The bigger they are, the harder they fall... asleep

by - February 22, 2012

Part of my job is getting people to sleep. No, I'm not a baby sitter. I'm an anaesthesiologist. I'm the guy whose profession evolved from the caveman who knocked you unconscious with a club so that the caveman surgeon could operate to the 18th century 'doctor' who held you down/choked you unconscious while the surgeon cut you up to operate on you. Yeah. That's me. Bet you were wishing I was the baby sitter now, huh ?

Anyway, a funny incident happened last night. I was on duty last evening at the hospital and got a call of a VIP patient having pain following surgery. Now, it's definitely  a common occurrence and usually there are orders for pain killers in their files. But the sisters and the patient's relatives kept saying the pain killers prescribed weren't enough. Being a VIP patient, they called me for a consult.

By the time I arrived, he'd been shifted out of his private room and down to the ICU where all sorts of monitoring devices were available. The guy was almost a stereotype - rich, mid-thirties, well built chap with a dozen relatives and well wishers. Anyway,the monitors revealed something very strange - there was no signs suggestive of a guy in pain. Yet there he was, writhing around, holding his relatives hands and they looked towards us ( the operating surgeon too had arrived by then ) to do what we doctors do : find the cure.

Over the next half an hour, I gave 4 varieties of pain killers, an anti-spasmodic and a couple of sedatives. The doses were on the higher side and would have usually been used by African tribes to tranquilize a rhinocerous, I'm guessing. 
And yet, even as the monitors showed us that there was nothing wrong, this man would slowly drift away to sleep ( thanks to the sedatives ), then wake up and demand we hold his hand. It took a good hour of cajoling his relatives to leave him alone to sleep and requesting the nurses to turn off the lights around him before he finally slept... for 15 minutes before he woke up and demanded we hold his hand again. 

It was around 11:30 at night, as we were leaving a good couple of hours later, that his in-law let slip a minor detail : our patient ree-eee-eally couldn't stand any form of pain, be it a mosquito bite or a stapler pin falling on his toe. And he had been sure before the operation that there'd be a lot of pain because 'we were cutting him up which is a million times worse than a mosquito bite'. Therein lay the flaw of our plan : All the pain killers in the world couldn't help a big guy who chose to embrace the fear of pain rather than the relief from it.
I've seen this quite a few times earlier as well, I must admit. The incident that comes to mind most significantly is this next one.

We had two particular patients posted in an operation theatre back to back - a 23 year old 'Salman Khan bodied' guy posted for appendicitis and a thin 15 year old girl posted for correction of a fracture of her tibia ( a long bone in the leg. ) Now normally, we'd give the guy a spinal anaesthesia ( his lower extremities  would be paralysed, but he'd be awake. ) and the girl a complete general anaesthesia ( owing to her young age, her apprehension and lack of cooperation ). 

While talking to her prior to taking her inside the operation theatre, I realised she was quite sensible and mature for her age and so, with her and her guardian's permission, opted for the spinal anaesthesia. Not only was she awake, she was absolutely calm during the entire spinal as well as the surgery. I still remember having a very smart and intellectual discussion with her on how life changes as we leave high school and have to join college, even as the surgeons worked on her leg on the other side of the drape.

As for the Salman wannabe ? You guessed it. He literally cried while we put in the tiny intravenous catheter, screeched like Britney and wriggled like Shakira as we gave the spinal and eventually had to be 'knocked off to sleep' with sedatives even though the spinal was working well, just so the surgeon could concentrate above his constant fears ( including a very defining - "I can feel the cutting" when noone had even started surgery !! )

I guess there's a lot of truth to the old proverbs - you really can't judge a book by it's cover, can you ?  
Salman-beta probably still visits the gym everyday, working extra hard on the weights to impress the girls when he rides his Pulsar. My recent patient will go back to wearing designer labels and Ray Bans and ordering his manual labourers to bow before his awesomeness. That little girl is probably in college right now, trying hard to fit in and be popular. 
But the fact is that the truth is about what lies beneath and how it defines who you really are.
Sometimes, the outer 6 pack abs are just a disguise for a terrified soul ; a big entourage and designer clothes do not successfully hide the fact that you need someone to hold your hand because you're scared of the pain... and sometimes, it's the small little girl who can barely lift her own school bag who turns out to be the bravest little pumpkin of the lot.

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  1. Wow! This is soooo damn true dude! Seen some of these while I was there too... Nice one :)

  2. I am sure that you want to suggest that because someone is big and muscular, would always think like this! But I agree how people believe affects very much their life-experiences!

  3. Sorry I meant that "you don't want to suggest"

  4. Denizen, you'll see so many examples as you carry on.

    Mr Sunil, absolutely not :) In trying to show the problems of stereotyping people, I don't want to create a new stereotype. I just wanted to point out how appearances may sometimes be decieving.

