Sunday, August 21, 2005
You Don't Really Have A Choice
I was on call both Thursday and Saturday. So that makes it 2 in a row. Crazy.
On the way to the car lugging my work bag on the left, and my on call duffel on the right, I was beyond exhausted. Slightly delirious, I walked down ‘The Pit’ – car park area, only to find my car was missing and to stand there about 2 minutes to remember that I parked just by the entrance- not in ‘The Pit’. Crazy.
You should have just rented an apartment in Scunnie instead of commuting back and forth. I heard my smug gremlin mocking grudgingly. That’s the thing, we don’t always know what’s best for us.
On that note, one of the cases I had to do was a 12 year old for manipulation of his broken radius, also with undiagnosed needle phobia. Being told that if he doesn’t want the needle, he can have the gas option by the nurses on the ward, he was adamant to not have the needle which at all times would be the safer option and in his best interest. I thought I made it clear to him and mum. When he got into my anaesthetic room, I wanted to murder the paediatric nurse.
‘I don’t want any needles’ he psychotically broadcasted it to us. He even folded his arms and hid them in the armpits. Wouldn’t even listen to my reasons why he needed the cannula. Didn’t even trust me anymore. His trust has turned to the paediatric nurses who knew absolutely everything about what these smartasses need for anaesthetics. Pfft!
12 is a difficult age. They are too big to be pinned down yet too immature to accept any logical reasoning. 2 year olds are trouble, 12 year olds are huge smartasses. You just don’t know what’s best for you my boy.
I got the cannula in by means I wouldn’t want to elaborate in here as it was not the subject matter. White stuff was injected in and I began to bag and mask him. No problems, all hunky dory. I shoved in the laryngeal mask. Once I was told that the opening to the laryngeal mask resembles closely to the lips that of vaginas. To some extent I have to appreciate the careful observation. It was a man who said that.
The seal was not perfect and I asked Lee my ODA to inject more air in. Still some leak and oxygen Sats was 95%. It was not right. I took it out remembering well the ‘in doubt, take it out’ rules we all abide by religiously. The minute it was out the boy made a cooing sounds, which rolled into a high pitch seagull sounds and the next sound was quiet, only strained Darth Vader forced expiratory sound barely heard, coupled with his back arching and lips turning blue. He went into laryngeal spasm, which by definition really meant - shit.
I could tell my face was draining fast and so was Lee’s. The paediatric nurse said
‘That doesn’t look right’ and Lee said ‘Shut up’, while helping me retrieved the tube. I threw the laryngeal mask on the floor and fixed the face mask on and started bagging, my worst nightmare materialised, I couldn’t ventilate, the cords had gone into a full spasm. I COULD NOT VENTILATE!!! Almighty, almighty, help me was all I could chant, quietly.
Lee stood still, his eyes darted back to the bag. We’re both desperate for the bag to move, for some oxygen to go through, just some please, not much. And it was tight, I couldn’t even shift a ml.
I was desperate. I yelled for somebody in the theatre to get my Consultant in.
I said to Lee, plan B, inject the sux, which was lying on the side of the work surface. How much he said. Half, fifty, 1 ml I said which all meant the same. In seconds, I saw the cords relaxing before my eyes, my left hand shaking, the laryngeal blade wobbled in my tight grip, my back breaking into cold sweat, Lee was sweating. I shoved down the endotracheal tube.
Bagged and bagged and bagged, could feel a field of silent prayers rising like a tide from all directions hitting my tympanic membrane which was really noisy for such a quiet room. From Lee, the paediatric nurse and the staff nurse. Come on!!!!
All eyes were on the 80% mark which slowly went up to 95 and then very soon 100%. Come on!!! Tears welling and a sense of huge relief overcame me, Lee let out a sigh. I didn’t cry.
I felt a beam of megawatt bright light flooding every corner of the room while a minute ago the feeling was very much total darkness with just a tiny candle flickering in the unforgiving wind. My whole body loosing all turgor to keep up against gravity. My legs weakened. Such the withdrawal from adrenaline.
Tying the tube in place, I was thinking what if I did not persist with the cannula and instead, did the gas induction as the boy wished for. How would I have given the suxomethonium to put the tube in which ultimately saved his life had we didn’t persist with the cannula?
You read the critical incidents like this described in the books, hoping everyday that none of them will ever happen to you. Like a smoker puffing away oblivious to the sticker ‘Smoking Kills’. But when it does happen it happens so quickly, it either makes or breaks a person.
In theatre, the surgeon asked, ‘what took you so long’, and Lee looked at me possibly giving a ‘shall-I-punch-him-for-you’ look. I said, ‘A bit of airway problem, sorry it took a while’. Oh he said. And everything carried on as normal.
