Preop Nurse (to cute little nun in full habit from the order of Penitents of the Blessed Virgin Mary*): Sister, did you have anything to eat or drink this morning?
Sister Mary Immaculate: No, dear; Sister Rita even put a post-it on our kitchen fridge so I'd remember.
Preop Nurse: That's good, Sister. (Starts applying blood pressure cuff to take vital signs.)
Sister Mary Immaculate: I was just thinking during Mass how easy it is to slip into a routine and forget these things, isn't it?
Preop Nurse: I know it. It's just like...wait, did you say you had time to go to Mass?
Sister Mary Immaculate: Of course, dear. We go every morning at six.
Preop Nurse: Did you receive communion?
Sister Mary Immaculate: Oh yes, I always do.
Preop Nurse: By any chance was it just wine, or was it bread and wine both?
Sister Mary Immaculate: Oh, no dear, it was just the host. Why?
Preop Nurse: Because I think we have to let your anesthesiologist know. (Gets on the phone.) Dr. T? Um...your next patient received communion at Mass this morning...does that count?
My initial reaction, from a phone in the operating room: Huh? (Then, recovering my bearings:) Sure. It counts. (Chin-stroking moment ensues...)
after ingestion of clear liquids (water, apple juice, black coffee): a minimum of 2 hours
The theory behind preoperative fasting is that stuff taken by mouth - even the act of chewing a stick of gum - can increase acid production and volume of contents in the stomach. This then poses an increased risk of aspiration of dangerous material into the lungs under anesthesia. If the surgical procedure is urgent and must proceed regardless of a patient's food intake status, there are a couple of measures we can take to reduce gastric acidity, facilitate gastric emptying, and mechanically reduce the risk of pulmonary aspiration.
I made my decision in Sister Mary Immaculate's case by taking into account the nature of her intake - a small, quick-to-dissolve, paper-thin wafer - and the nature of her surgical procedure, which would not require a general anesthetic.
I was talking to my boss and colleague, Maddog, later about it, and said, as an aside, "Theologically speaking, of course, it wasn't bread any more."
"True..." he said, pausing to think about it for a moment. "But technically it was heavier than bread, right? Theologically speaking? I don't know - I'm a Protestant."
"Oh yeah...that's true...Well, I guess it was good that I gave her Bicitra, then."
His eyes widened with feigned shock: "You washed the Body of Christ down with Bicitra?! Hey, I think we're supposed to have lightning later...Maybe you should stay indoors!"
I had to laugh. The surgeon chimed in as he passed us in the corridor, jokingly coming to my "defense," "Just think of the complications we would have risked, though, Maddog, if her patient HADN'T gone to Mass and received communion."
Banter aside, it wasn't the mystical issues that gave me pause when I was first asked how I wanted to proceed. It was the culinary issues. Is a communion wafer considered a solid rather than a liquid, even though it practically melts in your mouth? If so, is it a light solid, and if so, would it have required me to impose a 6-hour wait had Sister Mary Immaculate's procedure required a general anesthetic? Or could I proceed without waiting but with the usual precautions we take for a "full stomach?" And would those HAVE to include a rapid-sequence intubation? How much increase in gastric volume and acidity could a eucharistic host possibly induce? Certainly less than chewing a wad of gum, I would guess. But that's just it - I'd be guessing. Guidelines aren't answers or rules set in stone. They're guidelines. There's research to back some of the concepts up - there's even a paper on the chewing gum issue - but not detailed research on every possible scenario.