I see this in my hospital all the time and I am sure it is seen by anesthesiologists all over the US – how much sicker our patients are.
It is also evident that surgeons are pushing the envelope further and further. Patients are sometimes showing up for surgery whose short-term prognosis (don’t even consider the long term) makes one question the wisdom in a surgical intervention.
Then is the rather formidable (no pun intended) issue of morbidly obese patients who need their day in the OR.
We as anesthesiologist seem to take all these challenges in stride and in most institutions, the daily schedule is hardly affected as these challenging cases are shuffled through.
We complain about the wisdom of surgically intervening in these instances but since the show must go on, we do what we have to.
I dare to blame us though for these circumstances. Bear with me and I’ll make myself clear.
Imagine an institution where the anesthesiologist cannot manage ASA IVE cases or secure the airway in that 550 lb patient or get that patient through an exploratory laparotomy who just had a myocardial event. Just imagine!
What do you think the surgeons are going to do? Three options – take their cases elsewhere, stop taking these patients to the OR or hire an anesthesiologist who can or is prepared to do these cases.
What if this was a national phenomenon with all anesthesiologist? Maybe the sickest patients will not show up for surgery!
However, we have a specialty that prides itself in being progressive, being evidence-based and seeking to constantly improve itself.
We attract the smartest and most innovative minds.
We seek and employ CRNAs who are bright, focussed and unafraid.
The results – the ability to manage whatever the surgeons pitch at us! So they keep throwing and we as trusted batters, always hit the home run.
600 lb? Bring it on!
EF of 15%, cirrhotic and anuric? Bring it on!
Hematocrit of 15? We’ll fix it intro!
I think the realization has hit us so most anesthesiologists have stopped complaining and are just keeping on because maybe, just maybe, we are to blame, but in a good way.
No matter what we allow into an OR though, we always have to bear this in mind:
“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witness, that I will fulfill according to my ability and judgment this oath and this covenant…I will apply…(treatment) for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”