Thursday, July 17, 2008

Tales from Saint Boonie's: Songs in the O.R.

There are a few things that bring the docs and nurses at St. Boonie's together. The Red Sox. Food and drink. On occasion, certain movies or songs or T.V. shows.

And, escape fantasies.

As the nurse preps the abdomen for surgery, and the surgeon gowns up, and the anesthesiologist adjusts ventilator settings, sometimes they can be heard sharing the latest plan: leave St. Boonie's to become a mystery shopper or marry a millionaire; do locum tenens work and freelance for travel or food magazines between jobs; quit medicine entirely after winning the lotto. The same conversation comes back over and over again in different incarnations.

But do we hate our jobs so much that we're constantly joking around about means of escape? Is being in health care so completely odious that we just abhor getting out of bed every morning?

Well, no. I think we all dislike the annoyances, large and small, like workplace politics, and call, and the daily dose of obnoxious behavior from some unforeseen source. But we "have it pretty good" at St. Boonie's. It's a village, a family, and none of us would want to lose that kind of community life at work.

And the work itself has irreplaceable rewards - not always obvious or easy to appreciate. But if we keep ourselves mindful enough, they're there to remind us of why we chose this path in the first place.

Take old Sully Carlton. Sully had a cardiac defibrillator implanted into his body to deliver an electric shock in the event of a potentially fatal disturbance in heart rhythm. He was having dinner one night when the thing went off and jolted him right out of his plate of pot roast. He came to St. Boonie's so the cardiologist could test and adjust the device.

As the PACU nurse and I were putting monitors on him, as well as pads for an external defibrillator and an oxygen mask, he said to us, "You girls fussing over me like this make me feel like I'm important or something."

We both smiled at him and said something like, "Of COURSE you're important! In fact, at this very moment, there's no one more important to us than you."

Sully replied, "I think this is the only time anyone's going to feel that way about me." He sounded matter-of-fact, not self-pitying, but there was a hint of loneliness in his voice and eyes. I looked into his eyes, trying to find something to say. I couldn't think of anything, so I gave his arm an affectionate squeeze instead.

"You ready?" I said to the cardiologist.

I gave Sully the anesthetic through his IV, then started to assist his breaths with a bag-mask ventilator.

"I'm going to induce V-fib now," the cardiologist announced. That's that potentially fatal heart rhythm - the one we don't usually like to see, because it KILLS people.

"Great," I said, a little sardonically. "I can't wait."

The testing procedure went completely smoothly. Sully's implanted defibrillator fired and corrected the abnormal rhythm without a hitch. Five minutes later Sully was back with us. The drug I had given him sometimes gives people a very refreshed, almost euphoric feeling, and sometimes removes enough inhibitions to allow for some fairly intimate disclosures. Sully awoke thanking us and thinking about his late wife.

"I took care of her in the end, you know," he said, his speech still a little slurred. "I cleaned her up when she couldn't do for herself. I combed her hair."

We murmured words of admiration, of praise. Then he dozed off. Sully was a good guy. I wondered if in his dreams he and his wife were young and in love and unencumbered by things like defibrillators and terminal illness.

Then there was little Cassie Molloy. Cassie was a cute, curious, sociable little girl with honey-colored hair. She reminded me of Abigail Breslin's character in the movie Little Miss Sunshine. She had broken her forearm falling off her scooter. The orthopedic surgeon, Dr. Warbucks, was a pleasant, portly man with a poker-faced sense of humor. He sat in the corner of the O.R. waiting as we placed monitors on Cassie.

She began to get a little tearful and said she wanted her Grammy. I tried to console her and asked her if she knew any good songs.

"She likes Hush Little Baby," the nurse helping me said. We started singing to Cassie.

"Hush little baby, don't say a word; Momma's gonna buy you a mocking bird..."

We continued while I searched in vain for a blood pressure cuff of the correct size. Another nurse left the room to retrieve one. I gave Cassie oxygen with a well-cushioned face mask. She asked for Rockabye Baby.

"Rockabye, Baby on the tree top; when the wind blows, the cradle will rock..."

Still no cuff. We started on some songs from The Sound of Music. "Raindrops on roses and whiskers on kittens; bright copper kettles and warm woolen mittens..."

