Cowboy MD

"I promise I'll never break your heart."
"Awww that's sweet."
"But I will sedate and paralyze you so you suffocate on your own saliva."
"What?"
"I love you."
"Awwww that's sweet."

I have a few rules which have served me well in the past. They've never let me down, and I don't expect them to let me down anytime soon. I shall share them with you in the hope that you too, may someday benefit from their wisdom.

1) The authenticity of a Chinese restaurant is directly proportional to the number of spelling mistakes in the menu.


2) The authenticity of an Italian restaurant run by Chinese people is inversely proportional to the number of spelling mistakes in the menu.

3) Put on a shirt before you fry bacon.

4) Don't get anesthesia from Dr. S.

We were providing anesthesia for a healthy young patient who had come in for some elective surgery. Dr. S. had left me alone for several periods lasting 15 minutes at a time, which in retrospect, really shouldn't have been allowed. What the hell do I know about resuscitating someone? Or maintaining a proper state of anesthesia?

Beans. That's what I know.

At the end of the surgery, the patient was breathing on her own, so I decided to take the tube out. After the patient was extubated, I checked to see if breathing was still going on. "Come on, let's move her over to recovery." Dr. S said. I didn't move, still checking to see if the patient was going to take a breath. The patient hadn't taken a breath since I'd taken the tube out.

"Is she breathing yet?"

I looked a little closer. Come on, breathe dammit. My boss is hassling me.

"I don't think she is."

"Come on let's go."

I was surprised, but hey. He's the anesthesiologist, what do I know? I helped slide her onto the gurney and off we went down the hall.

I wasn't thinking about it but the whole time we were sliding her onto the gurney, cleaning up the OR, pushing her down the hall to recovery, the patient wasn't breathing. This took maybe 5-6 minutes. Try holding your breath for 5-6 minutes. I bet it's hard. I bet it's not good for your brain too.

So when we got to recovery, Dr. S told me to hand over to the nurses, because he had to make some important business phone calls. He left before the brakes were even put on the gurney. I started handing over but in the middle, I heard the oxygen saturation drop. A good oxygen saturation should be above %94. Hers were now 47. A code blue was called and everybody came running. The nurses were managing the airway and everything was being taken care of. All I could do was stand there and wonder to myself whether or not this was my fault and whether or not this patient was going to a) die b) have impaired brain function c) have some other complication I'm sure I'm not aware of yet.

I wondered if all this could have been avoided if I'd spoken up a little louder to make sure Dr. S had known the patient was breathing when we left the OR, so that we could have stayed and managed her airway properly before she started desaturating. I wasn't feeling very good about myself.

Later on, I heard from a few other clerks that that's just the way Dr. S operated. He doesn't perform up to the standard of care, and certainly doesn't do what was in the patient's best interests. I felt a little better hearing that. He would have been cavalier with her airway regardless of what I'd said.

The point of the story?

There are good doctors and bad doctors. Get the good ones to do your surgeries and anesthesia. And look for typos in your menus.