He smiled at me.  Had that award-winning grin.  Fate had given him a charm intended to propel him through life at warp speed, with doors opening, opportunities materializing, women swooning, and things in general going his way.  He really was cute, all  “6 years old of him.”

 

I’ve had a run of cute little kids lately.  I thought I had gotten over my addiction to pediatric anesthesiology, but it has started to become evident that I haven’t.

 

 

 

 

More than a year ago, the recruiter began to call….”XYZ center really needs a peds anesthesiologist to come help”.  Well, I had no intent of going to XYZ.  Nice people, but “another job” wasn’t really on my agenda.  I had convinced myself I really wanted to just fly airplanes, and I was going to continue to practice medicine “just enough”.  I simply wasn’t going to be trapped by “the jealous mistress” that medicine can become.

Some things changed…some contracts were lost, and I had more open time than I planned.  I hadn’t been doing “serious peds”…i.e., sick small kids….nearly as much as I used to.  The recruiter kept calling.

 

I finally agreed to do a single week at XYZ.  Just one.  No further obligation.

 

The recruiter agreed, and XYZ megacenter agreed.  I duly did the paperwork (which seems to grow with each application) and my privileges were granted.  A bit over a year ago, I began to go to XYZ a week or so each month.  The nurses were competent, helpful, and accepting.  Amazingly, the surgeons were competent, appreciative, and non-abrasive.  It began to be that when I would arrive for my week of work, I’d hear my name bellowed down the hall by some of the “old gray headed guys” (and gals) and I would be warmly welcomed.

 

So, it has become a routine…a week or so a month, I fly out, spend a week in the hotel, do cases, and it’s become part of my being again.  When I introduce myself, it’s “pediatric anesthesiologist” again.  The joy of doing an induction on a nervous child, or comforting a worried parent, or starting a difficult IV has become  part of life again.  The anesthesiologist’s goal….”make the difficult look easy, and the easy look difficult” has started to be part of me….again.  It’s magic.  There is nothing quite like medicine, when it’s good.  There’s nothing worse than medicine when it’s bad.

 

I’ve had a run of cute little kids lately.  Yesterday the blond princess, who was so genuinely sweet, who had charming parents, who lived in a rural area appeared on my list.  The small talk with the parents led to a discovery that they lived very near where I spent some of my youth.  The dad had that rural southwest strength that somehow seems so at home to me.  The routine surgery was interrupted by a unexpected difficult airway…fortunately handled well, with no decrease in oxygen, but I spent time talking with them, warning them about the potential for trouble if she ever required surgery again.

 

There was the gorgeous 2 week old baby…who was born with a heart defect.  Reminded me of my nephew who had multiple cardiac surgeries, who I believe to this day would have been dead had I not stomped into the ICU where he was being neglected,  been a genuine 4 carat asshole and insisted he be shipped out to a major cardiac surgery center to have surgery.  This cute little fellow had already had his heart partially repaired, but needed more surgery…and I was his anesthesiologist.  All went well, he woke up hungry, ready to grow.

 

But today, Mr. Award Winning Grin awaited me.  Third case of the day….the first two were cute kids…but I had read Mr. AWG’s chart.  He caught me by surprise, because after reading about the accident….I didn’t expect cuteness.  An automobile wreck had left him quadriplegic….and ventilator dependent.

 

I got the full effect of the smile.  He couldn’t vocalize well, but he had in a short time mastered the ability to impress his audience with his communication.  Medically, he was unstable.  The spinal cord disruption had left his body with a tumultuous connection that sometimes allowed his blood pressure to become dangerously high.  (go ahead, Google “autonomic hyperreflexia”….I’ll wait).

 

He was to get a procedure whereby  a pacemaker would be implanted in his diaphragm to trigger a contraction of the diaphragmatic muscle to allow him to breathe without the use of a ventilator.  It’s not common.  A surgeon from outside the institution would be coming in to perform this surgery.  Oh, by the way….when you trigger the diaphragm with electrical pacing….you occasionally get the electrical impulses too close to the heart, and then get life-threatening arrhythmias.

 

For some strange reason, the trainees in XYZ training program, and the academic professors of anesthesia weren’t lining up to do this case.

 

The equipment was brought in “from outside”.  The setup for the surgery was carefully done.  I met the surgeon…and the reputation for gruffness seemed justified.  After all was prepared, I made sure that the room was quiet…and brought Mr. AWG to the room.

 

He rewarded me with his grin.  Induction went smoothly.  We positioned him, and the surgeons went to work.  The aftermath of his urgent surgery after his accident made their job difficult.  The pacer wires were placed, and despite a few technical issues, the pacer worked as billed.

 

It seemed miraculous.  I could turn off the ventilator on the anesthesia machine, and the diaphragmatic pacer would cause his diaphragm to contract, and he would generate normal tidal volumes!  (tidal volume is the measured amount of air you breathe with each breath).

 

Things were tidied up.  Mr. AWG woke up as we moved him to the ICU.  The grin appeared again.

 

Six years old.  His future irrevocably altered.  I wanted to pick him up, hold him, tell him how much I wish that I could change things.  How much I wanted to magically heal his spinal cord, so he could run, play ball, dance with a girl.  All I could give the boy with the magical grin was a safe, stable anesthetic, with no autonomic hyperreflexia.  All I could do was give him drug combinations that would allow the surgeons to work their magic through the scopes.

 

So that’s what I did.