Agraphia Medical Tragicomedy

17Jul/07Off

Guess I Won’t Be An Anaesthesiologist

I've seen kids with their legs chewed up by motorcycle crashes. I've seen women shitting their guts out from C. Difficile infection. I've held the hand of a 15 year old coke addict while I ripped a tube out of his chest. I even sewed a man's arm that was sliced in half by barbed wire.

But I've never been so unsettled as I was today.

A lady came in to the Emergency Department, a Code White. As part of the trauma service, I was called down. She had multiple drugs on board, and was flailing around like a madwoman.

In order to safely intubate her, she was given Succinylcholine and some Versed. Briefly, Succinylcholine is a paralyzing agent that prevents people from moving (lets us stick tubes down their throat to help them breathe) and Versed knocks them out so they can't tell that a tube has been shoved down their windpipe.

I was excited because I got to bag-mask her (i.e. breathe for her, since she had been completely paralyzed)... but as we wheeled her over to where she was getting her CAT scan, I started to notice that she was drooling from her mouth, nose, and eyes. On top of that, her hand was twitching.

As we rounded the corners to Radiology her movements became much more pronounced. Her hands started moving up as if to rip the tube out.

I'll spare you the gory details. For the next 20 minutes or so, the nurses attempted to restrain her while she jerked around, arms and legs straining to rip off each and every tube out of her body. The nurses - and the doctors - were convinced that it was merely a rudimentary brainstem response. Intellectually, I agree, but I can't shake the feeling that she was awake and unable to speak or defend herself, while suffocated and drooled into every orifice possible.

I don't get wierded out easily. But her lying there, unable to scream, was just too much for me.

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  1. Sux would have worn off within 5-10 minutes… ditto with the versed… I hope she had a propofol drip with some vecuronium on board otherwise that was slow torture.

  2. hey, i love your blog, and i’m adding you to my list of med blogs i read, if that’s alright, since this blog is great!

  3. Tell him it’s not alright! Tell him he can’t add you to his list of med blogs he reads! They put me on a list once and now I can’t move without telling all my new neighbors! Don’t suffer my fate…

    On topic…the main reason not to become an anaesthesiologist: they have gas.

  4. During 1 of 3 ACL reconstructions, I felt the anaesthesia wearing off. Of course, I was able to tell the anaesthesiologist.

    I also remember when I was an EMT seeing a stroke patient for the first time. I had the same thoughts.

    K


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