Behind Closed Doors: Inside the Operating Room with Dr. Jeffrey Swisher

Welcome to my first post for PokitDok! Despite having a sister who is of one of the most prolific tech journalists on the net, I am a first time blogger. But bear with me, perhaps this is genetic, so I will give it my best shot. When Lisa Maki, my old college and Stanford Sierra Camp pal tracked me down after many years to invite me to be part of her new health/medical information venture “PokitDok”, I was intrigued. I also couldn’t get the image out of my mind of those little pastel colored sugar candy dots glued to the roll of three-inch wide ticker tape. I think they were called Candy Buttons, but I called them “Pocket Dots”. They were the perfect “pills” for playing doctor, and undoubtedly launched me on my career as a physician.

Lisa and I talked over the course of a long hike in the canyons of Mt. Tamalpais near my home in Marin. Our discussion ranged widely, and as is typical for Lisa, was engaging and insightful. We caught up on our respective lives and careers, our health issues that invariably ensue as you hit middle age, and our mutual fascination and frustration with the complexity, politics, and economics of health care delivery in our society.

I am an anesthesiologist who works in a large tertiary care hospital in San Francisco. My group of 53 physicians provides comprehensive anesthesia care for a wide variety of medical procedures and surgeries. From epidurals for relief of labor pain, to surgeries on tiny premature babies, to liver and heart transplants, and the whole range of surgeries and procedures in between, my practice is interwoven with the complex tapestry that is modern medical care. And believe me, “complex” is an understatement.

It is said that one should befriend a sharp accountant, a trustworthy mechanic, a relentless attorney, and a good butcher. I would add a well-trained anesthesiologist to that list. There are few doctors who are as present and responsible and as little known about as
anesthesiologists. Prior to your operation, we review your health history and current medical issues, as well as your medications and their various interactions. We perform a rapid and comprehensive physical exam, explain the myriad risks and benefits of the anesthetic procedure tailored specifically for you, then put you to sleep using powerful sedatives such as propofol, the “Michael Jackson” drug.

Or we can render parts of your body numb with local anesthetic drugs injected through precisely placed needles in your back, or arm, or leg. And then we stay right next to you for the entire duration of your procedure, watching you. We carefully monitor your vital signs, and oxygen, carbon dioxide, and anesthetic gas concentrations using complex machinery, tweaking here, and adjusting them as needed. We tally and replace fluids and blood loss. The latter surprises a lot of people. “You give blood during surgery?!” As opposed to whom, the blood fairy perhaps? We keep you stable, and alive, in a state of suspended animation while the surgeons do their job. Then we bring you back. Putting you to sleep is only a small part of what we do. It’s keeping you there and then getting you back—awake, safe sound and comfortable—that’s tricky.

What’s unique about anesthesiologists aside from our particular expertise, and good looks, is that we are always in the middle of things. We meet a lot of people, we listen a lot, and we have a lot of time to ponder. Operations are often long affairs involving a wide variety of folks: surgeons, nurses, scrub-techs, physician assistants, equipment reps, etc., all confined to the small space of the operating room. Conversations are lively, often about politics, economics, and the modern realities of medical care. We talk about Obamacare, death panels, HMO’s, PPO’s, mandated insurance, rising costs, decreased reimbursements, drug shortages, the list of new topics continues to grow.

So, exclusively on PokitDok, I will share with you medicine from the inside of this small room - conversations and stories accumulated over the years from encounters with my patients and my colleagues. Stories that highlight many of the issues we are all facing today with our new world of decisions and choices we must make about our health and our medical care.

Jeffrey L. Swisher, M.D.

San Francisco, CA



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