I see this in my hospital all the time and I am sure it is seen by anesthesiologists all over the US  - how much sicker our patients are.

It is also evident that surgeons are pushing the envelope further and further. Patients are showing up for surgery whose short-term prognosis (don’t even consider the long term) makes one question the wisdom in a surgical intervention.

Then is the rather formidable (no pun intended) issue of morbidly obese patients who need their day in the OR.

We as anesthesiologist seem to take all these challenges in stride and in most institutions, the daily schedule is hardly affected as these challenging are shuffled through.

We complain about the wisdom of surgically intervening in these instances but since the show must go on, we do what we have to.

I dare to blame us though for these circumstances. Bear with me and I’ll make myself clear.

Imagine an institution where the anesthesiologist cannot manage ASA IVE cases or secure the airway in that 550 lb patient or get that patient through an exploratory laparotomy who just had a myocardial event. Just imagine.

What do you think the surgeons are going to do? Three options - take their cases elsewhere, stop taking these patients to the OR or hire an anesthesiologist who can or is prepared to do these cases.

What if this was a national phenomenon with all anesthesiologist? Maybe the sickest patients will not show up for surgery!

However, we have a specialty that prides itself in being progressive, being evidence-based and seeking to constantly improve itself.

We attract the smartest and most innovative minds.

The result - the ability to manage whatever the surgeons pitch at us!

So they keep throwing and we as trusted batters, always hit the home run.

600 lb? Bring it on!

EF of 15%, cirrhotic and anuric? Bring it on!

Maybe we need to stop complaining and keep on keeping on because maybe, just maybe, we are to blame!

I may have written a post about this issue before. Anyway, if so, here we go again….

Loosing a patient is very traumatic. It happens to every doctor and it is a pipe dream to think it would never happen to you.  It is a fact that some specialties are less prone to experience it than others. However, when it does happen, most physicians have no one to talk to. Fellow physicians are the worst group of people to seek solace from. The majority have their own professional and personal issues. Then is the judgmental bit - “If you had done A instead of B, maybe…” Which leaves our significant others, the majority of whom have already been overburdened with medical talk to the point where they are insensitive and frankly do not care anymore.

Would it not be great it there was “Vent” for physicians. 1-800-VENT! You call and talk anonymously to a listening ear about the death you had in the OR. About the fact that the team did all it could. About the fact that the patient had undiagnosed SAM or carcinoid or cirrhosis! About the fact that you were in the OR for 15 hours. About the fact that you bonded with the patient and his wife gave you a hug and his kids shook your hand. About the fact that the malignancy was inoperable. About all those things we are supposed to keep inside because we are supermen but really aren’t.

What if…?

I meant to post this on Friday but then…

Anyway, I took care of a 63-year-old having redo-CABG and MVR on Friday. Her starting EF was 25% at best! Well, all hell broke loose when we tried to come off CPB. The right heart wouldn’t play ball - it kept failing.

So we let the Milrinone and Epi run, added an IABP and waited and waited. An hour later, she was off CPB with an index of 2.2 and a mixed-venous saturation of 78-82. Her hematocrit was never an issue.

I have just observed countless times how time heals matters of the heart in the OR. I guess it also applies in everyday life!

A ggod friend from the other side of the “blood-brain-barrier” commented positively on my blog and saw it as something more than cases and tales from anesthesia. She thought it represented the perioperative phase. So I’ve changed the tagline to mirror that.

Hope it brings more readers!