  5. Well written Doc! I can identify myself as the person who used to get terrified of pains (even headaches) and pop pills but ever since I joined pharmacy I realised how unnecessarily we are using drugs when only inner strength should suffice!

  6. Lol!! Even I have seen such people! While doing extraction, even if you give them LA more than what is needed, they'll still complain of pain!!

  7. Maithili, i was always the opposite, I feel. Used to keep quite in spite of a lot of pain, be it physical or mental... have a high threshold, I guess.

    Rohan, exactly. You'd have seen so many right. Across the street, we too suffer the same problem :)

  8. True that!! Appearances are often deceptive.
    Our presumptions/assumptions need not always hold true---a lot depends on who we are presuming/assuming about.
    Human nature is complex like that! :)

  9. ""he caveman who knocked you unconscious with a club so that the caveman surgeon could operate to the 18th century 'doctor' who held you down/choked you unconscious while the surgeon cut you up to operate on you. """


  10. Pri, yes. Thats why I went with the "monsters inc" pictures too... they were nothing like what they seemed.. they were the ones scared of the little girl, remember.

  11. JJ, sadly yes... well, maybe the caveman bit is an exaggeration, but till 150 odd years ago, surgeries were done by getting a lot of people to hold the guy down/ knock him unconscious. There really was no easy way to perform a surgery.

  12. So true, stronger looking patients are invariably the most delicate ones. With their overindulgent relatives making matters worse.

    Children are way tell them the facts and they believe you, if they don't understand, your "Midaz" touch does the job :)

    I have a special 12 year old friend who has ALL and comes weekly for his intrathecal therapy. Its far easier to do a spinal for him than most adults.

    Oh...keep writing about your anaesthesia experiences more often. Small community..annashetty bloggers from India

    PS: Annashetty is what most canteen boys, servants call us here, either as a joke, or inability to say Anaesthetist

  13. Great narration! I loved the way you've juxtaposed pics from Monsters Inc. ( a fav with my daughter and me) in the story. I guess it's a stereotype now but often enough the bravest people are the ones who don't look it.

  14. Nicely written, as usual. :) Now we know what the docs must me thinking when we are reduced to whimpering heaps at the mere sight of gleaming medical instruments.

  15. Yeah I guess that is the truth. People who look strong can have a very low threshold for pain and a frail person can take it all..

  16. Varsha, its that in between age - say, 9-15 years, I find surprisingly strong.. maybe they just wanna appear stronger than they are.. but they take things in a very matter-of-fact sort of way. And will write more annashetty stories as i recall them ( funny.. noone ever used that term here - annashetty :) )

  17. Manreet, I'm trying to avoid bracketing it as a stereotype.. but its definitely not an 'exceptional' case anymore. Its a lot more common than we imagine.

    Anitha, hehe :) forgive us.. we've seen too much. The only way to avoid empathising with people's pain is by distancing ourselves from it.

    Lazy Pineapple, so true.

  18. totally true... young, muscular males who look like they would give mike tyson a run for his money are the ones who feel d most pain.
    and of all d vaso vagals i've wittnesed while giving SA d majority were in young muscular males...
    men are "wimps".... :D

  19. This is almost like one of those inspiring moral stories that are even fun to hear :-)
    Like I told you before...I have had to deal with so many anaesthesiologist(I had to copy paste this to get the correct spelling)...I wish they were half like you...

    Discussing life before being cut-that's one hell of a good way to be cut:-)

  20. Arunima, the thing about the vasovagals during spinal is absolutely true..its the younger muscular men who are most likely to suffer it... no comment on the last bit though :p

  21. Been watching a lot of old "Scrubs" episodes.. hence, the nature of this post with a whole "moral at the end of the tale"

    And I actually would enjoy having more patients who I could have a rational chat with..

  22. Oh my this talks a lot about me ! Although I am not heavily built like Salman Khan. And I think a guy like you gave me the aneasthesia during my delivery- which was a C-section after suffering 8 hours of pain and trying for a normal delivery...and after that started the pain of a C section !
    Phew for my hour long screeches when a microtip pen touched my fingertip! And yes, threading eyebrows still hurt !

    I can so well identify with the pain and the differences in pain threshold. Doesnt have anything to do with the size or age of a person. Adipoli post!

  23. Thanks Anita... noone would know better than an anaesthesiologist the variations in pain threshold for different people.. we have to constantly gauge and adjust for people, both awake and under anaesthesia..

  24. LOL!!!! So true! Luckily although I am tiny, I have a mighty threshold for pain. And I believe in the body's power to heal itself too, well mostly.

  25. Nilu, went through some major physical pains myself.. that kinda made me immune to lesser pains.. led to a state where i was laughing when i fractured my arm.. seriously !!!

  26. Pains... mental of physical.. is always felt in the way we perceive it...and not what it is in reality...

  27. You're rt, Meety.. it all comes down to how you choose to respond to it.. whether you want to swallow the pain or scream out loud.
    And being big/small/male/female has nothing to do with it.


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