Things You Wish You Hadn't said to your Attending

My first week in Anesthesia, I get assigned to a hilarious, wry Italian in Cardio Thoracic, who's a bit on the embittered, jaded side. Of course his name is Guiseppe. Well, Guiseppe has been doing anesthesia since the late 80's and completed a Cardiac Fellowship at Harvard. So, it's no surprise that he is not as fascinated as myself with the intricacies of Cardio Thoracic surgery/anesthesia and the Heart-Lung Bypass machine.

Guiseppe is a rare breed. He doesn't pimp* and is not really interested to know if you know what the physiology of a left to right shunt is or how does one calculate the cardiac output from a TEE (TEE: transesophageal echocardiogram) or what the heck are Starling's forces. Instead, he is interested in you. Plain old you, if you weren't a medical student. And along the way, he drops little pearls of anesthesia wisdom, that is hard to come by.

I must admit that it is all very overwhelming at first; anesthesia and Cardiac anesthesia at that. There are 500 million things to do before surgery even starts....central lines, PA catheter, Arterial lines, zeroing transducers, cardiac output sensors, swan ganz.....I could be speaking in Arabic. The anesthesia machines are menacing to the untrained eye and there are many things that beep and scream for attention. Like a sponge, I soak it all, almost to a frenzy.

And then there is the Bypass machine. It was beyond fascinating to know that before heart repair is attempted, a person has to be exanguinated, his blood pumped through a contraption, that for the duration of the operation, will act as lung, heart and to a minimal extent, kidneys. It's a giant test tube where physiology is allowed to happen and "clean" blood is then returned to the patient. Meanwhile, on the monitors, the person flatlines, his arterial pressure is at 60 and monophasic (normal pressures have 2 components to it, hence, biphasic and is usually 120/80). For all intents and purposes, this man's heart has stopped and the only thing keeping him alive is a flip of a switch.

So you can understand how it is that I am utterly enthralled by this entire process and have like 90% of my attention affixed on the flat lined monitors and the bypass machine, a million questions zipping through my head, and only like less then 1% of my attention focused on Guiseppe, who is asking about where I was born, what is it that my husband does for a living, how did I meet him, where is Singapore and what is the Straits of Melecca? (The other 9% of my attention was focused on what I was going to have for lunch, which is unusual for me since I normally spend like 98% of my energy obsessing about what it is I would like to stuff down my gullet.)

In fact, I don't even remember how it is that we came to talking about Swinger's Clubs**, which according to Guiseppe, is quite a rave in Europe and hurls out some French term that sounded like some food item. Of course this is somewhere after I got done telling my story about how I met Mitch, which for the benefit of all who don't know, I will now subject myself to public humiliation by publishing it on the WWW. I told them that I had found it unnecssary, in my youth, to hide behind the modesty of a closed blind as I changed out of the shower. At this time, both the Attending surgeon and his resident have stopped working on the still heart and have now proceeded to stare at me in their google eyes through those vascular glasses they all wear. In my youth...I kept repeating.....in my youth!

Guiseppe now asks if I have participated in any Swinger's clubs here in New York and, not paying much attention, I said: "I wish!" like it had no consequence.

Guiseppe is nonplussed and the CA 2*** is laughing his head off. Meanwhile the monitors go on flat lining, the patient is still in full cardiac arrest. It's Friday and I take my que to leave.

Monday rolls around and I am now with a different attending rotating through ambulatory surgery. Dr M. is rather sparing with his words and doesn't really emit the impression that he is too thrilled with students. But my skin is thick. I want to learn and so introduce myself any way.

"Ah, Edna," Dr M. says, with a sort of knowing look in his eye. The CA 1, whose shirt tale I am tagging along on, grins from ear to ear and says: "It's never a good thing when the attendings know you by name."

Yes, it's Swinger Edna, just in case you don't know and here's my number: 612-IDO-SWNG.



*pimp-ing - used to describe a habit by attendings and residents who wish to test the student's general knowledge of useless medical facts and get very tickled when you know what Epstein's anomaly is or what is Valentino's sign like it makes a whole damn difference to the medical care of patients.

**A place where one goes to wife swap. I swear, on my mother's name, that my knowledge of such places goes as far as Episode 6, Season 5 of CSI.

***denotes an anesthesia resident in his second year of training.