Oh Almighty, I have faith in you and thank you for reminding me to have faith in myself. And thank you for Lee.
On the way to the car lugging my work bag on the left, and my on call duffel on the right, I was beyond exhausted. Slightly delirious, I walked down ‘The Pit’ – car park area, only to find my car was missing and to stand there about 2 minutes to remember that I parked just by the entrance- not in ‘The Pit’. Crazy.
You should have just rented an apartment in Scunnie instead of commuting back and forth. I heard my smug gremlin mocking grudgingly. That’s the thing, we don’t always know what’s best for us.
On that note, one of the cases I had to do was a 12 year old for manipulation of his broken radius, also with undiagnosed needle phobia. Being told that if he doesn’t want the needle, he can have the gas option by the nurses on the ward, he was adamant to not have the needle which at all times would be the safer option and in his best interest. I thought I made it clear to him and mum. When he got into my anaesthetic room, I wanted to murder the paediatric nurse.
‘I don’t want any needles’ he psychotically broadcasted it to us. He even folded his arms and hid them in the armpits. Wouldn’t even listen to my reasons why he needed the cannula. Didn’t even trust me anymore. His trust has turned to the paediatric nurses who knew absolutely everything about what these smartasses need for anaesthetics. Pfft!
12 is a difficult age. They are too big to be pinned down yet too immature to accept any logical reasoning. 2 year olds are trouble, 12 year olds are huge smartasses. You just don’t know what’s best for you my boy.
I got the cannula in by means I wouldn’t want to elaborate in here as it was not the subject matter. White stuff was injected in and I began to bag and mask him. No problems, all hunky dory. I shoved in the laryngeal mask. Once I was told that the opening to the laryngeal mask resembles closely to the lips that of vaginas. To some extent I have to appreciate the careful observation. It was a man who said that.
The seal was not perfect and I asked Lee my ODA to inject more air in. Still some leak and oxygen Sats was 95%. It was not right. I took it out remembering well the ‘in doubt, take it out’ rules we all abide by religiously. The minute it was out the boy made a cooing sounds, which rolled into a high pitch seagull sounds and the next sound was quiet, only strained Darth Vader forced expiratory sound barely heard, coupled with his back arching and lips turning blue. He went into laryngeal spasm, which by definition really meant - shit.
I could tell my face was draining fast and so was Lee’s. The paediatric nurse said
‘That doesn’t look right’ and Lee said ‘Shut up’, while helping me retrieved the tube. I threw the laryngeal mask on the floor and fixed the face mask on and started bagging, my worst nightmare materialised, I couldn’t ventilate, the cords had gone into a full spasm. I COULD NOT VENTILATE!!! Almighty, almighty, help me was all I could chant, quietly.
Lee stood still, his eyes darted back to the bag. We’re both desperate for the bag to move, for some oxygen to go through, just some please, not much. And it was tight, I couldn’t even shift a ml.
I was desperate. I yelled for somebody in the theatre to get my Consultant in.
I said to Lee, plan B, inject the sux, which was lying on the side of the work surface. How much he said. Half, fifty, 1 ml I said which all meant the same. In seconds, I saw the cords relaxing before my eyes, my left hand shaking, the laryngeal blade wobbled in my tight grip, my back breaking into cold sweat, Lee was sweating. I shoved down the endotracheal tube.
Bagged and bagged and bagged, could feel a field of silent prayers rising like a tide from all directions hitting my tympanic membrane which was really noisy for such a quiet room. From Lee, the paediatric nurse and the staff nurse. Come on!!!!
All eyes were on the 80% mark which slowly went up to 95 and then very soon 100%. Come on!!! Tears welling and a sense of huge relief overcame me, Lee let out a sigh. I didn’t cry.
I felt a beam of megawatt bright light flooding every corner of the room while a minute ago the feeling was very much total darkness with just a tiny candle flickering in the unforgiving wind. My whole body loosing all turgor to keep up against gravity. My legs weakened. Such the withdrawal from adrenaline.
Tying the tube in place, I was thinking what if I did not persist with the cannula and instead, did the gas induction as the boy wished for. How would I have given the suxomethonium to put the tube in which ultimately saved his life had we didn’t persist with the cannula?
You read the critical incidents like this described in the books, hoping everyday that none of them will ever happen to you. Like a smoker puffing away oblivious to the sticker ‘Smoking Kills’. But when it does happen it happens so quickly, it either makes or breaks a person.
In theatre, the surgeon asked, ‘what took you so long’, and Lee looked at me possibly giving a ‘shall-I-punch-him-for-you’ look. I said, ‘A bit of airway problem, sorry it took a while’. Oh he said. And everything carried on as normal.
Oh Almighty, I have faith in you and thank you for reminding me to have faith in myself. And thank you for Lee.
