As it turns out, the patient has a mutation in a liver enzyme that metabolizes medicine.  Her specific mutation causes her to metabolize medicine quicker than the average person, which they use as an explanation for why the patient wakes up from anesthesia.  Although this seems a plausible explanation, it would likely not happen in real life.  The mutation certainly does exist; however, because of the use of continuous monitoring during anesthesia care, it would become apparent to the anesthesiologist that the patient was starting to respond to the surgical stimulus long before she would be fully awake.  She would be given additional doses of analgesics, hypnotics, and muscle relaxants to make sure that she would remain anesthetized, in spite of her quick metabolism of these drugs.

Does awareness under anesthesia occur?  Yes, but exceedingly rarely.  Dr. Dhar has information on it in her book, Before the Scalpel, which you can find on amazon.com.  With all the monitoring that takes place, it is highly unlikely that an event such as the one portrayed on Grey’s Anatomy would happen.

V3XNPT9ER8FD

Seems that several doctors from Puerto Rico are chugging down big mugs of regret after posing for some objectionable pictures taken during a mission trip to Haiti.  CNN dug up pictures of the group on Facebook, posing with Haitian military, holding guns and smiling for the camera.

CNN reports, as can be read in an online article, that several doctors were sent to Haiti by the government of Puerto Rico just days after the earthquake in order to set up a field hospital to assist in addressing health care needs.  Although the intentions and work of the group were honest and admirable, several members of the team of doctors took pictures with Haitian military, holding machine guns and smiling.  This picture, shown above, as well as others were posted on Facebook.  Other pictures showed the doctors drinking beer and scotch inside the field clinic, dressed in surgical gear, with patients in the pictures as well.  The Puerto Rican government is quite ashamed of the situation, and has said that these photos may compromise the careers of the individuals involved.

I have to say that I too am embarrassed that these pictures surfaced.  I am sad for the doctors, who must have been under great stress to perform in those conditions, but whose actions are inexcusable.  I am sad that this has tarnished the public opinion of medical missions.  But it also illustrates a predicament that most doctors have to face at some point.  This job is so much more than a job.  The public holds doctors at such a high moral standard that something that would otherwise seem a minor indescretion to another profession becomes an unforgiveable grievance for a medical professional.

So I was on call for the operating room this weekend at my hospital in NYC, where I did a crush injury case – coincidence!  The patient was an 18-year-old who got his hand crushed in a piece of machinery at his job.  He had a complicated pinky finger fracture as well as nerve and blood vessel rupture to that finger.   A special orthopedic hand specialist was called in to perform the surgery to reconstruct the finger, including repairing the nerves, arteries, and veins in order for the patient to keep his pinky finger.  It was about a 3 hour case in a sophisticated operating room, with an infinitely expensive microscope used to repair the tiny nerves and vessels in the finger.

Compare and contrast that to the videos I watched of the surgeries taking place in Haiti.   Watch this piece below.

Pretty amazing to see that patients in Haiti are being anesthetized without the use of modern monitors. The surgeries are being performed on modular tables, open to the dust and debris carried in the air, with only ambient light – no high-intensity OR lighting to be found.  They are using garden hoses for tourniquets and Black-and-Decker drills intended for home use to perform the procedures, much less a 100K-dollar microscope.  And the goal is not to repair the limb, but to stabilize the patient to prevent further health risk, such as infection.

Just some food for thought…..

Hopefully the surgeons will come back to the US a little humbled by the experience, and maybe a little easier to get along with!!

V3XNPT9ER8FD

It appears that reality TV star Heidi Montag went under the knife to make a few improvements on her already flawless face.  She apparently had 10 plastic surgery procedures at one time!  That’s quite efficient.  She may have saved herself some recovery time and maybe some money by having to pay for only one anesthetic; however, she did not save on public criticism.

Heidi, a star of MTV’s Laguna Beach, The Hills, and other reality-esque shows, was interviewed by The Early Show on CBS.  She claims that she is not addicted to plastic surgery since she’s only had two surgery sessions in her life, despite having stacked several procedures into each session.  She also claims that plastic surgery does not contradict her belief in strong Christian values, nor is a promotion for her new album ironically titled “Superficial.”

A couple of her comments bother me.  She claimed in an interview with Access Hollywood that plastic surgery really had a negative effect on her health.  She even thought she was going to die.  She said, “I had too much demerol like Michael Jackson did.  And my breathing was five breaths per minute.”  Her doctors naturally refute this claim.  I tend to believe them.  She also claims to continue to be a role model for girls, saying that “beauty is really within.”  Please.

Read more on Popeater.com