Just a cog in the machine
“Hi, any chance you can help with a bowel operation (laparotomy) for a very sick man in intensive care?”
It was 8pm on a Sunday evening and the message from an unfamiliar number did NOT sound inviting. It was the weekend, I wasn’t on-call for that hospital and these kinds of complicated cases can be the stuff of nightmares for anaesthetists. Usually it means a big cut in the abdomen, blood pressures that can drop precipitously, a whole host of extra monitoring including placing lines into arteries and some of the biggest veins in the neck. All that just to get the surgery started! Hence, that sort of request for a favour comes from a surgeon who’s a friend, not an unknown number.
I politely declined. Not because I didn’t want to do it, but because I was doing almost EXACTLY the same case in another hospital where I was on call.
The patient I was dealing with had a perforation in their large bowel from an infection that had spread throughout the abdomen. Even after the surgeon meticulously cut and washed out all signs of infection, the patient still required enough medical support that we ended up keeping them in a coma with a breathing tube. Someone that unstable can require another operation with very short notice.
After getting home sometime just before 1am (early in comparison to some other on-calls!), I well earned slumber was on the cards. A few days later, I bumped into the surgeon who informed me that the patient had improved rapidly and made it out of intensive care just over 24 hours after the operation. They did need another surgery but it was no where near as complicated, nor did they need as much support.
The rest of the week passed relatively uneventfully. Most of the surgeries did not require anything outside the usual for their anaesthetic care. Intravenous cannula, a smidge of propofol to get the patient off to sleep, a bit of fentanyl for pain relief and a breathing tube to keep the airways open. Rinse and repeat. It’s almost meditative and calming when anaesthesia is uncomplicated.
Before long, it was Sunday again. One of the neurosurgeons asked to do some extra cases to clear the backlog that had happened due to Covid-19 and all the lockdowns that had happened in the past 12 months.
“Hi, sorry to ask again. Any chance you can help with a laparotomy for a very sick man in intensive care?”
Almost the same message from the same unknown number at almost the same time. Was it just an accidental message? Or some kind of error in the SMS systems causing a duplicate message?
I replied and found that almost a week later, there was another patient needing another laparotomy. This time, I was just about done at the hospital where this unknown surgeon proposed the operation. It was 7pm and we were nearly done with the neurosurgery cases. It had already been over 12 hours of work but the guilt of saying “no” again worked against me.
“Sure. I’m here anyway I suppose” I said.
“Awesome! This shouldn’t take long, an hour at most. This patient has had multiple operations already so today will be a quick look and closure.”
Multiple operations already? Usually this means that the original case was quite tricky. I looked up the electronic medical records to see what had happened in the previous surgeries. A week prior, this patient had presented very unwell with increasing abdominal pain. Due to logistics, the operation could not be done til much later until the patient was so unwell that they were rushed to the operating theatre and proceeded to have a near cardiac arrest when anaesthesia started!
“Is this the patient you messaged about a week ago?!”
“Yes” replied the surgeon. “I couldn’t find a team to operate on them last week.”
This patient had a very rocky journey. Very complicated surgery with wide spread infections that needed repeat operations every 2 days since then. The surgery commenced but wouldn’t you know it, it was much more complicated than anticipated. Instead of finishing at 8 or 9 pm, I was leaving the hospital at 2am. It’s a running joke amongst most anaesthetists that you need to at least double the time the surgeon says they will take to complete the operation, but this was much MUCH longer.
At the end of the day, I was just glad we could do the final surgery to get the patient better after a long period of illness. Exhausted but glad that we got to help someone in their time of need. As I drifted off to sleep, I couldn’t help but wonder if this patient would’ve fared much better if there had been an anaesthetist and other members of a surgical team available a week earlier…
So why am I telling you all this?
I’m not an especially gifted doctor or some highly academically gifted anaesthetist. I’m pretty certain I’d give an anaesthetic that is 99% same as any other given the circumstances. In fact, I’d say I’m pretty much unremarkable compared to some of the amazing people in healthcare.
Just a cog in the machine.
Said in these words, it inspires nothing but existential dread and a desire to question the purpose of one’s life. But just think back to the situation from a week ago. Due to reasons outside anyone’s control, a cog was missing in the machine that is healthcare. Because of that, the system couldn’t function as intended…
In fact, most things we do in the modern day involve hugely complex societal “machines” that we play the part of being a cog in. It’s easy to feel unimportant or to think that what we do is meaningless, but I hope this shows that EVERY person or role is a piece that makes the whole work. You need entire teams to pull off something complex like operating on a patient. Not just the surgeon, the anaesthetist and the nurses. There’s the cleaners who keep the theatres clean, the admin staff who keep the logistics of appointments in check, the pharmacists that keep the supply of medications in check and innumerable others.
So next time you’re feeling a bit dissatisfied about your role or feel a bit lost in the “machine” just remember that everything is composed of smaller parts. Each of those small cogs is what it takes to make the whole work and be greater than the sum of the parts.
This story is based on actual events but certain details about the cases and people have been changed for both privacy and to add some flavour to the story.
