The Three Anesthetists

In the government sector, the surgeons have few operation days in a week, while the anesthetists are daily in the Operation Theatre (OT). The surgeon also spends more time in contact with the patients in the preoperative (before the operation, i.e. in the ward and OPD) and postoperative (after operation) period. This leads to some change in the perspectives of the two important teams involved in the surgical care of the patient.

In most government sector hospitals, the OT working hours are fixed. It the OT runs beyond the fixed time the doctors and other staff do not receive any overtime for it. In contrast, in the private sector, the anesthetist may get extra money if their working time gets extended. Many are paid on case to case basis. So the monetary incentive to do more number of cases is a driving force for the anesthetist in the private hospitals.

A dilemma is sometimes faced by the OT team in the government sector. Suppose the OT working time is till 3.00 pm and the second last case on the OT list finishes at 2.15 pm. The next case is expected to last an hour. By the time the second last case is shifted outside to recovery room and the next case starts it will be 2.30 pm and then the last case will finish by 3.30 pm. 

At this juncture, the decision to be made is whether to stop the OT working 45 minutes early and cancel the last case or take the last case and work 30 minutes extra without any compensation.

Many surgeons request or pressurize the anesthetist to take the last case and extend the OT hours. There may be personal involvement, a feeling of doing the case for learning  purpose (especially by junior surgeons) or the surgeons see in the ward the inconvenience and hardships faced by the patients and their relatives if their operation gets postponed or fear of angry response by the patient’s relatives including abuses, physical violence, and complaint to administration. 

Depending on their response, Dr. Dev observed, different types of anesthetist while working as a junior and senior resident in AIIMS, New Delhi. 

One type of anesthetist will flatly refuse to take the case if there are chances that the OT time may get extended if they take the case. Some naïve surgeons do not like this fact while it for the betterment of all involved. 

The surgical team gets time to take a detailed round of the ward and the operated patients in the extra time saved in the OT. The surgeons get time for academic activities. The junior residents get time to have lunch when is it still daytime not in the evening. The nursing staff gets time to better wash and sterilize the instruments. The patient is saved from a hurriedly performed surgery by a tired team of surgeons and nursing staff all for a little inconvenience, some social and economic hardship to the patient. Such anesthetists are the true friends of the surgeons.

Faced with such type of anesthetist, the surgeon better work fast and complete the cases well in time, keep a short duration case as a standby at the end of the list or keep some cases to be operated under local anesthesia in the remaining time available.

The second type of anesthetist is like Dr. Raageshwari (Fictional Name). When the residents of the surgery department, AIIMS, New Delhi, used to approach her to take the last case, she used to ask who is going to do the operation. 

If the resident assures her that Dr. Sunil Chumber, consultant surgery, AIIMS, New Delhi would operate the case she used to frequently take the case. Her logic was as Dr. Chumber was the fastest surgeon in the unit, the surgery will not be unnecessarily prolonged and she may not be delayed too much. 

So, the residents used to ask Dr. Chumber, whether he will stay back to operate the case before approaching Dr. Raageshwari. Or if the residents wanted to do the operation themselves for learning purpose, then it was better not to ask Dr. Raageshwari to take the case. Better to postpone the case and do it next time.

The third type of anesthetist was like Dr. Bindu Pandit. She was most flexible in extending the time limit of the OT in the patient’s and resident’s interest. 

Again when the residents used to approach her to take a case late in the day, she used to ask who will do the case. If residents assure her that they (junior and senior residents) will do the case and not by any consultant or faculty member, she used to frquently take the case for the training and learning process of the residents. 

Once, Dr. Dev, then senior resident in AIIMS, approached her to take a case when the OT time was almost over. When he explained that it was an uncommon case that he had never done before and it will take only 30 minutes. If posted in the next OT, the consultant may operate the patient and they will be denied a golden learning opportunity, she took the case. But when the case lasted an hour she got mildly angry at Dr. Dev as he had promised to finish the case within 30 minutes and took double the time. 

But being a great lady with great compassion towards the resident, her anger just lasted a day, and she kept on cooperating with residents even after this incidence. A word of thanks to the great anesthetist, Dr. Bindu Pandit, who helped so many residents get experience in the OT.

