A Sobering Case

This post is inspired by a recent post by T. at http://anesthesioboist.blogspot.com/2008/08/losing-patients.html, (Maraming Salamat, Po) wherein she so eloquently describes the thoughts of many health care providers who have experienced losing a patient. I had started to post a comment on her blog, but found myself with so much to say.

I have lost patients before. Most times, I felt that it was out of my hands, that the patients were so sick. Nonetheless, it is emotionally difficult to have patients die, to call loved ones, and tell them of their loss. It was not easy for me, but it became part of the job during medical school and internship. Things changed when I entered anesthesia. Anesthesiologists are, "the Guardian of the Patient." We protect the patient from harm. But under anesthesia, a patient's condition can change so quickly. And like so many others in the field, I find myself wondering if there is anything I could have done differently. Should I have used different induction agents? Given them more slowly? Premedicated them differently? Cancelled the case? Can I really do this for the rest of my life? Am I really cut out for this career? Do I love it that much? Such was the case last Spring.

During the last two months of my residency, I was feeling confident, having done the most difficult cases on the sickest patients in the metro, and having done them well. I had worked with this particular surgeon a lot in the past few weeks, and had gotten a compliment from him that my cases went very smoothly, so when I was scheduled to do another case with him, I chose to follow a similar plan as I had been using. Since I was weeks away from graduating, my attending let me make all the decisions regarding induction, maintenance, and emergence. The case went well, but things got complicated post-operatively. Without going into detail, things went downhill fast. I called for help, and within seconds, there was a team of health care providers resuscitating the patient. The patient's blue, barren countenance is entrenched in my mind. Although the image fades in and out of focus, it remains a permanent fixture in my memory, affecting the way I go about my job, guiding the decisions I make regarding the anesthetic I administer. It has a voice that reminds me to go through my daily checklist again, triple check the drugs and concentrations that I draw up, watch the patient and monitors vigilantly, be especially thoughtful during induction and emergence. This is what the image has become, having evolved from a deterrent for me to continue a career in anesthesiology.

The patient did fine; she went home without sequelae. Immediately after the event, I took a few minutes to run to a stall in a distant restroom to release the tears I had held back during the resuscitation. After I returned from my catharsis, I faced my next patient and told him, "You are the most important person to me right now." I meant it. I face each new patient with the same mantra, and it balances the spectre from the previous case that keeps me respectful of how fragile the human body can be, and what a responsibility it is to watch over it.