The anesthesia world is spinning up to a tizzy over the upcoming theatrical release of the movie "Awake." For those of you living "off the grid", Awake is a story about a poor victim who has the extraordinary misfortune to be subjected to cardiac surgery awake/paralyzed. None of us have seen this movie, but advanced word is the anesthesia folks aren't favorably depicted.
I am really, really looking forward to its release. For a lifetime, I have wholly devoted myself to my craft; medicine and anesthesiology. While I have not minded being in the background behind my surgeons, I have, over thirty years, grown tired of the surgical attitude that what I do is trivial; of course it is, because if it weren't, well, they'd be doing it themselves, wouldn't they? And if I and my colleagues had been made of better stuff, we would have gone into surgery. What a load of nonsense.
One slip of the surgeon's knife, and a patient's meaningful life is over. Just so, one mistake with a syringe of vecuronium, and a patient is dead, or perhaps, worse than dead... The truth is, if I don't practice smartly and on form, patients will suffer and perhaps die in ways both obvious (aka "Awake") and subtle (ie high blood glucose leading to higher post-op infection rates) It's about time everybody understood it. It doesn't help when colleagues (especially CRNA's, I note over the years) minimize what they and we do; "oh you're going to take a little nap while your (big strong) surgeon operates on you." I even avoid the use of the word sleep to describe what I do. I usually say "sleep is what you do at night. It is free and natural, but if your surgeon were to attempt to operate while you are asleep, you would wake up in great pain. What I provide is drug induced unconsciousness, not unlike a temporary coma. You will not wake up until I reverse the process. It is a safe procedure in my hands, and I will stay with you the entire time to maintain this state and see you safely through." I have no tolerance for anybody who suggests that I am scaring patients like this; it is simple truth, which is the stuff of informed consent.
For every patient that says "oh, doctor, anesthesia is soooo important," I have ten patients who believe that I belly up to the table with a syringe of clear stuff, inject it, and walk on to the next room, or out for a cup of coffee... ("who was that masked man? I don't know, but he left this bill pinned to my dickie...")
A little patient apprehension about their upcoming anesthetic is a good thing-it's appropriate. And if the patients get the idea that who is giving their anesthetic; their education, dedication, compassion and diligence, matter to their outcome, well, then, so much the better. Because it's true.
Where I come from, there' was a saying; "a good surgeon deserves good anesthesia. A bad surgeon needs it." I can't remember all the times I've had to hold a patient together physiologically while the surgeon tried to work his way out of a nasty situation. I have auscultated the hearts of 20000 patients to avoid missing that once-in-a-lifetime patient with critical aortic stenosis who would otherwise die on anesthesia induction (I've found 2). I've sniffed around thousands of diabetics for a whiff of the coronary artery disease that might progress to a fatal perioperative MI. I've sat on the floor of the holding area hundreds of times looking up at anxious three year olds and their parents, quickly forging a rapport that I could leverage into a less scary induction.
I can deal with healthy patient fear; it just takes a little time, some patience and explanation. I hope that every patient for the rest of my career has the good sense to ask me what I'm going to do to keep them alive, and how I'm going to prevent the excruciating agony of their being awake "under the knife", and then I hope they look me in the eye as I explain it all, to be sure they see a soul they can trust.
And if anesthesia leadership on both sides of the aisle (AANA and ASA) settle for some bland reassurances about anesthesia diligence and try to undermine the message of "AWAKE" by pointing out the inevitable inaccuracies they will find in the movie, than they (and we) ought rightly to be banished to the back benches of the medical pecking order.
I say, "bring it!" I'll be there on opening night with a big bag of popcorn to assuage my vicarious anxiety...