Dr Jonathan Healan describes a busy day in anaesthetics
Running down the corridor at the beginning of the on-call shift, I headed for the Obstetrics and Gynaecology ward in response to the bleep my senior house officer (SHO) and I had received about a clinically unstable patient with an ectopic pregnancy. It was a scenario that, throughout med school, had been red flagged as critical.
Arriving on the scene, I was greeted by a couple in their twenties – she was on the bed in clear pain; her husband was white as a sheet. The SHO asked me to gain better access as she only had a small pink cannula inserted – certainly not sufficient for emergency surgery.
The SHO, cool as a cucumber in contrast to my own nerves, indicated the orange 14G cannula before rushing off to call down to theatre. I went through the now well-rehearsed routine of employing the tourniquet, checking for veins and administering local anaesthetic – noting the small veins. The patient’s haemoglobin was 60g/L with a raging tachycardia. She needed to get into theatre as soon as possible. This was pressure…
Flashback and a smooth flush! The previous two months of relentless IV insertion in theatres was clearly paying off. The tide of relief released the breath I had been holding for the past few moments.
My time on this rotation has only served to confirm that anaesthetics is an exciting branch of medicine. There is a real satisfaction in appreciating the balance of physiology in the body and being able to influence the cause and effects of medicines. The specialty involves patient contact and collaboration with colleagues across the hospital.
A typical shift involves getting the theatre list, joining the consultant for the preassessment of patients (specifically looking at the airway and whether they have had anaesthetic before), discussing the type of anaesthetic with the patient (regional or general) and going to theatre to prepare the necessary drugs. Although patient contact is more limited than I have experienced on the medical wards, I have found the job rewarding - patients are often anxious about their upcoming surgery and it is an opportunity to give them reassurance about their anaesthetic.
When embarking on my foundation year programme, I based my decision primarily on an existing interest in anaesthetics. The focus on complex physiology appealed to me. Has the experience met my expectations?
"Additionally, the day to day variety is greater than I anticipated – one of the biggest attractions of this speciality as cases could involve anything from tonsillectomy to spinal surgery".
I have to say it has; the specialty is fundamentally about problem solving and tweaking the bodily processes to regain balance. In that way, practitioners get to see immediate results and the practical side, surprisingly, is more fun than I imagined. Additionally, the day to day variety is greater than I anticipated – one of the biggest attractions of this speciality as cases could involve anything from tonsillectomy to spinal surgery. Moreover, the skills I have honed in this area are fundamental in times when patients are in extreme situations such as cardiac arrest. My time in anaesthetics has undoubtedly prepared me to go into other specialties.