Cancelling surgery: When the show can’t go on

It’s showtime.  No need to worry.  This is just another routine performance.  I can do this.  All I need to do is get on stage, do my dance, and wait for the curtain to fall.  Then move on to the next stage and do it all again.

The curtain opens.

My patient is wheeled into the operating room.  With the help of the circulating nurse, we guide her from the hospital gurney over to the operating room table.  With the grace and precision of a ballerina, I start my recital by securing an oxygen mask over her face.  Next, I apply the monitors – a blood pressure cuff to her right arm, a pulse oximeter probe to her left ring finger, an EKG sticker to each shoulder and one more on the left side of her rib cage.  Before turning my back on my patient to draw up narcotics, I start the Levaquin – one of two antibiotics she is to receive before surgical incision.  Less than ten seconds later, her right arm, the one with the IV, has a brilliant red streak tracking along the path of her vein.

The background orchestra stops abruptly.  The silence is deafening.

I’m forced to adapt.  Without a moment of delay, I disconnect the antibiotic from her IV tubing.  Quickly, I grab a vial of Benadryl from my drug cart.  Before I can draw the medication into a syringe, the patient speaks the words I never want to hear.

“I can’t breathe.”

I shoot the Benadryl into her intravenous line.  My hands are shaking, my adrenaline pumping.  I order the nurse to retrieve Pepcid, which will further help to diminish my patient’s escalating allergic reaction.  Meanwhile, I administer a hefty dose of steroids.  As fast as I am able to grab the next medication in my arsenal, her symptoms worsen.

“My throat is tight.  I feel like I can’t swallow.”

Mine, too – but for different reasons.

The scenery behind me changes to an ominous and foreboding backdrop.

I thrust an inhaler at the young woman.  While she puffs Albuterol, I grab my stethoscope.  Fortunately, she seems to be moving air well, and I don’t detect any wheezing.  But my patient has asthma, and I fear respiratory compromise is only moments away.

When I speak, my voice sounds high pitched and unfamiliar.

“Are you feeling any better?”

“No, but not any worse either.”

We sit there in the operating room for what feels like an eternity.  Every few minutes, I listen to her lungs.  Everything sounds normal, but she still feels like her throat is closing off.

The surgeon, the resident, the scrub tech, and the circulating nurse – they are all staring.  One minute at the patient, the next minute at me.

I am dancing on a stage of fire, where the critics are relentless.  One misstep, and I will be crucified.  It was not my choice to be here.  I never wished to perform.

Twenty minutes pass.  The patient remains stable.  I pull the surgeon aside and do my best to sound confident and convincing.

“I don’t think we should proceed with surgery,” I tell him.

“Why not?  What are you concerned about?  Not being able to intubate or not being able to extubate?” he asks.

“Yes,” I answer without hesitation.

The spotlight is on me, and the rest of the stage is pitch black. 

My skin burns under the scrutiny.  Even though I have rehearsed countless times, I am nervous and shaky.  I hate myself for getting so rattled.  I’m doing the right thing, but there are so many barriers.

The surgeon speaks, “Well, if you think it’s the right thing to do, then let’s cancel.  But Kate, what do you think we are going to achieve by delaying surgery?”

This act should have ended long ago, but the stagehands refuse to lower the velvet curtains.  I continue my pirouette, but I’m growing tired and my grace is fading.

“Well,” I say, “right now I have an asthmatic patient who may or may not go into severe bronchospasm at any minute.  By instrumenting her airway, I am likely to tip her in the direction of disaster.  This procedure is elective.  We have nothing to gain by proceeding.”

Finally, my performance ends.  From the galleys, there is unexpected applause in pockets of the audience.  Yet, other clusters remain silent, shaking their heads in dismay.

Tomorrow, the scene will be replayed, and the role of the anesthesiologist will be played by another.  My performance will be critiqued, ridiculed, and dissected.  Ultimately, those who never witnessed my performance will judge me.  The reviews, I am sure, will be unfavorable.  I should have kept dancing.

The show must go on – at any cost.

Kate O’Reilley is an anesthesiologist who blogs at katevsworld.

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