Oft Unsung Medical Heroes
By Priyangwada Perera
At Medirigiriya, around 8 in the night, a little boy was brought to hospital. The villagers in Medirigiriya grow fish at home, in specially-made huge cement tanks. They later sell the fish to be released to the tanks. This was something most people did to earn money. They mostly work at night. Around 8 in the night, the father of the little boy had realised his youngest child of two and a half years was missing.
The boy was not in bed, not at home and when looking at the direction of the fish tank he saw air bubbles coming from the massive tank. The boy was quickly pulled out of the tank and brought to the hospital but upon arrival, he was almost dead. His heartbeat was barely heard. The doctor who received the little boy was Medical Officer in Anaesthesia (MOA) Dr. Rangika Athukorala.
The situation was dire in which anyone could have lost his cool but the fine training in resuscitation, basic Cardiopulmonary Resuscitation (CPR), and the courage and competence which Dr. Athukorala believes to have become almost innate to any anaesthetist is what made him not lose his cool. “We put tubes. Managed to transfer the baby to Batticaloa. He was in the (intensive care unit) ICU for one whole month but was saved. After being fully recovered, he came to see us. There are patients who are saved because of gutty anaesthetists. Highest stress levels, unbearable shifts, an anaesthetist should have 12 hands to do what has to be done.”
History of anaesthesia
If not for that crucial find where the first successful demonstration of diethyl ether anaesthesia was on 16 October 1846, most of us would have died a thousand deaths by now. William T. G. Morton (1819-1868) is considered to be the founder of modern anaesthesia. The young dentist Morton, was in search of a better agent than nitrous oxide that was being used by other dentists. It is recorded in history that Morton’s ‘tenacity driven by enthusiasm and discovery’ along with the renowned surgeon John Collins Warren at Massachusetts General Hospital was what made history on that day.
It was the first successful surgical procedure performed with anaesthesia. He goes in history as single-handedly proving the world that ether gas, when inhaled in the proper dose, provides safe and effective anaesthesia. In honour of him, the World Anaesthesia Day is celebrated on 16 October. It also is the day of the often forgotten anaesthetists and anaesthesiologists whom we never get to know. If not for them, life would have been far more painful.
Not something ‘specifically taught’
Dr. Athukorala – the MOA from Gampaha District General Hospital – never wanted to be an MOA. He wanted to be an obstetrician gynaecologist (VOG). Anaesthesia is also not something that is ‘specifically taught’ at the Medical Faculty. “Surgery, paediatrics, gynaecology and obstetrics come in the main course. One needs a very special training for anaesthesia. I was trained under a brilliant VOG with safe hands, great personality, and impressive decision making skills, who wanted me to become one and I too had little doubt of taking the same steps.
Gynaecology and obstetrics were ‘my thing’. It was at this point I got my post internship appointment to Polonnaruwa, Medirigiriya. There, I understood the impact of a good anaesthetist.” Dr. Athukorala said there are male and female anaesthesiologists and in fact, quite contrary to the popular belief, there are a number of excellent female anaesthesiologists.
Not an easy job
It is no easy job. According to Dr. Athukorala, being an MOA is quite a different journey. “Anaesthesia is also about machines and mechanics. For example, take something like a ventilator. It is about its physics,” he tried to make it simple. If you ever wondered why you had to study all that chemistry and physics when all you wanted to be was a doctor, this is where it counts. Working for three and a half years, Dr. Athukorala’s function as an anaesthetist became a major factor of survival for many in an area like Medirigiriya.
“I do not think I slept throughout the night for even one day. There would be trauma patients who come, after being struck by an elephant. It is a life-saver’s role. It might look as if we are inserting tubes but underneath, we are making crucial decisions. Each prompt decision we make in a matter of a few minutes.” In reality, no star surgeon can function independently in a postoperative care at a surgical ICU, without an anaesthetist. “Recognising the crucial function of an anaesthetist, at Medirigiriya we did not consider whether it was day or night or what time it was, whenever our service was needed. Nobody else can do what has to be done by the anaesthetist,” Dr. Athukorala said.
