Thursday, March 23, 2006

wakey wakey

I'm on call overnight tonight, and just finished a case. It was a hysterectomy and abdominoplasty (you know, a tummy tuck), and the wakeup was just gorgeous. I mean, if I do say so myself. I timed everything right, and turned down my sevo and turned up my nitrous, got her back breathing and titrated in my morphine, and the second, I mean the SECOND that the drapes came down, I said my patient's name and she just opened her eyes like THAT, instantly following commands and ready for extubation. It was the equivalent of landing a 747 on the runway so nice and gentle that you don't spill a drop of your in-flight beverage. (That is, if the stewardess didn't already wrestle that plastic cup of Coke from you before we began our final descent.) No ugly straining or pain or bucking on the tube, just a nice sweet emergence. Does it make me a dork to say that it was beautiful? Because it was. It was beautiful.

And the annoying thing is, no one ever notices or appreciates stuff like that, except for maybe other anesthesiologists. The patient doesn't remember. The surgeons and the nurses only take note if something doesn't go well--if the patient takes a long time to wake up, for example, or if the patient gets a little light at the end and starts doing the Electric Slide while they're still being stitched up. Then they yell or say snide things. But a nicely timed piece of anesthesia gets no recognition. They just don't know how much planning goes into it! My attendings were right, by the way. The first six months of your anesthesia residency, you're consumed with the specifics and the details of just how to get through your day. Only after that do you really start to appreciate the art of good anesthesia.

I say this not to say by any means that I'm a good anesthesiologist (though I aim to be When I Grow Up) or that the surgeons are oblivious (though they sometimes are, just they way that I'm also oblivious to things that aren't part of my job). It just say this because it seems like the further and further I get into medicine, the more and more I become like some sort of idosyncratic connesieur of obscure things. I'm the equivalent of one of those people who go to comic book conventions in search of collectibles, like Garbage Pail Kids cards, or McDonald's Happy Meal toys from the 1970's. Everyone else's throwaway moments are my treasure. At the end of the case, when everyone's bustling around, dictating and putting stuff away and returning pages, I have my big moment with the patient, the culmination of what can sometimes be hours of preparation and planning, and dammit, it is gorgeous when it works out well, even if nobody else notices but me.

Currently watching: College basketball. This is not my choice, it just happens to be on the TV in the lounge, and everyone seems to be watching it so avidly I don't dare ask if we can change the channel.