Anaesthetic assistants

It was after Christmas and the day it snowed. I heard scrambling noises next to the bedroom. A rat had somehow found its way in from behind the eaves. We got rid off it, but it found it’s way back in. Then it was a google search to find a pest controller. It was only recently that I find out that one of my good friend’s husband runs a pest defence business. We had already found someone to deal with our problem by then. They put down the drugs and caused it’s demise, but how did it get in, that was the issue.

The drain guys put cameras down the drains to find the source. All to no avail, but what they did find was a broken drain, under the tiles. It would have gone unnoticed if it wasn’t for the rat. So today someone came to fix the drains. Now we need to find someone to put the wall back together again. Everything happens for a reason, or so they say. A nuisance which turned out to be a blessing in disguise.

The men came to fix the drain just as I was leaving for work. I got delayed. Luckily I had a trainee with me. The first patient is late. The minute he walks in, he heads straight for the water cooler and drinks a glass of water. Which means we cannot give him an anaesthetic for at least two hours. It is a urology list filled with elderly patients. I know how cranky some patients can be. After all my father used to be the prime example. This patient has already been cancelled once due to lack of HDU beds. I ask my trainee to see him again to find out if he really needs a high dependency bed and if so to arrange one before theatre.

I go to theatre to start the list while she sorts out the patient and bed. The first patient arrives. I get the drugs ready and prepare to anaesthetise. My assistant is meant to connect up the monitors and get ready while I site the cannula. Instead she starts looking for a vein. I do her job and attach the patient to the monitors. She fails in her first attempt at cannulation and tries again. I say “no, I will do it”. Once is enough. I don’t think she is happy, but I ignore it. The day gets underway.

My assistant goes for her annual appraisal and another assistant takes over. We get ready to put a spinal for the patient. As my trainee goes to scrub up to get ready, I position the table. The table won’t budge. We all try, with no luck. It was fine during the last case and now it won’t move. We have to find another working table. The spinal is not easy, I go to scrub to help her. No one offers to open the gown or gloves for me, even if it will save a bit of time. We have to ask for everything. No one uses their initiative.

The third patient arrives. An immunocompromised patient. I draw up the drugs and set it by the anaesthetic machine. Another assistant, who is now relieving my regular assistant for lunch, deposits her dirty drug cupboard keys on top of the drugs in the drug tray. Of all the places to put down the keys, she couldn’t find an appropriate place. I ask her to discard the drugs and get me a fresh tray. I later find out that she is the person in charge of ANTT or the aseptic non touch technique. I wonder if she understands what the term stands for. She gets me a fresh tray ie syringes and drugs. Now I have to draw it all up again as my patient waits to be anaesthetised. They are allowed to mess up our prepared trays, wait around while we do everything ourselves and cannulate patients, but not allowed to draw up drugs.

Our anaesthetic assistants can make or break our days. They can turn the easiest of lists into a nightmare and the good assistants can prevent bad lists from turning into nightmares. The good ones know how to read us and get things for us before we even ask for it. If only I could choose who to work with my life would have been so much easier. Sometimes I do wonder why people chose this career if their heart is not really in it. It is not a job for the faint hearted. They cannot freeze when things go wrong. They are our eyes and ears if we miss something. Life is not a simulation and sometimes we may not get a second chance. A few years ago when a young patient went into VF arrest on the table, if it wasn’t for the help of my anaesthetic assistants both from my theatre and nearby theatre he would not have survived. Forty five minutes and counting, seven rounds of defibrillation and adrenaline later he survived to tell the tale with minimal injury. Similarly there are a lot of operating department practitioners and anaesthetic nurses who are angels in disguise and worth their weight in gold. The rest can learn from their examples.

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