You either love it or hate it
“There are those who love this and those who detest it; no in-betweens. However, we have more female consultants,” Dr. Athukorala said. “We have to be extremely alert at the ICU surgery. Our ears are so accustomed to it that we are sensitive to each sound of heartbeat frequency, blood level and so on. Without looking at the machine we know the situation. It is keeping all that under check we work in the theatre. Sharp, swift and steady are their lifeline. Sometimes, this stress is our motivation”, Dr. Athukorala eased the tense interview with a broad smile.
Preoperative and postoperative periods
Dr. Haritha M. Dharmakeerthi, Consultant Anesthesiologist from Colombo North Teaching Hospital, Ragama spoke of the depth and function of an anaesthesiologist. “Anaesthesia is supplementary for both the patient and doctor. It is our duty to minimise complications and to monitor the patient safely,” he explained. At Preoperative level, monitoring of blood pressure, oxygen saturation and basic measurements of basic parameters become their responsibility. Preoperative complications are also for them to find out.
There are four forms of anaesthesia; full body or intravenous anaesthesia, regional anaesthesia which is given to a part of the body such as the upper body, local anaesthesia using ultrasound technology, and local anaesthesia which is done only by the surgeons. There are three kinds of drugs used in anaesthesia; analgesics or strong painkillers, anxiolytics or sedatives plus local and general anaesthesia. There are muscle relaxants as well. Basically, they control functions using machines or drugs. To maintain it gases are used. While there are anaesthesia workstations with machines, monitoring, and ventilation available, the continuous presence of a skilled anaesthetist is vital.
According to Dr. Dharmakeerthi, an anaesthesiologist has to identify the problems related but it has to be done early. There are only rare cases of sudden fatalities. But with anything, early identification is the key. If there is blood loss, again it is up to them to manage. Post-operative period is when you recover the patient from anaesthesia. There is monitoring to be done outside the theatre but before the patient is taken to the ward. Pain relief is also a part of their responsibility. One can continue with multi modal techniques for pain relief.
Their duties, services continue. Dr. Haritha added, “90 per cent of the responsibilities at the ICU rests on the anaesthesiologist or the MO in anaesthesia. Since we do not have the specialist medical practitioners called Intensivists, specialising in ICU care, everything at the ICU rests on us.” Unknown to most of us, Anaesthesiologists take it upon themselves to educate and train the public on CPR. ‘Restart a Heart’ is their mission in which they raise awareness. These are things lesser known to the public but crucial in making lifesaving differences.
Statistically, around the world maternal mortality is often due to the shortcomings of anaesthesiologists but a country like ours where our maternal mortality rate is very less, the sterling service offered by the anaesthesiologists, should be even more appreciated. How mistaken we have been to have thought that an anaesthesiologist is merely someone who knows the right dose to free us from pain? One after the other the parcel gets unwrapped, revealing how many more things are the responsibility of an anaesthesiologist.
Just as much as their responsibility is immense in anesthetising, they cannot idle the whole day doing nothing else but anesthetise. anaesthesiologists also cover up at Lady Ridgeway Hospital for kids. Emergency Room (ER) and those critically ill are also their domain. There is so much work that they do in these specific places. Their never-ending services are also extended to emergency outreach and medical emergency teams. If someone is critical in a ward, who else but anaesthesiologists that reach at lightning speed. They reach and they make a difference. They are unbelievably versatile. As the World Restart a Heart Day also falls on 16 October, it further elevates the importance of anaesthesiologists, spreading the message of hope of CPR.
If you were someone who underwent any kind of operation or medical condition that required anaesthesia, what if you are asked about your anaesthetist or the anaesthesiologist? “How wold I know him when he made me unconscious,” you might answer. Of course, they are the oft forgotten, and left behind the curtain as heroes you never really get to recognise. They save us from pain unimaginable. If we have not met them before, to discuss the procedure, if it was an emergency, we would never know who they are. Yet, we leave our lives in the hands of those unknown men and women whom we hardly ever get to know. They have never really disappointed us. From behind the curtain they have helped us cross the bridge.