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

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.