I was worried. The patient I was scheduled to do had been so sick that the Chief sent message for me to talk to the anesthesiologist who had evaluated her the day before. I had to make a separate phone call to him after getting my assignment from the front desk. We spoke for twenty minutes about this patient! I rarely have a concern over anyone that is sick: I have seen everyone and taken care of everything. I am a Cardiac Anesthesiologist. Anesthesia for the dying and the half-dead is my expertise! But for this one, I called Mom on the way in to work and asked her to pray for a good outcome on the case.
What was making me worry? It was the ongoing battle of sepsis. If the bacteria win, the patient has no blood pressure and anesthesia is very difficult and challenging, especially in the senior population.
The tumor had blocked the biliary duct in the pancreas. Bile had backed up. A stent had been placed. But the bile did not drain. The liver, pancreas were inflamed. The urine was the color of coca-cola. The stool was the color of chalk. There was complete biliary obstruction, and early sepsis, with only a single dose of Zosyn stacking the deck in my favor.
And the surgeon. The most gifted one in the hospital. And his assistant, who normally scrubbed in for hearts and was frankly overqualified for this case.
I called in early for my Anesthesia Technician to set up for full invasive monitoring and transfusion capability during the case. At my old hospital we could send blood gases for lab work during the cases. Here, we did not, and I would have to fly by the seat of my pants in the case. I wanted arterial line with cardiac output monitoring capability, central venous pressure, and a blood warmer in the room.
In pre-op, the patient, a tiny thing, was eerily calm. No questions. The son was very concerned. I speak Spanish and I spoke well between the two of them. I did not give sedation prior to starting the case.
In the O.R., everything went like clockwork. Induction. Intubation. Securing the tube. The arterial line had some trouble going in, and then it jumped, like some unseen hand had guided it into the proper place. I moved on the the volume line, the large bore peripheral i.v. for access. And then the central line, the Triple Lumen Central Venous Catheter in the right I.J. In less than thirty minutes we were ready to scrub. For a heart, we allow one hour for anesthesia monitoring and induction, and I had expected one hour for this case.
Once asleep the surgery went flawlessly. The specimen had negative margins. Lymph nodes were negative. But there were two positive blood culture results reported to me in the O.R. Bacteremia with gram negative rods, Klebsiella most likely. The liver was a nasty shade of black from the backed-up bile within it.
I gave Reiki.
Inside, I was surprised. This patient wanted to die. They wanted to send the message to the family that 'everything had been tried', and to pass in the near future. The operation was going to be a success, but the patient was 'done'. I picked up the effort of trying to make a living and being a poor Latino just wore them out. The cards were stacked against me and I am tired and I want to go Home. I gave Reiki and the Transition Symbol, hoping there would be some resolution between patient, disease, surgeon, and family in the upcoming times. Most important, that soul wanted to be heard, and I understood. I let it know I did. (Mind you, all of this is taking place while I pretend to be futzing with my anesthesia equipment and the patient. I also am consciously running a safe anesthetic at the same time, which takes priority over the rest. During my treatment of Reiki, I got interrupted several times, for example, once to answer the phone from Pathology and put them on speaker for the surgeon to hear the results.)
We were done in record time. A Whipple takes six hours with the best of the best of foregut surgeons. This one took four, including a feeding jejunostomy and a g-tube to vent the stomach.
If this interests you, you may also like reading about Reiki and Awake Neurosurgery posted two days ago. Namaste.
