Today I had another opportunity to give an anesthetic to a colleague’s child. It was a small, straightforward procedure in an otherwise healthy child. But oh…how those personal connections ramp up the nerves! Now, it is extremely flattering when you are asked to care for a child by someone you work with, but it certainly adds extra worry. If I had my way, there would be a rule against it! (That is a bit extreme, but really, doing these cases does take some time off my life, I am sure of it).
This colleague does not work in the OR, I have come to know her through work seeing consults in clinics and following patients on the ward. We also sit on a committee together. My own insecurities always make me believe these people ask me to look after their children because I am generally personable and “seem nice”. I secretly think that since they don’t really know about my level of expertise they would choose someone else if they really did know! I mean, what kind of thinking is that? Come on….Dr. Potter, be confident.
An early mentor of mine gave me very good advice about dealing with patients with whom I have a personal connection. She reminded me that you can’t avoid this situation, even in large centers, you will always come across someone you know at some point. She stated that you “must treat the patient exactly as you would any other patient”. Her belief was that when you veer off from your normal path, even if you are trying to do something even better, you increase your chance of trouble. After all, if you didn’t think what you usually did was the best, why do you do it that way?
And so with these thoughts swirling in my mind, I cared for her child. All went well, but not perfectly. It took me a couple of tries to get the caudal anesthetic in place (usually just takes one) and he woke up comfortable but restless. But the worst part was, he had a full on meltdown in phase 2 of recovery. He had been fine, but then lost it. Crying, yelling, hitting his mom. She was so upset, of course, crying herself. And there wasn’t anything I could do. We knew he was comfortable, because he had told us just a few minutes ago. I knew it wasn’t emergence delirium (a known phenomenon in little ones after gas anesthesia) because he was oriented.
So I watched helplessly and felt like world’s worst anesthesiologist. I am sure my poor colleague wasn’t feeling like such a great mother at that point, either. These are the thoughts we have when people we care for are hurting: guilt, helplessness, and even a little bit of pain ourselves.
Of course, our little patient settled down, had a popsicle and went home quite quickly after his outburst. I really don’t think there was anything else I could have done with my anesthetic that would have changed this incident. But if I hadn’t know the parents, I would have explained that the outbursts sometimes happy, there is no one to blame, and went on with my day. But because I knew them, I am going to worry and rehash what happened. Because I feel personally responsible for how that child felt after surgery. Arghhh…and I will keep thinking about it until next week, when I have been requested for another colleague’s child…