Follow the Lizards, and other anesthesia lessons.

Anesthesia. Most people have a general idea of what this field does. Anesthesiologists put you to sleep and wake you up. Some people have an (IMO) irrational fear of anesthesiologists due to cases like Joan Rivers, Michael Jackson, and other celebrities whose deaths were caused not by anesthesiologists, but by mishandling of anesthetic agents (example: no anesthesiologist was present when either of them died. MJ had a prescription he shouldn’t have, and JRs surgeons didn’t think they needed an anesthesiologist to administer what they did… Then she went into laryngeal spasm and didn’t wake up.). So, case in point, you DO in fact need someone with 4 years of training in this particular field any time you have a procedure done (and you shouldn’t abuse prescriptions, but that goes without saying).

My anesthesiologist texted me before my rotation asking if I had an interest in anesthesia. Any med student can tell you this is a difficult game to play. I didn’t have an interest in anesthesia. I was interested in peds. And I really loved my surgery rotation. Anesthesia? Nah. But how do you honestly tell a doctor who specialized in that field that you have no interest in it without sounding like a close-minded idiot? I told him I wasn’t sure and hadn’t had much exposure to the field, but was interested in peds and surgery (navigated like an expert, honest but not offensive!). His reply? “Tomorrow meet me at the surgical center. We are doing peds ENT.”

What?! I couldn’t contain my excitement. Not only was I getting to see anesthesia, but I would be helping with peds AND surgery! It was the best possible scenario, especially since I wasn’t super thrilled about starting anesthesia.

The next day, I arrived and asked the woman at the front desk how to get to the OR. She replied, “just take the elevators to the second floor and follow the lizards on the floor!” I couldn’t help but bust out laughing. Only peds hospitals can be that awesome (although I think adults would be happier if they learned to approach hospital decor and customer service like the peds hospitals do!). That day, I got to intubate peds patients from babies to teenagers (something I think is unique and not a lot of medical students get the chance to do) and I had the opportunity to give injections (something you would think we would learn in medical school. We don’t.). I got to learn another aspect of pediatrics and how (as everyone in peds will tell you) kids aren’t just small adults. Their whole physiology is different, from medical management to surgical protocol to anesthetics administered. Kids breathe faster and their heart rates are higher, so anesthesia is completely different for them and changes based on their age too. I was fascinated by the way my doctor interacted with the families and patients, explaining procedures to them, helping them sign forms, doing quick math to figure out what doses of each anesthetic were needed, and calming down the scared kids by letting them bring their favorite stuffed animal into the OR (and only taking it away once the kid was happily asleep). It was such a different feel than adult surgery. The part I wasn’t expecting was that I loved it!

Another type of surgery my doctor helped with was cardiac cases. My husband had open heart surgery in October (see my last blog post), so when my anesthesiologist told me to meet him in the cardiac pre-op area for an open heart procedure, I wasn’t sure what to expect or how I would react emotionally or if I would be able to handle it. I had a small woozy moment when they were placing all of the large bore IV needles (including two in the neck, shudder), but I took a deep breath and reminded myself I had always wondered what they did with David and now I had a chance to see. I wasn’t going to ruin that over some dumb vasovagal syncopal reaction!

I watched them do a midline incision, then they sawed through the sternum (not as gross as you would think), then they cut through the pericardium…
And there it was.

A beating heart.

I’ve seen cadavers and I’ve seen museum-preserved hearts, but I had never prepared myself for seeing the center of life beating in front of my eyes. I immediately started tearing up in the OR. I felt a little silly but I didn’t try to stop myself either. I think I needed to allow myself to experience my emotions and see that everything was ok in heart surgery and that everyone involved knows their job expertly. In the past, my husband’s docs have offered to let me watch, something that I sternly refused (because, hello, who wants to watch their loved one go through that?) But in this safe space, with a patient I had only briefly met, in my position as a med student and not as a scared wife, I was able to fully appreciate each step of open heart surgery and how incredible it truly is. It sounds cliche, but that surgery changed my life. I can’t explain how it feels to watch the very thing giving life to someone be stopped for the surgery, put on bypass, and then restarted. I also can’t explain how amazing it was to watch the next surgery, where the doctor operated on a beating heart and didn’t stop it, a skill few cardiothoracic surgeons possess!). It was incredible recognizing how fragile our lives are, but also how strong our bodies are. It was overwhelming and wonderful. The heart surgeon could tell I was fascinated and explained to me every step of what he was doing. He said something that really stuck with me: “any monkey can stop a heart. All that takes is a gun or some trauma. It takes a real magician to restart it.” And suddenly I understood the God complex many surgeons have-and how could they not? They literally steal life from a person, then give it back. It is amazing.

So, back to anesthesia. It was really incredible getting to watch the surgeries, and sure, the patients were grateful for the surgeons… But the doctor the patients and their families really loved was the anesthesiologist. Because that’s who wakes you up. It doesn’t matter how the surgery went if your loved one doesn’t wake up. My anesthesiologist told me “patients love us because we’re the good guys. We’re the ones who make you feel good and relieve your anxiety before the surgery, and we’re the ones who wake you up and make your pain go away after surgery.” I really hadn’t thought of it, but he’s completely right. The surgeons are really talented for what they can do, but a lot of their technical procedures are over patients’ heads- and the thing the patient cares about most? Waking up and not being in unbearable pain. Anesthesiologists really ARE the good guys!

