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Education  |   November 2015
Beyond the Mask
Author Affiliations & Notes
  • Riya Jose, M.D.
    From the Christian Medical College Hospital Campus, Vellore, Tamil Nadu, India. riyamithun@gmail.com
  • The author has received permission from the patient to publish the information included in this article.
    The author has received permission from the patient to publish the information included in this article.×
  • Accepted for publication June 25, 2015.
    Accepted for publication June 25, 2015.×
Article Information
Education / Mind to Mind / Pain Medicine
Education   |   November 2015
Beyond the Mask
Anesthesiology 11 2015, Vol.123, 1210-1211. doi:10.1097/ALN.0000000000000823
Anesthesiology 11 2015, Vol.123, 1210-1211. doi:10.1097/ALN.0000000000000823
I first saw her at the holding bay of the operating theater, screaming in pain, while awaiting emergency surgery for her ischemic right leg. She had been in the operating theater just fourteen hours earlier for her first surgery—a right hemipelvectomy and insertion of a megaprosthesis—in a gallant attempt to save her right lower limb from disarticulation. She had bled 3 liters during that first surgery, and was still being resuscitated in the intensive care unit postoperatively, when she developed the pain in her right leg. As I held the mask over her face for preoxygenation, I hoped everything would turn out all right for this 30 yr old mother once she recovered from the anesthetic. However, when the vascular surgeon opened the dressing over her leg, the stench of necrotic flesh was unmistakable. He shook his head and quickly applied a fresh dressing on the dying limb. He offered a curt response when he saw the stunned expression in my eyes, “She refused amputation. There is nothing I can do. Sorry. You can reverse the anesthetic now.” The megaprosthesis was kinking her iliac vessels, causing acute thrombosis of her femoral artery. I took her back to the intensive care unit for monitoring after she regained consciousness.
Four days later, I went to the hospital ward where she had been transferred. The nurse informed me that the patient had finally undergone an above knee amputation after her family was convinced she would not survive without losing her leg. As I entered the room, she lay moaning with pain on the bed; her husband looked forlorn and stared vacantly out the window; his parents were weeping softly in the far corner. She gazed at me with a puzzled expression—she didn’t recognize me without my cap, mask and theater garb. After I introduced myself, she held out her hand over the bed’s side-rail. I held her hand with both of mine. We spoke nothing for ten minutes. Then, as if emerging from a trance, she asked, “Why me, doctor? What wrong have I done to deserve this? How can a loving and just God allow this to happen? I haven’t seen my three year old daughter in a week because I am scared I will cry in front of her.” I had no answers. I held her hand more tightly and blinked back tears as I pondered her predicament. If I were in her place, I would not have half the courage she had to face my destiny. I left her a little while later when she slept, thanks to the morphine she had been given for her pain.
Something in my heart drew me to return to her bedside after work every evening the following week, to spend a few minutes with her, holding her hand. She would speak of her life before the diagnosis of giant cell tumor of the ilium, of her dreams of having a dozen children, of her happy childhood and schooling in urban India. The day she was finally discharged from the hospital, she waited for me to come. As I bade her goodbye, she whispered, “Pray for me, doctor, that one day I may find there is life beyond this pain.”
As practicing anesthesiologists, we tend to focus on the procedures we may be required to perform on our patient—starting a central venous line or inserting an arterial line, or performing a neuraxial or peripheral nerve block to enhance postoperative analgesia, or administering general anesthesia tailored to the patient’s and surgeon’s needs. After the surgery is completed, we may eagerly wait to reverse the general anesthetic, or see if our nerve block is effective. Does it matter to us what happens to our patient thereafter? Should our involvement with our patient end when the anesthetic wears off?
This patient taught me what years of practice and scores of books on the subject never have – that the person I hold under the mask to anesthetize is more than an identification number on his or her hospital tag. He or she is someone’s mother or husband or son or daughter. He or she is precious to someone. Precious to God. She has made me richer through her friendship: she has instilled in me a yearning to live each day to the fullest, giving my best both in my work and my relationships. As we go through our share of joys and disappointments, triumphs and tragedies, failures and heartaches, I urge you to walk the extra mile with your recuperating patients. You may find, as I did, that the wounds that heal faster are your own.