A Blog About An Asian Medical Student. Yes that's redundant.

Wednesday, May 16, 2012

David Poon and the Road to Medical School: Hypnos

aka Why I Took Classical Mythology AND Medical Terminology in My 2 Years of Premed

“Why did Michael Jackson die?” I asked sincerely.

A short silence, then an almost amused sigh. My senior physician replied candidly,

“Because he didn’t have an anesthesiologist.”

Heath Ledger, the famous actor, apparently had such difficulty sleeping when playing the role of a psychopath, he inadvertently overdosed on anxiolytics (pills to calm a person). Within a the span of a few months, the death of songstress Whitney Houston was followed by celebrated painter Thomas Kinkade, both, apparently, to similar medications, as well as suspected heavy alcohol use.

And of course, the King of Pop himself, Michael Jackson famously was “killed” (according to the courts) by his physician, a cardiologist, when he was given propafol to help him sleep. Propafol, a powerful and common anesthetic, is used to keep patients sedated during surgeries, where Michael Jackson’s heart doctor used it to get him to sleep. The man who made Thriller died suffocating, as he was so heavily sedated he couldn’t breathe.

This is what the public learns about anesthetics.
Pop culture has pervaded our common sense in a variety of medical facts. Many of the populous truly believe an atrocious number of myths, from fallen food being unable to attract dangerous pathogens due to an inane “Five second rule,” to being under the impression that slamming one’s fist into someone else’s chest while yelling “Live, damn you, live!” will bring anyone back to life should it be a dramatic enough point in the story.

I’d be remiss if I did not say I am subject to these eccentricities myself. 

While it is a widely known fact that medical students are heavy drug users – caffeine is our lifeblood after all – it’s an odd secret that many of us are so wound up from the large amounts of stress, challenge, and coffee that we are faced with that we have trouble sleeping. So zopiclone (a sleeping pill), Ativan (an anxiety pill), and other calming drugs are used more often than we’d admit. I myself use the occasional sleeping pill during a bout of insomnia. And I’ve been terrified quite a few times because of what I see on the news.

And I’m supposedly well educated on the subject (though I’m sure many of my professors would doubt that!)

So I wonder – how does any patient unfamiliar with pharmokinetics face a time where they must receive anesthetics? Before a surgery, does the man fear the sensationalism presented to them from the media, with his favourite pop stars dying from commonly used medications?

During my surgery rotation, we spend a few days doing anesthesia – that’s the doctor who puts the patient to sleep while the surgeon essentially cuts open their bodies. The anesthetist is actually the one technically responsible for the patient’s life during surgery; not only does he or she make sure the patient is unconscious, immobile, and amnesic during the procedure, but the anesthetist monitors the vitals (heart rate, breathing rate) and gives medicine to keep them stable. Legally, if a patient crashes or dies on the table, the anesthetist, not the surgeon, is typically primarily responsible.

This is why the anesthetist has a thorough discussion with a surgery patient before a procedure. I’ve seen many of these over the past few weeks. The doctor typically describes the anesthesia as a very deep sleep, or the anesthetic as a very strong sleeping pill. They cover the risks of having these medications, such as feeling nauseous, feeling sore, feeling weak, and of course, the small but very real possibility of in fact, “dying on the table.”

Which brings me full circle to the base topics of anesthesia. Awake and life.


And death.

With a recent patient I saw going to surgery, a kind older woman having a hernia repaired, watching the propafol blissfully cause the patient to close her eyes, I could think of no more fitting words than those of Homer, the Greek poet:

 "There she encountered Sleep, the brother of Death." 

Quite suiting is that these words are from the Iliad, an epic poem depicting a great battle of high stakes. Much like the Illiad, a patient faces her fears, challenges myths, and is literally set upon a stage of life and death, with only the chance of waking up  being the sole distinction from sleep and its brother.

Thanatos was the Greek embodiment of death, and in these legends, his brother was in fact Hypnos, the personification of sleep. So close are they seen in the popular culture of humanity, that artists ranging from the aforementioned Homer to current day rapper NaS, where audiences are told “… never sleep, cause sleep is the cousin of death.

With this continuous cycle of myth surrounding sleep and death, there will always be the air of tragic hope whenever our eyes close. As we face the medications and surgeries to save our lives, in many cases all we can wish is to awaken once again.

Or, in the immortal words of Kenny Roger’s ‘The Gambler,’ “And the best you can hope for is to die in your sleep.”

Anesthetists in many ways are the keepers of this mythic symbolism. They bring about sleep, and they can fend off death. They are the first voice to awaken the patient after surgery, therefore in some sense, bring about life. With every patient they see to the operating room, they define a journey that some may not survive, though a great many more pass. And like any great odyssey, this is a journey taken out of necessity to live a dream of better health.

Perhaps this has all already been said eloquently: as Hamlet ponders the mortality and morality of man, he muses,

“To die; to sleep; To sleep; perchance to dream.”

- David

This was written as a Reflective Narrative Assignment for my Surgery and Anesthesia rotation. For my reflective surgery assignment, I decided to create a special Anesthesia related post for my blog. The topics on my website are based on my thoughts and reflections as a student of medicine, in a series I call “David Poon and the Road to Medical School.” They are all inspired by specific instances and observations during daily ward life. No confidential or identifying information is ever presented. The concept is similar to Parallel Charting, though in my case is as much an introspective on public perceptions of medicine than the medicine itself.

This was written on 3 hours of sleep and South Park playing in the background. 

The Avengers movie was incredible - I originally wanted to name this post Thanos.