The issue of MJ’s death bothers me not because I was a huge fan. No! I loved his earlier work but I recently realized I don’t have any of his albums! ….and believe me, I collect! It bothers me because it shows physicians behaving badly.

This guy was one using several aliases to get narcotics and propofol, and no one noticed or tried an intervention! My only explanation is that the money all the physicians were getting bought their silence and compliance! How sad!
Another issue that bothers me is the fact that MJ was using propofol like water! But then there are lots of non-anesthesiologists who demand to use the drug and will probably not appreciate it’s effects.
The practice of anesthesia is a not something one dabbles in. There are peoples’ lives at stake. I know there is a perception out there that “we just put the patient to sleep”! Well, someone just put MJ to sleep, this time eternally!
We as a profession may also have contributed to this perception. True, there is a lot of downtime during certain cases but the probability for loss of life is ever present. Less if you are dealing with healthy, young adults having elective surgery but much higher with the old and very sick.

So we as a profession always stay vigilant. We understand the medications we use, know their effects and appreciate the possible complications. We get to know our patients as well as a physician should and tailor the anesthetic to their needs, the surgical procedure and their general health status. Most important of all, we try TO DO NO HARM! We will not provide an anesthetic for a patient if the anesthetic will endanger his life and the surgery is not life-saving. We will not provide anesthesia at places where we feel the we will not be able to support the patient’s if he needs cardiopulmonary resuscitation.
Of course there are exceptions. If one works in developing countries, one makes do with what they have in equipment and supplies. Then also, there are anesthesia providers who may not be conscientious, but that is the minority.

So it bothers me to see how easily our practice was mimicked to someone’s detriment. We don’t know the details yet but a non-anesthesia provider thought administering propofol in someone’s home without the necessary support and know-how was a piece of cake.
Whoever you are I have news for you – IT AIN’T EASY!

Every anesthesia provider loves the calm, cool and collected surgeon who does not bark and yell at every and anything around him/her. They stay calm through thick and thin and are so level-headed.

However, their lack of excitement can be a negative.

We as anesthesiologists can’t always see what is going on in the surgical field and so we depend on feedback from the surgeon, the sound of blood being sucked up or welling on the field or the expletives emanating from the surgeon.

If the surgeon is so level-headed that he/she never gets rattled, how does one know if something is going badly? it is worsened by a taciturn and level-headed surgeon.

So, colleagues, appreciate a surgeon who curses and swears. Like a fire alarm, they have their use.

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?

We rushed a young patient to the OR who had blown a hole in the left anterior chest with a .357 magnum in an apparent suicide attempt. Before the shot, several medications including Xanax, Tylenol, Percocets and several other unknowns had been ingested.

After several hours of surgery – thoracotomy and laparatomy -and several units of blood and blood components, the patient makes it out of the OR but still in critical condition.

During the case, we find out that, this is young patient had attempted suicide a year earlier in a very similar fashion. The hospital stay then lasted 6 months and was very rocky.

So we are probably going to see the same course again.

I don’t mean to be callous but when do we say stop? When do we as a health system and society oblige those who do not value life at the expense of those who do. If any other trauma had come in, in that space of time, care would have been extremely hampered by lack of blood and blood products!

This patient is apparently severely disturbed and needs a lot of help.  Is this a measure of the psychiatric and social care this patient was receiving? From what we could tell, compliance was not a strength of this patient.

So, should there be a strike system for how many times one would be resuscitated after an attempted suicide? Maybe two strikes….

In an environment of scarce healthcare dollars, maybe we should use what we have wisely.

jnkdg