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 Kashmiri Surgeon and the Goat (Bakra)

The media is abuzz with Kashmir and upcoming festival of Bakri-Eid. This triggered Dr. Dev’s memory of an incident from Surgery Department of AIIMS, New Delhi, involving a Kashmiri doctor and a slaughterhouse (he-goat) when he was a junior resident there.

Dr. Kool (Fictional Name), who was from Kashmir, was the senior resident in the Surgery unit III in AIIMS. He was quite a charmer with a taste for all good things in life. 

Once a patient got admitted in the surgery unit, whose emergency operation was done successfully by Dr. Kool. At the time of discharge from the hospital, the patient’s elder brother noted Dr. Kool’s mobile number and asked him what could he do for him to show his gratitude for saving his brother’s life. 

Dr. Kool offhandedly remarked him to bring 'bakra' (he-goat) the next time he comes to visit him. As Indians all know, the meat of Bakra or goat is most frequently eaten meat in India. 

One week later, Dr. Kool received a call from the patient’s brother, while he was taking the evening round in the D7 surgical ward. The brother said, ‘As requested by you, I have bought the 'bakra' for you. Where should I bring it?’

Dr. Kool, imaging it is must be 1 or 2 kg of cooked goat meat, asked him to bring it to the D7 surgical ward. The surgical ward was on the 7th floor of the hopsital building. After some time, the patient brother reached the D7 ward towing a large live goat with a rope tied around his neck and proudly announced, ‘Sir, here is the 'bakra' as requested by you.’ 

On seeing the live goat in front of him in the D7 surgery ward, a normally loquacious Dr. Kool become speechless. 

The patient’s brother had taken the literal meaning of Dr. Kool’s word of bringing a 'bakra'. He brought the live goat to Delhi in a bus from his village, then in an auto-rickshaw to AIIMS. On talking to Dr. Kool on his mobile phone from outside the hospital, he bought the goat through the private ward lift, normally reserved for the Staff and only private ward patients. When the guards tried to stop him, he countered that he is taking the goat to the surgery ward on order of Dr. Kool.

Dr. Kool explained to the patient’s brother that he meant goat meat, not a live goat when he asked him to bring ‘bakra’. The brother then took the goat to a slaughter house in Delhi, and then bought the meat to Dr. Kool’s residence. Dr. Kool’s wife cooked the goat meat and gave a big party to all the surgery unit III members at their home.

We should be careful about what we wish for. Someone may take our word literally and try to fulfill them taking unnecessary pain and hardship.

(Based on an allegedly true incident)

— ND
© Author. All rights reserved. 

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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 Brahmin, the Cow and the Cardiologist

There is an ancient story of the Brahmin and the old cow. The Brahmin had a lovely garden which he had designed, constructed and took care with great love and labor. He used to proudly show his handiwork to the people who used to come from faraway places to view his garden. 

Once an old cow entered the garden and started eating plants. The Brahmin on noticing this got enraged and started beating the cow with a stick. The old sick collapsed from the beating and died. Once the fit of rage had passed the Brahmin realized his mistake and got guilt-ridden. 

There was an uproar when the villagers learned of the cow’s death, considered a holy creature. The Brahmin being a learned person thought of a way put the death of the cow on someone else. 

When the villagers gathered to punish the Brahmin for his crime of killing the holy creature, the Brahmin explained, ‘Lord Indra (Hindu God) is the deity presiding over the hands. The cow died due to Indra’s fault as he was the controller of my hand. So Lord Indra should be blamed for the cow’s death and not me.’ 

The villagers got convinced by the brahmin’s argument and the news spread like wildfire that Lord Indra was responsible for the cow’s death.

When the news reached Lord Indra ear, he was mortified to be blamed for the holy cow’s death. Taking the form of a traveler he reached the brahmin’s village. 

On reaching the brahmin’s garden, he asked him to show him the garden of which he had heard so much praise.  The disguised Indra asked, ‘Who had designed this garden?’ the brahmin proudly replied, ‘I did.” When they reached the lovely flower beds the disguised Indra asked, ‘who had planted these lovely flowers?’ The Brahmin proudly replied, ‘I did.’ When Indira asked, ‘who had planted these tall trees? The Brahmin again proudly replied, ‘I did.’ 

Similarly when Indira asked, who had watered the garden, removed the weeds, constructed the flower beds the Brahmin proudly replied ‘I did!’ to all these questions. 

Reaching the spot where the cow had died, the disguised Indra asked, ‘Who had killed the cow at this spot?’ The Brahmin caught at this sudden twist in the questioning replied, ‘Err, Indira killed the cow.’

Showing his true form, Lord Indira asked the Brahmin, ‘When you take personal credit for the construction and upkeep of this lovely garden, how can you blame me for killing the cow?’ ‘The praise and blame are both yours alone,’ saying this Lord Indira vanished.

Now let’s come back to the present times. I was visiting a friend admitted to a large multi-specialty hospital. I noticed an old lady sitting with tears in her eyes and prayer on her lips in front of the angiography cath lab. It appeared that her husband was undergoing emergency angioplasty procedure to restore the blood supply to the heart after a severe heart attack (MI – Myocardial Infarction). 

Shortly afterward, the door of the cath lab opened. The cardiologist who was performing the angioplasty procedure walked out with a swagger and style which would have been difficult for even Salman Khan or Shahrukh Khan to copy. Putting his hand over the lady’s shoulder like a God bestowing a boon on a supplicant, he said, “Don’t worry Amma (old lady). I had done an excellent operation and saved your husband’s life.” The woman gave a look of gratitude and effusively thanked the cardiologist. 

But mishaps can happen, and if perhaps the woman’s husband had not recovered and died in the hospital, would the same cardiologist have come and said, ‘I had botched the operation and killed your husband?’ 

In the above story, we see how the Brahmin wanted to take all the credit for himself but in the case of accusation, he didn’t want to accept it and he wanted to blame others. This is a perfect representation of our nature.

Doctors today are quick to take credit for a patient’s recovery, perhaps as; compensation for the long hard work they do, pride in their skill and knowledge acquired through years of hard work and study, to satisfy their egos or to justify their hospital charges.

 The patient’s general condition and immunity, the disease stage, facilities available in the hospital and the city, the help and effort of the other staff members and even the patient’s relatives, and if you are so inclined then God’s grace or luck factor should be also routinely given credit for patient’s recovery so that the public become conditioned that the outcome of patient’s treatment is not due to the doctor’s treatment alone. Other factors may play a more important part in the death or recovery of patient.

If a patient’s death cannot be blamed on the doctor alone, likewise his recovery cannot be credited to the doctor alone.

 (Based on an allegedly true incident)

— ND
© Author. All rights reserved. 
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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.