As an anesthesiologist, the odds are I might get to work thirty minutes or an hour before you to prepare for the case or cases which you will perform that day. No matter what the procedure is, I am prepared for the worst possible scenario. This includes emergency drugs and an intubation plan, even if the procedure would not typically require intubation. As each patient is different and reacts differently to the medication I give, I have to be ready for severe obstruction, apnea, or oxygen desaturation that would require me to emergently intubate.
Despite the guidelines issued from the American Society of Anesthesiologists, The Anesthesia Patient Safety Foundation, The American College of Surgeons, and the Center for Disease Control, many hospitals are continuing with elective cases during the COVID-19 crisis. Or worse, they are hiding behind the facade of canceling or postponing elective cases. At many hospitals, a tiered system of urgency allows leeway to surgeons or family to manipulate or distort the urgency by overplaying symptoms. Let me be clear. Each and every one of my colleagues in anesthesia is here and willing to sacrifice our own health and wellbeing in order to help with every transplant, trauma, and truly emergent case you will bring us at this time. And we will do it without hesitation.
For many of you, your hospital administration has forced your hand to continue operations or made examples of you if you disagree. There is pressure from your chiefs who are also likely being intimidated at the risk of losing their jobs. To those of you willing to lose your job, I commend you for being honorable even at great personal sacrifice. For those of you who are torn right now, please, do the right thing. We will only be able to get through this if we both utilize every bit of resilience and ingenuity we have when we work together as a team. I am asking you to call your patients. I am asking you to help us practice good social distancing. I am asking you to risk your jobs in your uncertain economic times. Because if you do not, you are risking my life.
In addition to gambling on my very existence, every case you participate in that is not absolutely necessary right now is putting your community at risk. We do not have the luxury of practicing social distancing in our job. Every family that comes into the hospital is a potential vector for this virus, and we have no choice but to do the cases and then potentially spread this to our patients or our own family. We are sending mixed messages to our family by encouraging them to stay home in every aspect except this one. Every case you leave on the board requires us to use gloves, gowns, masks for all parties in the operating room. In addition, we must use anesthesia circuits, airway interventions, and medication that will be critically important in the coming days. As I alluded to earlier, even cases that do not typically require intubation might require it. In the same vein, intubation does not guarantee extubation. You must consider that your patient may need postoperative ventilation. Even as a national blood shortage looms, I still see cases on the board that may require transfusion and could easily be postponed.
Our relationship has always been one of symbiosis. We do our best work when we both understand what we are doing and why. If you have a case that looks elective but truly is not, please come find us. Come talk to us. Let us know your thought process. Otherwise, if you still want us to be able to do what we do best, which is keeping patients safe while facilitating your procedure, please do the right thing. Keeping us healthy now will be a sacrifice to your practice. However, when this all blows over, I would be willing to bet my life on this: we will be at the hospital earlier than ever, willing to stay later than normal, to help you take care of your patients. And we will do it without hesitation.
The author is an anonymous anesthesiologist.
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