A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Sometimes our best decisions as physician anesthesiologists are when we decide to call off a surgery or procedure. The “best anesthetic I never gave” was for 18-year-old Hunter Jones and her case really demonstrates the importance of talking with patients before surgery.
Hunter was an active, normal high school student enjoying her senior year when she received a colon cancer diagnosis. Both Hunter and her mother were shocked at the diagnosis and surprised again when I had to call off her surgery to remove the cancer after conducting the preoperative evaluation.
Hunter told me that after two previous exposures to anesthesia for colonoscopies needed as a result of her cancer diagnosis, she experienced a tingly feeling and numbness in her legs. What really concerned me was that she was unable to walk without falling for a couple of days after undergoing anesthesia the second time. I knew something just wasn’t right.
After the pre-operative assessment and subsequent cancellation of surgery, our medical team decided a pediatric neurology appointment was needed to study Hunter’s brain and spine. The results identified a brain tumor. We told Hunter’s mother, Maria, the next day. Additionally, the neurologist on our team told Maria if we had proceeded with surgery the day before, there would be a good chance Hunter would have been paralyzed for the rest of her life.
It’s very rare that I postpone a surgery because our entire medical team works together with our patients to ensure we’ve carefully reviewed their history, physical exam and made sure they are optimized before surgery. But ultimately, it’s up to me, the physician anesthesiologist to say “yes,” we’re ready to go, or in rare cases, cancel the surgery.
Many patients are not aware of the value of pre-surgery consultations by a physician anesthesiologist and in general, there is limited understanding of what we do before, during and after surgery.
Before surgery it’s important to review the patient’s health history and do a physical examination. I talk to my patients. I want to make them feel more comfortable. I educate them about their anesthesia care plan and what is going to take place. I answer any questions they have. During the surgical procedure, my role is to make sure the anesthetic is working and ensure the patient is in good condition so the surgeon can complete the operation. I also safeguard the patient by monitoring his or her vital bodily functions to make sure no problems occur. If a problem arises, it ultimately becomes my responsibility to handle. And then finally at the end of the case, after the patient comes out of anesthesia, physician anesthesiologists take care of their pain. We make sure they’re doing well and recovering according to plan.
It’s important for patients to be properly prepared for surgery. The Preparing for Surgery: An Anesthesia Checklist is a great resource and can help patients take simple steps by 1) planning for the procedure by doing their homework and getting healthy 2) talking to their physicians to find out who is providing the anesthesia and reviewing their overall health, medications and experiences with anesthesia and 3) preparing for the day of the surgery.
These types of public education efforts are important to help ensure the safest outcome for patients. I know postponing the case that day helped Hunter get a clear diagnosis. She also got the treatment she needed and, I think, in the long run it kept her from harm.
Today, I’m still very involved in Hunter’s care. She is cancer-free, attending college, and running a fund that allows her to give back by donating Chemo Cozy jackets to pediatric and young adult oncology patients receiving infusions.
When I see Hunter in the hospital, it makes me proud to see this vivacious young woman making a huge difference in the world. I know that my medical training helped her get where she is today. I did exactly what a physician should do and that’s to do no harm.
Mary Herman is an anesthesiologist.
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