Counting Backwards: A Doctor's Notes on Anesthesia in Science and Inquiry

Nov 29, 2017 Petra X rated it really liked it

Shelves: medicine-science, 2017-read, 2017-100-reviews, reviewed

My late father had a triple bypass where the anaesthetic didn't work. As his muscles were completely paralysed as they have to be, he was unable to let anyone know that he was in excrutiating pain. Afterwards he repeated to the surgeon things he had said and the surgeon was very apologetic but that was all. (If he'd been American he could have sued!)

I thought maybe this was a one-off but then last year I had surgery in the Bumrungrad in Bangkok, the world's 9th best hospital, so I expected top- My late father had a triple bypass where the anaesthetic didn't work. As his muscles were completely paralysed as they have to be, he was unable to let anyone know that he was in excrutiating pain. Afterwards he repeated to the surgeon things he had said and the surgeon was very apologetic but that was all. (If he'd been American he could have sued!)

I thought maybe this was a one-off but then last year I had surgery in the Bumrungrad in Bangkok, the world's 9th best hospital, so I expected top-notch care. The anaesthetic didn't work on me either but I wasn't paralysed and could tell the surgeon who said he was sorry but he couldn't do anything about it as I'd had the maximum amount of drugs they could give, but he would give nerve blocks.

You know those phenomenally painful injections they do in your mouth at the dentist? Well, every few minutes I had to have one or two of those for the duration of the operation. It was agony one way or another, just plain agony. I need to have a further procedure but cannot as Irma and Maria have screwed things up, so maybe next year. With full anaesthesia.

My surgeon on the island, an English doctor of considerable reknown (as a world-class racing sailor though) used to use a magical form of anaesthesia. He used intravenous valium for a light sleep, ketamine (yes, the club drug but also the one used in road-side accidents where the pain or danger is too great for opioids) to take you away into another world, mine was always light and fluffy and filled with colourful hallucinations, and also those vile sharp-pointed needle nerve blocks, except I couldn't feel them being as I wasn't 'there'.

He's not allowed to give ketamine any more. Sad that, you woke up from an operation feeling totally rested from a dream-filled sleep rather than nauseous and with a scratched throat from a general anaesthetic.

I was interested then in the job of the anaethetist whom I had not really thought of as just the guy who keeps you asleep while the Really Important Doctor, the ~~butcher~~ surgeon does their thing. However, the book explained that far from the person who keeps you (hopefully) asleep and (hopefully) pain free, the anaethetist is the doctor who is keeping you alive and is calling the shots on how and if the operation can proceed. It is fairly detailed as to layout of the anaethetist's area in the operating theatre, the gasses, tests, equipment and drugs used. That was interesting.

Two things kind of got me about the book though. One he only ever heard of one patient (not his) who had woken up under anaesthesia, really? So my father and I were that rare? I don't think so. I think there is a lot of covering of mistakes going on. Secondly when the author dedicates himself to pain relief before, during and after surgery he gets guilty about the patients like ones with cerebral palsy who couldn't advocate for themselves. He said he figured they'd moan louder if it really hurt and that if they couldn't talk or control their muscles then they were unlikely to be any more aware intellectually. What????

He saw a documentary where a CP sufferer using a computer generated voice said that having CP was like having a brain locked in a box. Then he saw the light. I had never presumed that someone physically disabled was necessarily mentally so too, I don't even see the correlation.

My late uncle was, in his sphere as an anaethetist very famous. He took part in the UK's first heart transplant and the experimental surgery that led up to that, including the one where the pig (the subject) escaped and ran amok in the West End of London. He invented the concept of Intensive Care. I wonder if he ever had people wake up in operations and say, as I did to my surgeon, wow that was wonderful can I have some more ketamine please? (No, was the answer, you aren't in pain and there is only the sewing up to do. btw the sewing-up was done by a theatre nurse whose hobby was embroidery. Small island life...) ...more

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