Author: Nanadadzie Ghansah

There is something irreversible about acquiring knowledge; and the simulation of the search for it differs in a most profound way from the reality.”
– J. Robert Oppenheimer

A Simulator is defined as:
– a machine with a similar set of controls designed to provide a realistic imitation of the operation of a vehicle, aircraft, or other complex system, used for training purposes.
– a program enabling a computer to execute programs written for a different operating system.
Simulators are used extensively in the military, aviation, medicine and other industries for training purposes. With or without actors, they can be used to create scenarios for training. Each scenario is usually managed by the person or team who created the scenario and can be watched live and/or videotaped to be watched later for evaluation. Events in the scenario can be altered to challenge the participants.
Simulators are now used extensively in medical training. They are also required some specialties for recertification and for continuing education.
Being old-school, I wasn’t a big fan of the whole simulation thing. I believed and still do that, for training purposes, a real live scenario beats a simulated one hands down. However a real live scenario is not always available. That is where a simulated scenario is invaluable for training purposes. It is also great for testing one’s reaction and for revising training. For my recertification a few years ago, I had to spend some time in a simulator and in the process, became a believer. It surely has it’s place.
Recently, I have been thinking of taking another simulation course. As I reviewed the available options, I had a thought. We are in the mother of all political seasons. The presidential elections are around the corner and with that the debates. I thought of how we choose who we think deserves to occupy the highest office in the land.
I am sure people vote along party lines, by race, by looks (I’m not kidding!), by their stand on social issues like abortion and gay marriage and so on. Sometimes their experience may sway us. This year, it’s crooked versus crazy!
Even though what they say and promise should not be that important in our decision making, even though words are cheap, they do play a huge role. Unless it is an incumbent, no one has had the prior experience being a president so we are really dealing with the unknown.
So then I kept thinking – what if we could get our presidential hopefuls into a Simulator and have then manage some “crisis” situations?
So, back to my candidates.
We get a simulator and create scenarios that mimic crisis situations for a US President.
We get actors to play all the different parts – Congress, the Supreme Court, the Tea Party, Teachers’ Union, Putin, ISIS etc.
We get the candidates, one after the other to manage these scenarios and see how they perform.
The candidates will know to put their best food forward since the whole world would be watching. It would be impressed upon them to take the scenarios seriously.
Having been in a simulator myself, I can honestly say that it is rather difficult to mask your real abilities during these scenarios.
If they are well written and planned, they can be so real as to elicit reactions from the participants that reflect who they really are in crisis situations.
Remember Hilary’s “3-am ad” against the then Obama? Well we could simulate that.
We could simulate an economic crisis, wars, attacks, conflicts with Congress, natural disasters and so on.
It might just be a better measure than empty words and promises.

I see this in my hospital all the time and I am sure it is seen by anesthesiologists all over the US – how much sicker our patients are.
It is also evident that surgeons are pushing the envelope further and further. Patients are sometimes showing up for surgery whose short-term prognosis (don’t even consider the long term) makes one question the wisdom in a surgical intervention.
Then is the rather formidable (no pun intended) issue of morbidly obese patients who need their day in the OR.
We as anesthesiologist seem to take all these challenges in stride and in most institutions, the daily schedule is hardly affected as these challenging cases are shuffled through.
We complain about the wisdom of surgically intervening in these instances but since the show must go on, we do what we have to.
I dare to blame us though for these circumstances. Bear with me and I’ll make myself clear.
Imagine an institution where the anesthesiologist cannot manage ASA IVE cases or secure the airway in that 550 lb patient or get that patient through an exploratory laparotomy who just had a myocardial event. Just imagine!
What do you think the surgeons are going to do? Three options – take their cases elsewhere, stop taking these patients to the OR or hire an anesthesiologist who can or is prepared to do these cases.
What if this was a national phenomenon with all anesthesiologist? Maybe the sickest patients will not show up for surgery!
However, we have a specialty that prides itself in being progressive, being evidence-based and seeking to constantly improve itself.
We attract the smartest and most innovative minds.
We seek and employ CRNAs who are bright, focussed and unafraid.
The results – the ability to manage whatever the surgeons pitch at us! So they keep throwing and we as trusted batters, always hit the home run.
600 lb? Bring it on!
EF of 15%, cirrhotic and anuric? Bring it on!
Hematocrit of 15? We’ll fix it intro!

I think the realization has hit us so most anesthesiologists have stopped complaining and are just keeping on because maybe, just maybe, we are to blame, but in a good way.
No matter what we allow into an OR though, we always have to bear this in mind:
“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witness, that I will fulfill according to my ability and judgment this oath and this covenant…I will apply…(treatment) for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”