 (Based on allegedly true incidents)

— ND

© Author. All rights reserved. 

Just joking: The anesthetist plays a very important role in the safe conduct of any operation and deserves the respect of the highest order.

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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.

The CPR Exam

Dr. Dev (Fictional name), while still an MBBS student, appeared for his Anesthesia department’s end of posting practical exam. Dr. Dev had been irregular in going to the practical posting classes. Dr. Raageshwari (Fictional Name) was taking the exam.

As part of the exam, Dr. Raageshwari asked Dr. Dev to demonstrate the external cardiac massage part of the CPR (Cardio-Pulmonary Resuscitation) on the electronic life-size dummy. The dummy was equipped with sensors and gave an indication if the CPR was being done properly or not, such as the palms/ hands are in right position and whether adequate force is being applied or not.

For Non-Medicos: In external cardiac massage the lower part of the central chest bone (the sternum) is pressed down with hands. The bone moves downwards and compresses the heart lying below it to passively pump blood from it to the body via the aorta, the biggest artery in the body. When the pressure is released the heart passively expands, like a hollow ball, sucking the blood from the body via the veins. This ensures that blood keeps circulating in the body when the heart has stopped due to some disease, until the time the doctors get it to start working again.

Dr. Dev went to where the dummy was kept on the bed. He checked and placed his hands, palms on over another at the location which he had learned from the books, elbows extended (straight) and locked and applied pressure.

A warning beep sounded and red indicator light turned on indicating that Dr. Dev was not giving the external cardiac massage properly. Dr. Raageshwari looked at Dr. Dev with an amused look on her face. A worried Dev re-checked the position of his hands; they were in proper anatomical site. He re-checked his elbows and body position and once again applied pressure more than previously. Again the warning beep and red light turned on. The look of amusement on Dr. Raageshwari face broadened. She asked Dr. Dev, “What is the problem? Why are you not able to give a proper cardiac massage?”

Dr. Dev frantically raced his mind to crack this mystery of inadequate cardiac massage. Suddenly it dawned on him the reason for the inadequacy of the cardiac massage.

Dr. Raageshwari had the dummy intentionally placed on a particularly soft mattress with spring bed. So whatever the force Dr. Dev applied to push the chest bone down to compress the heart, it used to get absorbed by the mattress and spring bed. So the heart was not getting compressed adequately despite proper technique on Dr. Dev’s part.

Dr. Dev answered to Dr. Raageshwari, “Ma'am, the dummy is lying on a soft mattress which is absorbing the force being applied. Therefore there is not adequate compression of the heart.”

Dr. Raageshwari asked, “Did you not attend the class on CPR during the posting?” “Yes ma'am, I did attend the CPR class during the posting” promptly replied Dr. Dev.

“It was told clearly in the class to check the surface the patient is laying on before starting the CPR. It was clearly told in class to put the patient on floor or put a hardboard below the patient if the bed or mattress is soft. If you had really attended the class then how come you do not remember this?” asked a perplexed Dr. Raageshwari.

Dr. Dev tried to salvage his practical exam going downhill. He raced his brain for some plausible explanation and replied, “Ma'am, I did attend the class, but it was taken quite some back and I had therefore forgotten this point.”

Dr. Raageshwari informed Dr. Dev, “The CPR class was held just yesterday and I know this very well as I had taken it.”

Needless to say, Dr. Dev was rendered speechless.

But luckily for Dev, Dr. Raageshwari was a kind teacher and did not cut his marks for his tall tale of attending CPR class and gave him marks commensurate with his overall performance.

Tip: Always attend all your classes.

Tip: If you do not attend all classes than at least attend those classes which are near your exams.

Tip: If not possible then at least do attend all classes taken by your future potential examiner/s.

Tip: If even that is not possible for you then at least find out beforehand which class was taken when and who was the faculty taking them before going to exam.

Tip: If even that is not possible then at least find out beforehand which class was taken and when by the examiner.

 (Based on true incident)

— ND
© Author. All rights reserved. 

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behaviour illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behaviour illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.