Anesthesia Lessons
The Continuing Education of Doctors
I am a voyeur of human anatomy. Not in a perverse sense, but rather as part of my profession. In a single day, I can watch a heart beating in its chest cavity in one operating room, walk two doors down to view an exposed brain, and then cross the hallway to an abdomen incised down the middle to expose the organs and viscera inside. I see joints replaced with shiny, new prosthetics, and I see diseased organs removed: thyroids, adrenal glands, ovaries. I even watch the exploration of places unseen, as cameras attached to catheters dive deep into the pulmonary tree or stomach, or climb up the colon or ureters.
Anesthesia touches nearly every area of medicine, and beyond the pieces and parts of anatomy, I also get to see the range of human life as it inevitably unfolds each day.
Today was no exception.
My oldest patient was ninety-three, my youngest was a newborn baby, and there was everything in between. I saw the healthy who needed minor procedures. Those with infections that required debriding. The twenty-something year-olds trying to get pregnant or their counterparts with miscarriages; all fit and well, some harboring hopes and others having briefly enjoyed it as it alighted and extinguished with the heartbeat inside them.
I saw the ill, those with failing organs who needed either grafts to bypass them or stents to salvage them. Dialysis grafts, coronary artery grafts. Endovascular stents in the brain, the legs, the aorta.
There were many cancer patients. I saw a whisper of my past in the newly diagnosed presenting for lumpectomies or oophorectomies. I glimpsed my possible futures. Some women were far enough removed from illness to hardly recall it, having surgery today for an unrelated issue. And there were the others. Those in the midst of treatment, one who had finished treatment a year ago only to develop a persistent cough over the prior weeks. She presented for a bronchoscopy, and my heart sank as I skimmed the report from her CT scan, “Scattered pulmonary nodules, suspicious for widespread metastatic disease.”
“I’m glad I at least got this year,” she said.
I went to the ICU to visit a patient I’d cared for the day prior. He was seventy and had undergone a pancreatic cancer resection. We had chatted at length as I put in hemodynamic lines and placed an epidural for his pain control after surgery. The epidural was working well this morning.
“I’m comfortable. Except for this thing, anyway,” he indicated the nasogastric tube snaking from his nose and draining his stomach contents into a bedside cannister.
“I know it’s uncomfortable,” I said. “I’m sorry.”
He shrugged. “Eh. That’s life.”
Is it though?
My ninety-three-year-old patient said something similar as I put an arterial catheter in her arm. She was quite healthy apart from the conduction system in her heart, which, after firing 60–100 times a minute for ninety-three years, had finally given out. She was in complete heart block and needed a pacemaker. I apologized if I’d hurt her with the catheter.
“You can’t get through life without a little pain. You just can’t.” she said.
At her age, she was an authority on life by any standard. It struck me that she might be the most fortunate person I’d cared for today, having somehow gotten through nearly a century of dodging so many of those things that come at us despite our best efforts: the inexplicable organ disease, the broken bones, the cancers. Having lived most of her tomorrows, she enjoyed the luxury of no longer having to worry about them.
It brought to mind a quote from The Curious Case of Benjamin Button; a musing about his childhood in the company of the elderly.
“It was a wonderful place to grow up. I was with people who had shed the inconsequences of earlier life. Left wondering about the weather, the temperature of a bath. The light at the end of the day.”
She had outlived even her own heart.
The new baby was her antithesis, born that afternoon via c-section because her placenta had grown into the wall of her mother’s uterus. It is a dangerous condition that can result in uncontrolled bleeding and can require a hysterectomy. I watched her come, pulled from her mother in the blink of an eye, to enter this, her birthday.
Her mother was my patient, and it was she who demanded most of my attention, monitoring the blood loss and watching the progress on the surgical field. But I watched the baby from the corner of my eye, making certain I wouldn’t need to intubate her. Being a doctor and a mother have both taught me over the years that the little ones can get into trouble quickly.
She was sluggish from the anesthesia, and the pediatric nurses breathed for her through a bag-mask. Here and there came a weak cry. I watched them tap the ball of her foot to wake her, watched them do a trial, and then another, of letting her breathe alone.
This was it. She had, God willing, many tomorrows ahead. She was absolute potential encased in a seven-pound, one-ounce form, she just needed to breathe for it to be realized.
And finally, she did. Her skin blushed into a healthy shade of pink, and she cried an angry squall and kicked her wild, tiny feet. And I wondered if perhaps it was actually she who was the most fortunate patient I had cared for that day. Who knew what life might bring her? Wonders? Ailments? Both? She was just beginning the journey that her centurion counterpart down the hall was close to ending. She was just beginning to chase her dreams.
I suppose no one can determine who is most fortunate. I suppose those of us between zero and ninety-three are blessed in our own way as well. We are here, swirling in a jumble of the inconsequential and consequential. We’ve enjoyed some of the world’s beauty and reserve the potential to experience more. Some of us will have longer than others, but perhaps we should focus on savoring rather than quantitating it. Even if it’s only one more year.
That’s life… I have it on good authority that you can’t get through it without a little pain.
In the meantime let us remember that it’s never too late to chase dreams.
Originally published at https://facingmonsters.com on July 6, 2020.
