Are We to Blame

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.”

Stand With Her

In the night time hours of June 30, 1982, three judges and an army officer were abducted from their homes in Accra, Ghana and murdered. Their charred remains were found July 3, 1982 miles away from their homes.
Almost 34 years to the day, two young men and an enabler choose to go on air and spew the most abhorrent threats towards the Supreme Court (SC) judges. By far the most egregious is what was directed at the 69-year-old Chief Justice, her Ladyship Georgina Theodora Wood!
Shockingly, these men were not prosecuted by the Attorney General so the SC had to take matters into its own hands. The men were tried by the SC for contempt and sentenced to 4 months (instead of the maximum of 3 years) in jail each and fines.
Even more amazing attempt to petition the president to pardon them….led by women, of all people! 

MY FELLOW GHANAIANS, DON’T YOU HAVE ANY DECENCY???
I don’t care which party you belong to because decency knows no party affiliations! It should be as innate as the desire to breathe!
So if you are Ghanaian and have any shred of decency in you, #StandWithHerLadyshipGeorginaWood
Remember, she could be your mum, grandma, aunt or sister!
#IStandWithHerLadyshipGeorginaWood
#TheConscientiaCampaign

That “It”

Sure, it’s in you! You can do it! You are greater than who you now are!
Over the years, I guide my life with a set of principles.This is one of them and as I watch the Olympics, I cannot help but see that principle in every instance. That is why I love watching the games and I bet that is why the majority of you do too.
Sure, patriotism, nationalism, girls in bikinis playing volleyball, girls with six-packs so tight you wonder if they eat, the swag of Bolt, the indomitability of the Phelps…sure all that but at it’s core, what draws us to the games is the chance to marvel at the fact that these athletes found “it”. They surely found it and it made them believe they could win, break that record, jump as high…that “it” that said, “You are greater than who you think you are so go for it!”
So we watch them and realizing they are just as human, somehow gloat in the feeling that just maybe, we can find that “it” too. We return each night to take a toke from that joint of “it” and revel in the high of knowing, it might be in us too after all, and it is. As sure as the fact that the sun will rise tomorrow, so is that “it” in us and if we look, we can find it.
Thus in spite of all her troubles, Brazil found it in herself to stage the Olympics Games for the world, Phelps did it again, Ledecky left everyone behind, Bolt accelerated and Biles soared.
So in spite of whatever, you can find it in you to quit smoking, get that degree, stop drinking, spend more time with the family, listen more, be empathic, appreciate, work out, kiss your wife more or just smile.
You can! It’s in there! Find it!

Olympiosis

I am suffering from severe case of Olympiosis.
Symptoms are quite prevalent in the mornings but are felt all day long – tiredness, yawning, red eyes, arthralgias, headache, deafness to alarm clocks and gross irritability. It can be confused with a hangover. The difference is found by measuring the blood alcohol level in most patients.
Cause is thought to be inability to extract the human mass away from a television set during the Olympic games. It was first described in the 1970s.
Most experts attribute the pathology to pure wonder at athletic prowess. Game and his team in a seminal paper postulate that the sheer determination exhibited by the athletes induces heightened admiration leading to insomnia. Track et al measured the level of light emitted from the medals the athletes receive and noticed a high correlation between the amount of gold won and the severity of Olympiosis and laryngitis.
Cases of Olympiosis spike during the Swim, Track and Beach Volleyball events. Men seem to be particularly afflicted during the Beach Volley Ball events. This year, the CDC is reporting that doctors are seeing a spike around the Ladies Gymnastics events too.
Four years ago, researchers in London isolated two viruses called the Phelps and the Bolt that might play roles in the severity of Olympiosis. This year, scientists in Rio de Janeiro have isolated two more viruses – the Ledecky and the Biles. A group outside Rio reported on a variant called the Manuel. A team at the NIH is working on vaccines.
Olympiosis might be contagious, a fact that the experts cannot seem to agree on.
Treatment is avoiding television sets. A good televisionicide will do the trick. Also, one should avoid contact with the internet in all it’s forms. Symptoms usual subside after about 3 -5 days of avoidance.
Failure to treat leads to a chronic state that is incurable. The long term prognosis is dire. It seems to lead to sundaynightfootballiosis, modaynightfootballiosis or even EPLiosis. Most chronic patients end up in rehabilitation centers, where they spend the rest of their lives watching TV and drinking beer or knitting.
A select group of patients seem not to progress to the chronic stage and I think I belong to that group so for now, Olympiosis, bring it on!