Photograph by Andrew Tolson
Q: And no surprises. I was surprised by your account of explosions in the OR.
A: Yeah, it’s rare but it does occur, when built-up methane and hydrogen gases are set off by the electrocautery. Sometimes the patient is lifted off the bed.
Q: People survive this?
A: Yeah, though there have been people who have died. But if it’s caught and we do emergency surgery, you can cut away the bad, burnt parts and the person will be okay.
Q: What about the people in the OR?
A: You get a singed face. The surgeons, they get hair that has been burned in their eyebrow, and singed faces, yeah.
Q: That would be a particularly bad time for a patient to be awake. How common are the cases when patients remain aware?
A: There are instances—maybe one to six in 1,000—where people actually will feel something, the knife cutting through. I mean, it’s a horrible thing to imagine. Once you go to sleep it’s maintained with vapours, but there are a number of factors that will increase the chance of being aware. One is genetics. Certain people have been shown to have a genetic predisposition to “resist” the amnesic effect of anaesthetics. Just as there is the opposite—Orientals on the whole being very, very sensitive to narcotics, while East Indians, for some reason, are very, very resistant.
Q: You give the aware patients more anaesthesia, of course, both for the pain but also in hope they won’t even remember having been awake. That’s for their sake and yours—you have to have lawsuits on your mind.
A: You maybe give a little, you know, something to help with amnesia, and you ask them after, “Are you okay?” and “Do you remember anything?” And if they do then you talk to them, you reassure them. There have been lawsuits reported about this, although there are also people who actually dream about being awake even though they’re not actually awake, so you have to consider that as well. But, on the other hand, there have been cases where people knew exactly what was going on in terms of the conversation in the room, like the gallbladder patient I know who remembered, word for word, a conversation between the anaesthetist and a nurse about colour preferences in the kitchen.
Q: One thing your catbird seat in the OR has given you is insight into doctors and their personality types. The orthopaedic surgeons certainly stand out, especially the one who said he didn’t feel he’d done a good job unless the blood splatters reached the ceiling.
A: He was only half-joking, let me tell you! For those guys it’s in their personalities: ortho as a perfect combination of carpentry and medicine. They love doing that kind of stuff. They need to feel that way for their work. They gotta get that bone out. I’ve been behind an ether screen, sterile drapes between me and the surgeon, and I’ve been splashed numerous times. He’s hammering away because he’s gotta ram the implant in. Of course his assistants all have these shields around their faces because they know. But I never expect blood, and then here it comes flying right over the screen, slopping on to my notes, on to me, on to my anaesthetic machine. I’ve handed in records that were just covered in blood.
Q: As for your portrait of anaesthesiologists, does that include you?
A: That’s me. You know, most anaesthesiologists are behind-the-scenes guys. Personality characteristics and psychological profiles show us drawn to the Internet, to movies, sort of nerdy type people, not good dressers by any stretch of the imagination.
Q: You wrote you’re deficient in emotional intelligence!
A: Yeah. Slightly. On top of that, though, it’s been shown there’s a high incidence—higher incidence than other specialties—of drug addiction.
Q: But isn’t that directly related to your access to drugs?
A: Sure, access, but maybe too because you’re such an introvert you’re looking for something from within, or stimulus from within or something. I don’t know, that’s just a theory I have as well. But there is a certain personality characteristic, for sure.
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