You are giving anesthesia for a diagnostic procedure to a 69-year-old woman, Patient A. Surgeon A sends in tissue which is found to be malignant. In the majority of cases, the extent of the malignancy in this patient will preclude surgery but  Surgeon A believes that a not-so-often performed procedure may be a cure. He scrubs out and talks to the patient’s family who agree to this procedure. The surgery goes well and Patient A is home after 4 weeks and is doing well.

Three months later, you are giving anesthesia for a similar diagnostic procedure for Patient B who is 58-years-old. It is being performed by Surgeon B. The extent of cancer in Patient B is similar to that in Patient A. Surgeon B, who does not believe in this not-so-often performed procedure that saved Patient B has no intention of offering this Patient B. He scrubs out and goes to talk to the family about the futility of any surgical resection.

What do you do?

Do you mention the success surgeon A had with patient A?

Do you recommend surgeon A to patient B?

A 90-year-old woman shows up in your Emergency Room with a ruptured abdominal aortic aneurysm (AAA).

The patient is known to the Vascular Surgery team. She was diagnosed with a AAA five years earlier. She has been refusing treatment since saying “I am too old”. Now she wants surgery to repair the aneurysm!

BTW, the aneurysm is such that it is not amenable to endoscopic repair so it has to be done open.

What do you do?

A new surgeon has just been hired at your hospital and you have had the chance to work with him/her several times as the anesthesia provider for his/her cases. Truth be told, you think he/she is a terrible surgeon. Long operating times, lots of blood loss, complications galore!

What does a gaspasser do? You still are supposed to be the last wall of protection before the surgeon is let loose.

Any thoughts?

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