Sunday, September 16, 2007

Abalone Cove Stormset- Flickr Shot


Abalone Cove Stormset, originally uploaded by Dan90266.

Saturday, September 15, 2007

will anaesthetists please make up their minds about 'it'!!

i guess everyone undergoing a specialist's training in anaesthesia has to go through 'it', but i'm about ready to throw a tantrum right now because of 'it'.
and i do mean a real, no-nonsense, fists-and-toes-banging-on-the-floor-and-bawling-away kind of tantrum because 'it' irritates me no end.
'it', my current bugbear, is 'how to do things' in the practise of anaesthesia.
here's how things work. a junior anaesthetist and a senior anaesthetist are posted in a theatre for one whole working day, and provide anaesthesia for all cases coming to that theatre on that day. so the junior has to basically do what the senior wants him or her to. obviously, one allows for the fancies and peculiarities of individuals; i always thought of it as "when in rome...."
but sometimes, it gets to be too much.
here's a few examples:

most people think 100 micrograms of fentanyl should be diluted in a 10 cc syringe for various reasons including being able to titrate the dose, and that giving 100 mcg together can lead to chest wall rigidity. and i guess if everyone does it, it leads to less confusion. but there is a guy who says it's a waste of a 10 cc syringe, and that he's never seen chest wall rigidity, and that most adults can take 100 mcg without any problems. so he uses a 2 cc syringe. that is all very well but for the fact that the same guy insists on using a 10 cc syringe for morphine. when i asked him why not 2 cc, the answer was not very clear-cut. so i guess even people who attempt to sound logical are doing stuff more out of habit than anything else.

i've always been taught here that if one uses a regional anaesthetic technique (like a caudal or epidural or brachial plexus block) in additional to general anaesthesia, one can do without morphine, and thus avoid it's problems. in general, isn't it better to interfere minimally with the body? but there is a person here who absolutely loves morphine and insists on giving it even in patients getting additional regional anaesthesia. the apparent reason is that the patient has pain in the mouth and throat from the endotracheal tube or laryngeal mask which needs to be treated with morphine. fine, the person concerned is an expert on pain management and i'm not about to say he or she is wrong, but surely there is no need to get angry because i did not give morphine till you told me to. i mean, was i supposed to divine that you like to do other than what i had been told to do till then by everyone else?

how does it matter whether i take air or saline or saline-with-a-bubble-of-air in the syringe while finding the epidural space by loss-of-resistance technique? then why insist that it has to be done in any particular way? interestingly, one day, before putting in the needle, i asked one senior what he wanted me to use, and this guy happened to not like that at all! " what do YOU like to use? go ahead and use it!" is what he said! imagine that! on the one day i decided to ask instead of getting rapped on the knuckles (metaphorically) after starting!

truth is, there are more than a few ways of getting from point a to point b in anaesthesia, and i guess i must walk all of them during the training period before i get enough freedom to choose what i'm comfortable with. but i wish they weren't so dogmatic about sizes of syringes and the like. i think i've decided to be a little less picky about the small print when i get the opportunity.

there's someone i hate

was describing to the best friend how the day went, and it started me off on a train of thought that's......., well, for want of a better phrase, thought-provoking.
and the best friend threatened to blog about it if i did not.
so i have, by verbal acclaim, and depending on said person's honesty, declared my right and my intention (though fulfilled very late) to blog about the issue.

was telling him how much i dreaded working with one particular senior colleague in my department. well, i just found out that i'll be doing a 24-hour duty with that person in a few days time. and already, i can't stop thinking about it.
so why do i dread working with the guy?
well, truth is, he was my senior in medical school, and we lived in the same hostel. as things were not too long ago, seniors had a lot of freedom to behave as they felt like with freshers. and this guy, and his bunch made life miserable for me in my first year in medical school.
i guess things were magnified by the fact that i was all of 17, away from home for the first time, in a new culture and environment. still, i never look back to those incidents with any sort of peace or happiness. i just can't seem to forget the nasty behaviour (do i sound like a sissy, or a victorian lady about to swoon?).
but i realised something important about myself as i was describing all this aloud.
i realised that all this while, i kept saying that i dreaded working with the guy because he was pretty nasty to me, and that he surely hated me for one reason or the other.
what was not said, was that 'he hates me' is just a "christian's" way of saying 'i hate him'.
i don't mean all you lovely christians out there, i mean me, the one who keeps trying to be christian, but never succeeds.
and yes, i realized i do hate him for making me miserable so long ago.
is that so wrong? i think it is wrong, but right now, i can't help it.
maybe i'll get the strength to get over it sometime, and look beyond what was miserable in life, to what was, and is, wonderful in life.