Finally the correct blood pressure cuff arrived, and we put it on. I turned on some nitrous oxide and asked Cassie to pretend there was a little birthday candle inside her oxygen mask that needed to be blown out. "Big breath now, sweetpea. Blow that birthday candle out. Brown paper packages tied up with strings...These are a few of my favorite things..."

Cassie was calmer now, her breathing more relaxed. "How are you doing, sweetheart? Give me one more nice deep breath, that's a girl. Edelweiss, Edelweiss, ever morning you greet me..."

I began pushing the milky white drug into her IV. Her eyes began to show the familiar movements of a child entering an anesthetized state. I started to assist her breathing. Everything was going as smoothly as I'd hoped.

As I gave Cassie the anesthetic I heard a sound coming from the corner of the room. A baritone voice, soft at first, almost distant, singing as I inserted the laryngeal mask airway.

"Perhaps I had a had a wicked childhood. Perhaps I had a miserable youth."

Then, a little louder, "But somewhere in my wicked, miserable past there must have been a moment of truth." Dr. Warbucks, though feeling a little impatient over the delay with the blood pressure cuff, had gotten into the Rodgers and Hammerstein spirit.

As I secured the LMA into place, he stood up, put on his x-ray apron, and belted in my direction, "For here you are, standing there, loving me, whether or not you should!"

So I replied, and we finished together, "So somewhere in my youth or childhood, I must have done something good."

Later in the recovery room, after a smooth awakening, Cassie was sitting up in bed chatting happily with the nurse, totally comfortable and in good spirits. Dr. Warbucks had given her a bright pink cast for her arm. "Hi, sweetie," I said, checking in on her. She gave me a big smile. I asked how she was feeling, and if she remembered anything. She said she dreamed she was wearing a beautiful dress like Cinderella at the ball. And she said, "I remember you sang me a song."

Sigh. Okay. The lotto can wait.


rlbates said...

I talk to my patients and hold their hands while you anesth guys/gals put them to sleep T, but don't sing to them.

How nice of you.

T. said...

It's my pedi background coming back to nudge me...I never could resist an adorable kid...

Michael Leddy said...

"So I replied, and we finished together, 'So somewhere in my youth or childhood, I must have done something good.'"

So great when life turns into a musical.

T. said...

And you can bet this scene happening with a SURGEON playing Captain von Trapp to my Maria is a RARE one indeed!

Good ol' Warbucks...He once asked me if I'd heard of the "Errol Flynn School of Spinal Anesthesia," then proceeded to demonstrate how to do an imaginary spinal using fencing moves... :)

Anonymous said...

latest plan: leave St. Boonie's to become a mystery shopper or marry a millionaire; do locum tenens work and freelance for travel or food magazines between jobs; quit medicine entirely after winning the lotto. The same conversation comes back over and over again in different incarnations. <-------that was hilarious. i thought it was really sweet what you guys did for sully he does sound like a good guy. Cassie sounds like a doll i love children!

you seem great at your job, good for you.


Anonymous said...

I am laughing so hard I'm crying. I swear, if any surgeon had started in with "Something Good" he'd have been my favorite for the rest of time, no matter his reputation, or temper, or closing speed. I'd have loved to have been a fly on that wall.

BTW, I was ALWAYS singing to my patients. I took requests, but Somewhere Over the Rainbow was my favorite.

T. said...

Katy - I am SURE you actually have a NICE singing voice, so I envy you! I can carry a tune ok, but it's not what I'd call NICE...

I'll have to remember Somewhere Over the Rainbow for next time. :)

Margaret Polaneczky, MD (aka TBTAM) said...

MY favorite musical of all time. I must have listened to that album a hundred times when I was a kid. Even took the Sound of Music bus tour when I was in Saltzburg once.

Great post!

Alex said...

I had a miserable-looking little five year old with a temperature of 104.5 sing me a song when he came in on Christmas Eve and just happened to be missing his two front teeth: "All I want for Christmas is my two front teeth..."
He made my day!

Rogue Medic said...

I do not sing to kids. I come from the Bob and Ray school of singing - "I can carry a tune in a bucket." Milk of amnesia may not be enough to drive my cacophony out of a patient's head.

If patients misbehave, I threaten to sing. Rarely do they continue with their misbehavior.