Redeemers of the O.R.

Have you ever been under the knife? I don’t know the exact statistics but chances are someone in your family or a friend has had to undergo surgery. And more often than not, they sang paeans to the surgeon who did his job well. But then, how many spoke of the wonders done by their anesthesiologists? I’d venture "seldom" is the answer. It’s as though an operation could succeed without that other doctor putting us to sleep or numbing us, and then waking us at the right time, all the while making sure that we don’t sleep till kingdom come.

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The year 2001 marks the 50th anniversary of the Philippine Society of Anesthesiologists. For the third time, the ASEAN Congress of Anesthesiologists will be held from Nov. 13 to 17 at the Shangri-La Mactan Resort Island in Cebu. The biennial gathering brings to our shores anesthesiologists from the United States, Europe, Australia and New Zealand who will deliver lectures to their Southeast Asian counterparts.

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I take interest in this event for various reasons. As someone supportive of the current national leadership, I consider international conferences that we host as an opportunity to show that ours is a generally safe country, and tourists can have the best times of their lives right here, among our smiling people. At least, we can show our anesthesiologist friends that it’s pain-free to come here.

On a personal level, I owe anesthesiologists a big thank you. Considering that I have given birth to five daughters, I cannot imagine having gone through those "ordeals" without an anesthesiologist.

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Dr. Restituto de Ocampo from Tarlac shared with me some interesting experiences from his career as an anesthesiologist.

"There is no dearth of materials when it comes to tales in the operating room. Heroic tales, horror stories, funny incidents, heart-stopping incidents or accidents – name it and it happens in the OR," Dr. Restie says.

After more than 35 years of giving anesthesia, he recalls that there’s always something old, something new, something borrowed, something blue in that OR. Cyanosis anyone? Cyanosis is the bluish discoloration of the skin and nail beds because of hypoxia or oxygen lack. Well, here are tales from the operating room.

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Dr. Restie calls this his "That’s Incredible!" story. Read on and find out why.

Sometime during the ’70s when salvaging was rampant in Tarlac, a man presented himself in the emergency room literally gasping for breath. His throat was slashed and he was bleeding. He was immediately brought up to the operating room for emergency repair of the trachea. But that’s going ahead of the story.

Apparently, the authorities had been after this former policeman for quite sometime "for a series of robberies he committed."

To continue, one night some goons tracked him down and captured him. He was brought to a secluded place near the river and mauled severely. To finish him off, they tied his hands behind his back, slashed his throat and threw him into the ravine. They left him for dead. Or so, they thought. Amazingly he did not die. Instead, he untied himself, climbed the hill and hailed a tricycle to bring him to the hospital.

When Dr. Restie saw the patient at the emergency room for pre-operative evaluation, he was in respiratory distress. He could not lie down, lest he choked to death. He was also in shock from loss of blood. This was indeed a challenge for the anesthesiologist because:

• He was hemodynamically unstable from blood loss.

• There was very little history that could be asked because he couldn’t speak – his trachea was transected.

• There was the danger of aspiration because of a full stomach.

• He had to be put to sleep sitting up before he could be positioned supine for the surgery. And fast, too.

So, how does one deliver general anesthesia on a seated patient gasping for breath? Let’s hear it from the doctor.

"I had to get a stool high enough so I could put an oxygen mask over his face. While I was holding the mask, an assistant injected a hypnotic intravenously. As soon as he was asleep, he was placed in the supine position, paralyzed and intubated. All of these in a matter of two minutes. The surgery then proceeded and the trachea repaired successfully. The anesthetic course was, thank God, uneventful. His recovery was fast. And soon, wonders of wonders, he was ready to go home."

One day, the surgeon, in one of his post-operative rounds discovered that the patient was gone – like a puff of smoke, never to be seen again. No good-byes, no thank yous, no hospital bills or professional fees paid. Absconded. That’s the word they use in the hospital.

Sometime later, the doctor heard that a former policeman was found dead from gunshot wounds in the body. He had a scar on his neck. This time, his luck had run out.

Moral of the story – "Crime does not pay." And a criminal who does not pay his hospital bill will get it, sooner or later.

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"The above story will certainly qualify us for the sobriquet unsung heroes," says Dr. Restie. Then again, he believes that at one time or another, all doctors are unsung heroes. Especially anesthesiologists. "The Hippocratic Oath, remember? Do you know that?" he asks me.

"Consider this," he continues, "we ‘hid’ behind the screen during surgery doing our best to put the patient to sleep, keep him alive and well – paralyzing him, breathing for him, giving him the necessary drugs so the surgeon can work wonders. At the end of surgery, we have to wake the patient up, free from pain, with stable vital signs, to re-sleep safely, and wake up again pain-free."

Consider this wonder too: Anesthesiologists do not generate their own surgical patients. It is the surgeons who see the patients beforehand. Then he telephones the anesthesiologist if surgery is needed.

It is only during the pre-operative visit that the anesthesiologist sees the patient, examines him thoroughly, so he can explain and device an anesthetic plan. One that will be safe and reversible. For that is one of the most important aspects in an anesthesiologist’s occupation and specialty, reversibility! The drugs and agents they use during surgery must be reversible – from an awake state to unconscious, to ultimate recovery. This is all done with no fuss, no mess and, most of the time, no fanfare.

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Consider this again: Surgery could not have progressed in leaps and bounds were it not for safe anesthesia. Imagine an open-heart surgery without safe anesthesia and a competent anesthesiologist. Or a brain operation without the benefit of general anesthesia and precise control of the patient’s needs. No way!

"But no," Dr. Restie says, "we try to find ways that will keep patients under control, with steady and normal vital signs, safely anesthetized. Anesthesia had to develop and progress even ahead of surgery to allow the surgeon to do these amazing feats. Heart transplants. Kidney transplants. Liver transplants. We have the answers to those successful operations."

And this: Modern technology has allowed them to monitor the patient continuously during surgery for safety. The introduction of the pulse oximeter, which Dr. Restie nagged me to buy when I was governor – and he got it – is a device to monitor the oxygen saturation of the patient, drastically cutting down the mortality rate in the operating room.

Today, monitors are so versatile. This means, the anesthesiologist and not just anybody, can measure the concentration of the anesthetic given to the patient, analyze the oxygen as well as the carbon dioxide content of the expired breath. The ECG, blood pressure, pulse and the temperature can be monitored continuously during an operation with one machine. Anesthetic equipment have become so sophisticated, it is amazing what information they can give. Sometimes, Dr. Restie says he and other anesthesiologists ponder, "How did we survive without monitors? Then again, it is the anesthesiologist, vigilant, capable, compassionate and caring that matters in the end."

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We remember the surgeon, but we take the anesthesiologist for granted, don’t we? Well, life is full of unsung heroes. But it need not be that way all the time. The more we know about anesthesiologists, the more we realize and the more we’re so frightfully grateful.

Good luck to Dr. Iluminada Camagay, another woman president, but this time of the Philippine Society of Anesthesiologists on her preparations for the anesthesiologist conference and for the delegates to the 12th ASEAN Congress of Anesthesiologists, we say, "Welcome and Mabuhay!"