On the Patient Side of the Ether Screen

  • Hertzberg, Linda, MD, FASA
| Nov 28, 2011

There are plenty of people who are fearful of needles, and I am one of them. It seems a bit of an oxymoron for an anesthesiologist to feel this way, but I have met a number of other anesthesiologists who will secretly admit to the same thing. Even if you know how to do something well, it does not mean that you want it done to you, personally. So when I finally decided to have surgery to fix my painful left shoulder (fortunately I am right handed), I was more fearful of the interscalene block needle going into my neck than of anything else.

I did have concerns about other parts of the process as well. In an attempt to mitigate the risk of aspiration and the chance of dehydration, I had a small meal at dinner and drank tea into the evening. No aspiration fortunately, but despite being the first case of the day, I was dehydrated. Starting the IV therefore proceeded as one might expect in a needle-phobic, dehydrated patient. The nurse was experienced, but new to our hospital, and I secretly believe she must have drawn the short straw on me. Eventually the IV went in, I received midazolam (yes, it does burn) administered by my partner, and off we went. On arriving in the OR, I saw the lights, and surgical and anesthesia equipment but felt oddly detached from my surroundings. Allegedly I was even willing to look at the ultrasound of my neck, but after more medication, remember nothing else of what ensued until I awoke in the PACU. All that anxiety about a needle in one’s neck for nothing…

It took a while to wake up, since I am a medication lightweight. I kept dozing off and asking for ice chips for my sore throat, but eventually I was alert enough to leave. The interscalene block worked really well. I had no pain whatsoever, but my arm was like a dead lump that seemed not to belong to me, but rather was an alien attachment. I kept it in the sling and supported on pillows, but found the total lack of sensation and proprioception alarming; this probably reflects the concern that many physicians—myself included—have about lack of control. The block eventually wore off after 24 hours, and it felt good to be able to use my left hand, if not my shoulder, for something.

Fortunately I did not need a rotator cuff repair, just an arthroscopic debridement and decompression for major bursitis. Although I don’t know how the injury happened, I suspect it may be related to over 25 years of masking, intubating, moving patients and shoving beds and gurneys around with my left arm. After two days I was able to dispense with the sling and start moving my arm around, however my range of motion was more limited than previously. The postop pain was definitely different in type and quality from the preop pain, which I took as a good indication. The pain was reasonably well controlled with naproxen and acetaminophen.

After five days I went to physical therapy. Having done PT all spring and summer in an effort to avoid surgery, I thought I knew what to expect. So wrong. If full function is 100%, and where I was preop was 60%, then I was starting at 30% in terms of strength and mobility. And it ached all day afterwards. I am feeling more in-tune to my patients’ experiences, as my days now seem to revolve around PT exercises, ice, anti-inflammatory medication and rest. Fortunately I have a few weeks for these therapies to do their magic before I go back to work.

The entire peri-operative experience was about I expected. I had my surgery done at the hospital where I work, and not at a boutique-type ASC. Although the amenities weren’t great, I felt comfortable and well cared for—a feeling which I hope all patients experience in my hospital. Some might want to go to a place where they don’t work to have surgery for privacy concerns. Personally I feel more at ease in a place where I have knowledge of how things work, what resources are available, and who will be taking care of me. Although I know my patient experience was not “typical”, since everyone knew me, it was pretty close to typical, since I did not ask for or receive any special treatment beyond being the first case of the day and picking my anesthesiologist, something we allow all our patients to do, upon request. For a large, tertiary care hospital we do an excellent job of treating people as individuals, hearing their concerns and caring for them.

Certainly there are some things we can do better along the continuum of surgery: the (already unnecessary) chest X-ray needed to be cancelled twice, patients are given no guidance about where to obtain chlorhexidine for the preop showers, the registration process for the first case of the day starts at 5:30 a.m. and could be streamlined, and I had to ask for xylocaine to be used during the IV start. Also despite having had regional anesthesia for two C-Sections in the past, I was not expecting the profound motor block and sense of dissociation from my numb arm, something we as anesthesiologists could be cognizant of when we discuss blocks with our patients. In the big picture these are all minor things, and I am extremely satisfied with the care I received. However, to many patients, these are the details they may remember, and which I, as both a patient and an anesthesiologist, will also keep in mind.

While I wouldn’t encourage all CSA members to seek out a surgical procedure to experience treatment from the patient’s perspective, having had to myself, I can speak to its merit (while resting comfortably on the couch). It certainly is important for those of us providing clinical anesthesia care to consider these and other tangible and intangible details as we work to provide the best possible experience for our patients.

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