April 1997
Volume 61 |
Number 4
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| Letters to the
Editor |
Is There Hope for 'Chicago Hope'?
The other day I caught a glimpse of a television show called
"Chicago Hope." During an operating room scene, a problem
developed with a patient. Amazed, I watched the surgeon identify,
diagnose and treat this "anesthesia" problem. The anesthesiologist
was portrayed as a lost soul looking to the surgeon to tell him
what to do next. One such surgical command to the anesthesiologist
was "check the airway," something this anesthesiologist
would never have thought of himself (?). Unfortunately, millions
of people watch this show and think they are viewing an actual
representation of the operating room.
The power of television should not be ignored. They have glamorized
the "E.R." physician, and residencies in this field
are now highly sought. High school students who know nothing about
medicine want to be "E.R." doctors. We need to be aware
of the role television assigns anesthesiologists. If we are not
portrayed as leaders in the operating room and specialists in
the care of the hospitalized patient, we must write the producers.
Tell them how well anesthesiologists are trained, and educate
them to the real role an anesthesiologist plays. Ask them to be
more accurate in the future.
We need the 34,000 members of the ASA to awaken and insist on
fair and accurate portrayals of anesthesiologists. Our public
image is important. Let us not allow gross misrepresentations
to go unchallenged.
Scott B. Groudine, M.D.
Albany, New York
Commentary: Since
1991, the ASA Committee on Communications has offered a service
- free of any charge - to more than 100 movie and television script
writers, producers and directors as well as novelists and journalists.
This service is intended to do exactly what you so aptly note
is necessary: to make sure that the right information gets to
the powerful entertainment industry; to serve as a credible source
of factual information about medicine in general and anesthesiology
in particular; and to shape our image as caring, knowledgeable
medical specialists who play as important a role during an operation
as does the surgeon. Any re-enforcement by way of letters from
ASA members to producers and writers to "set the record straight"
also would be most welcome and appropriate.
Margaret G. Pratilla, M.D., Chair
Committee on Communications
Never and Always
"Young man, if you ever gave an anaesthetic in the manner
that you just described, let me tell you what your fate at the
Boards would be!"
The British are so gentlemanly to their victims, probably from
years of training during the days of Queen Victoria, when the
sun never set on the British Empire. Ruling the unruly required
the strong arm of authority to be tempered by a modicum of social
grace that separated the godly from the heathen overlords that
preceded their rule. This young resident, an ex-colonist no less,
was now on the receiving end of such an execution, at least of
the soul if not the body.
"In six months time, if you tell your examiner what you
just told me, he will suggest that you both take a walk to a nearby
window. He will then ask you what color are the leaves. With luck,
you will get that question right and reply 'green.' He will then
suggest that you return to the examination hall, not when the
leaves turn from green to brown, but to wait until they turn back
to green. He will then politely escort you to the door."
The Consultant was taking a little poetic license as the leaves
in London were usually gray/black year round, but he made his
point.
The case under discussion was how to induce anesthesia in a patient
who had had a tonsillectomy and now was bleeding postoperatively.
The answer, which could be summarized as "pent, sux, tube
in the head down and lateral position," was responsible for
the scathing response.
Much to the amazement of all concerned at the time and something
which still continues to confuse his colleagues, this young resident
passed his Boards. Bursting with the confidence of the inexperienced
as well as forced by the poverty associated with apprenticeship,
the time had come to hit the road to seek fame and fortune. Like
many other British anesthesiologists, both resident and consultant,
Sweden was the destination of this financial pilgrimage.
It was not long before this resident faced his first real challenge
which was, of course, a tonsillectomy with postoperative bleeding.
With the advice of the Consultant so clearly etched in recent
memory, the course of action was clear.
"Inhalation induction" was not greeted by the experienced
nurse anesthetist with quite the enthusiasm or support that was
anticipated. In fact, downright skeptical would be generous in
describing her attitude. However, I was "the doctor,"
a phrase that every nurse knows is a euphemism for other less
polite descriptions and was determined to proceed with "the
plan."
The third attempt at induction met with the same fate as the
two prior attempts. The first stage of anesthesia was passed deceptively
easily. It was during the second stage that the coughing, breath
holding and sputtering effectively terminated an otherwise very
skillfully managed inhalation induction and brought us back to
square one. Throughout the proceedings, the young patient was
remarkably stoic and cooperative though even he was beginning
to have doubts after three failed attempts. At this time, with
a surgeon in the neighboring O.R. beginning to wonder what was
going on (an anesthesia induction room does have some advantages),
the pride was swallowed and the patient stopped swallowing as
another method for the induction of anesthesia was demonstrated
and this time was successful.
Since that time, the lesson has been learned many more times,
only each time it gets easier to accept. What is "always"
in one town is "never" in the next, whether it is the
use of inhalation agents in neurosurgery, reversal of relaxants
even if the patient is doing press-ups on the table or the presence
or absence of parents at the induction of anesthesia of their
children. Each point of view has its advocate, usually an anesthesiologist
with a deep tan that is not characteristic of those who spend
a large portion of their time in concrete bunkers under fluorescent
lights. However, for those of us faced with the mundane task of
getting the work done in the real world, black and white are merely
extreme shades of gray.
There was also a second lesson learned in Sweden by that young
anesthesiologist, namely that the language barrier, which still
exists in this common nation only separated by a common language,
spared me some of the embarrassment that I so richly deserved.
Martin Mackworth, M.D.
Editor's Note: From
time to time, our readers are entitled to a bit of levity in order
to lessen the impact of the many transgressions upon our daily
existence. The short essay titled "Never and Always"
is a bittersweet reminder of our early practice experience. Martin
Mackworth is the pseudonym of one of our "Down East"
colleagues and an ex-patriot of the U.K. - E.L.
The views and opinions expressed in the "Letters
to the Editor" are those of the authors and do not necessarily
reflect the views of ASA or the NEWSLETTER Editorial Board.
The Editor has the authority to accept or reject any letter submitted
for publication. Letters must be signed (although names may be
withheld on request) and are subject to editing and abridgment.
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