All in all, I loved anesthesia (Add that to peds and surgery on my list…. And my decision becomes even more difficult!). For about 36 hours I considered doing peds anesthesia instead of general peds. I researched residencies (and found out there are even a handful of joint peds and anesthesia residencies!), but ultimately realized that I would be unhappy working on adults for 4 years of residency before ever really seeing kids, and I don’t know that after the strenuous nature of med school that I could handle waiting even longer to do what I really want to do. Either way, if I could go back and re-answer my preceptor’s initial question about if I’m interested in anesthesia, I would answer with a huge yes. I really loved my doctor and my rotation. Anesthesia helped me in so many ways, namely reaffirming yet again that I love peds and helping me realize/deal with my suppressed fears I had about my husbands heart surgery.


Heart Surgery from the POV of the scared wife… and not the med student.

Texas Childrens Hospital - West Campus

Well, it’s been too long for me to recap everything that has happened since my last post. I’ll try to hit the high points!

My husband had open heart surgery at the end of October. For the sake of his privacy, I will just say it was planned (not emergent) and was done to further correct a congenital defect he has.

The surgery he had was pretty routine for the surgeons… and pretty life-altering for our family. His mom and dad and siblings (with the exception of one actress and one lawyer) and me are all in the medical field. And we all experienced very different things as we went through this.

His parents and siblings were shaken up from memories of his past surgery in 2003… I wasn’t yet in his life at that point (I was actually celebrating my 13th birthday when he was having his first major surgery!), so my experience was a new and scary one. I didn’t have anything to base my fears or hopes on other than my knowledge of medicine and surgery. You would think as someone aspiring to become a physician, I would have hope in medical care, but I found myself questioning every decision the doctors made and wondering if the nurses were checking on him often enough and if there was enough communication going on in the medical team.

His mom and dad had the right questions to ask. They “knew the drill,” so to speak, and they knew the doctors fairly well and could talk about their careers and families together. Everyone kept asking me if I wanted to see cool medical things or if I had considered residency there or if I had any questions… I had questions and I wanted to ask them but froze when they asked. I was so scared and the last thing I wanted to talk about was my own future in medicine. I was so flattered they wanted to help me with my future, but I was also facing something I never have before- the emotions of a terrified wife. Honestly, I didn’t want to experience David’s surgery through the eyes of a medical student. I wanted everyone to back off and let me be an ignorant non-medical person. I wanted to be comforted by the medical team instead of offered career advice and “insider info.” I wanted to forget the intricacies of surgery and the step-by-step process of how to stop and restart a heart. I wanted people to stop asking how I was handling things, because I didn’t know how to answer that question without becoming bitter about having to go through this alone, without Dave by my side holding my hand. I wanted to move forward and not have to deal with the recovery period that brings its own share of post-op complications.

Sometimes knowing the medicine doesn’t make things better. Sometimes it makes things much worse.

Trying to be strong for his family was difficult too, because they haven’t experienced my personal struggle and fears. Where David is their son or brother, he’s my husband- i.e. I chose this life with him and we promised to share a future together in front of God, our family, and our friends at our wedding. Even though the surgery was bound to be successful, I couldn’t help but entertain the horrible thoughts: What if we don’t make it through this? What about the future we promised we would share together?

All I remember feeling when his 6 hour surgery turned into a 10+ hour surgery was that I wanted to call him to talk to him about how scared I was. I wanted to talk to him because he’s the one I go to when things are rough and when I need to calm myself down. And it wasn’t an option because he was sedated on the operating table. That was the most difficult part for me, I think. Not having that one person that is always there. I felt really lonely even though I was surrounded by love. I guess that’s what makes marriage so special. We really are a team in this thing called life.

They brought him to the cardiac ICU then admitted him to the floor the next day. He was able to go home 5 days later (pretty phenomenal considering his last surgery was 17 days in the hospital!). His post-op appointments went well and everything checked out nicely.

His recovery period has been an adventure in itself. He had sternal precautions which meant he couldn’t use his arms to do pretty much anything (lift over 5 pounds, drive, push, pull, etc.). He had activity precautions which meant he couldn’t get his heart rate up (going up stairs, any form of exercise, etc.). He had psychological recovery too, which was difficult for us both. Once the pain went away and he felt 100% better, he got really frustrated by his activity precautions. I had a difficult time knowing how to help him through his own mental battle while maintaining my own sanity. He had mostly good days but some bad ones that really tested both of our patience levels. Overall I think this experience brought us closer together. It’s a unique struggle to be completely dependent on someone and have someone totally dependent on you. I helped him wash his hair and use the bathroom, and sure, it was awkward- but we promised “in sickness and in health” and we meant it. I definitely had weak moments where I wished it would all go away and we could just go back to our normal lives. It was a really humbling experience for me and helped me understand what families go through when we discharge them. I hope these memories stick with me so that I can be more sensitive to my future patients and maybe make their experience a little less scary than it has to be.

Today he is past the 6 week mark and can resume normal activity! He was so excited to go to the YMCA and be able to work out again! His recovery won’t be fully complete for another 6 months or so, but as far as limitations, he is good to go! I couldn’t be more proud of him for his strength through this whole adventure.

Unless you’ve been there, I don’t know how else to relay my experience. I definitely don’t wish it on anyone, but I will say it has made our marriage stronger. I can’t explain how exactly- maybe it’s just the small things that we both appreciate a little more- but I am thankful for the hand we’ve been dealt. It’s unique and it’s terrifying but it’s ours, and I love it.