performance with them. They weren’t getting better at performing coronary artery bypass grafts. They were becoming more familiar with particular nurses and anesthesiologists, learning about their strengths and weaknesses, habits, and styles. This familiarity helped them avoid patient deaths, but it didn’t carry over to other hospitals.

At a medical convention, a male doctor and a female doctor start eyeing each other. The male doctor asks her to dinner and she accepts. As they sit down at the restaurant, she excuses herself to go and wash her hands. After dinner, one thing leads to another and they end up in her hotel bedroom. Just as things get hot, the female doctor interrupts and says she has to go and wash her hands. Once she comes back, they go for it. After the sex session, she gets up and says she is going to wash her hands. When she comes back, the male doctor says, "I bet you are a surgeon." She confirms, and asks how he knew. "Easy," he remarks, "you're always washing your hands." "That's very clever!" she says, "I bet you're an anesthesiologist." "Wow, how did you guess?" he asks. And she replies, "I didn't feel a thing!

Dr. Abhinav Gautam, an anesthesiologist trained at the University

There wasn’t much more to it. But getting teams to stop and use the checklist—to make it their habit—was clearly tricky. A couple of check boxes weren’t going to do much all by themselves. So the surgical director gave some lectures to the nurses, anesthesiologists, and surgeons explaining what this checklist thing was all about. He also did something curious: he designed a little metal tent stenciled with the phrase Cleared for Takeoff and arranged for it to be placed in the surgical instrument kits. The metal tent was six inches long, just long enough to cover a scalpel, and the nurses were asked to set it over the scalpel when laying out the instruments before a case. This served as a reminder to run the checklist before making the incision. Just as important, it also made clear that the surgeon could not start the operation until the nurse gave the okay and removed the tent, a subtle cultural shift. Even a modest checklist had the effect of distributing power. The surgical director measured the effect on care. After three months, 89 percent of appendicitis patients got the right antibiotic at the right time. After ten months, 100 percent did. The checklist had become habitual—and it had also become clear that team members could hold up an operation until the necessary steps were completed.

I’m Jay Powers, the circulating nurse”; “I’m Zhi Xiong, the anesthesiologist”—that sort of thing. It felt kind of hokey to me, and I wondered how much difference this step could really make. But it turned out to have been carefully devised. There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do. And Brian Sexton, the Johns Hopkins psychologist, had done studies showing the same in operating rooms. In one, he and his research team buttonholed surgical staff members outside their operating rooms and asked them two questions: how would they rate the level of communications during the operation they had just finished and what were the names of the other staff members on the team? The researchers learned that about half the time the staff did not know one another’s names. When they did, however, the communications ratings jumped significantly. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These were limited studies and hardly definitive. But the initial results were enticing. Nothing had ever been shown to improve the ability of surgeons to broadly reduce harm to patients aside from experience and specialized training. Yet here, in three separate cities, teams had tried out these unusual checklists, and each had found a positive effect. At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork. Eleven surgeons had agreed to try it in their cases—seven general surgeons, two plastic surgeons, and two neurosurgeons. After three months, the number of team members in their operations reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals in Southern California, researchers had tested their checklist for six months in thirty-five hundred operations. During that time, they found that their staff’s average rating of the teamwork climate improved from “good” to “outstanding.” Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors. In

She had put off getting her epidural prior to her water breaking because she did not think that the contractions had been painful enough to warrant it. This was a mistake (her words). She requested an epidural shortly after that, but unfortunately for her, several other women were also in labor, and there was a limited number of anesthesiologists in the unit to administer the epidural, so she was effectively last in line to receive it. It took approximately three hours between her water breaking to when she received her epidural, and even after that, it took some time for the drugs to have an effect. Throughout those hours, my wife looked like she was in a tremendous amount of pain, and it made me worried that something was wrong.

The anesthesiologist had a point. Magnetic resonance imaging equipment surrounding the patient’s head provided three hundred and sixty degree visibility of the entire lower brain cavity. The delicate depression known as Turk’s Saddle, which housed the pituitary gland, was clearly visible on a bank of monitors mere inches from Rick’s keenly scanning eyes. And the tiny flexible penlight snaked carefully up the boy’s left nostril into the sphenoidal sinus gave an unmistakable close-up view of the organ in question.

The other feature of this list is that many of these signals could easily be viewed as obvious and redundant. For instance, do highly experienced professionals like nurses and anesthesiologists really need to be explicitly told that their role in a cardiac surgery is important? Do they really need to be informed that if they see the surgeon make a mistake, they might want to speak up? The answer, as Endmondson discovered, is a thundering yes. The value of those signals is not their information but in the fact that they orient the team to the task and to one another. What seems like repetition is, in fact, navigation.

Tracey Vogel, an anesthesiologist also trained as a rape crisis counselor, told me that trauma-informed care, crucially, shifts power. "It takes us from 'I am your doctor, and this is what I'm going to be doing to you' to 'I want to know what you might need from me,'" she explained.