What are you so scared of? by David Christie (@bagheera79)

“Now, what I want you to do is focus on your breathing. Slow big deep breaths, in and out. You’ll think nothing’s happening at first, then you’ll feel the world become a warm, fuzzy place. Maybe imagine yourself somewhere like a hot sunny beach, waves on the shore, warm sun… big deep breaths, in and out…”

I usually say something along these lines as I’m drifting you off to sleep for your operation. The wording and phrasing obviously varies, and to be honest it’s the tone of my voice that’s important. The aim is to create an atmosphere of calm and reassurance. Something to focus on instead of the beeping of the monitor and the plastic smell of the mask, and the thought of what happens next. It sounds daft, but it’s important. People can be terrified, when they come into theatre, truly terrified. 

Some of the reasons for this are obvious – perhaps the reason that you’re having surgery, such as cancer. Or the surgery itself carries risk – such as surgery to major blood vessels, the brain, the heart. But some of the reasons are a little less obvious, I think, and easily forgotten. Imagine you’re coming to theatre. Just getting to that point involves the co-ordinated effort of many, many different teams. Patients need to be referred, seen in clinic and booked for surgery. There’s a need to have pre-operative assessment done for all the medical, nursing, physiotherapy and social needs. A raft of co-ordinated investigations such as blood tests, ECG and more are ordered to make sure that we know enough about you to be able to do it safely. The booking teams need to create lists that need to match with the availability of the surgeon, the waiting time, the urgency of the surgery and the availability of the patient – and possibly that of your carers or relatives. The theatre team needs to know what particular bits of kit are needed and to have it ready for you on the day. Extra members of staff from different departments may also be needed – such as additional surgeons or radiography – the list goes on and on. The whole process is so enormously complicated and intricate that it astonishes me that it works at all. And it needs to have this level of complexity – we humans are not car parts, stamped out in a factory. There are so many different individual problems that need to be overcome, the system needs to be able to cope with them all. And, by and large, we do.

The downside of being able to cope with all of this with a high degree of safety is that the process has become streamlined, smoothed, tick-boxed and protocol-driven. The most widely publicised example of this is the WHO checklist. With a few simple questions this checklist manages two things that seem obvious but used to be done very badly. The first is that it requires all members of the operating team to meet, introduce themselves to each other, and discuss the day’s work ahead before anything happens. In one neat moment, suddenly everyone knows who everyone else is, what the plan for the particular patients that day is, and what problems are anticipated. The second is that, for every patient – before they’re sent off to sleep, is involved in a discussion that is designed to ensure we have the right patient for the right operation, and various safety aspects taken care of – antibiotics, crossmatched blood, prophylaxis against life-threatening blood clots… It’s simple, effective, and has saved many lives all over the world. Unfortunately, all of this can be hugely depersonalising, and worse, unsettling. Having a group of strangers discuss how much blood you’re possibly going to lose just before you fall off to sleep isn’t necessarily reassuring. The whole process of coming in early on the day of surgery – hungry and anxious – to be told to get undressed and meet a sometimes bewildering range of people, including a surgeon that might be different from the one you expected. To be repeatedly asked about yourself, and then to be discussed while you anxiously wait – no wonder people are scared!

So, what can we do? We only have a few minutes with each patient in the morning rush – but that’s enough. To engage with people on a human level, to let them know that we care, to stop them being quite so terrified is not as difficult as it sounds. Simply saying hello and telling people your name goes a long way – it says you care about them enough to let them know who you are! Tell them what’s going to happen and why, what to expect so that they don’t get a fright. Remember that the nonagenarian in front of you may have had an extraordinary life and seen more than you can ever imagine, don’t be patronising.

All of which brings me back to my little spiel at the top, there. Recently I was anaesthetising a man in his eighties for a straightforward urological procedure. He’d been telling us about his life, time in the mountains, his high-flying daughter, an severe accident he’d had racing motorcycles over fifty years ago. I started to inject the medicines to send him off to sleep, and talking about sunshine, warm weather – and he interrupted to say, “Nah, son. I’m gaunnae dream about scoring a penalty fir Liverpool, right in front of the Kop.” I loved that, it made me smile. It made everyone in the room smile, in fact. It reminded me anew, yet again, that our patients are people, with hopes and dreams and complicated lives, and to not lose sight of it. And it reminded me also, that no matter how old we get, boys never grow up.

David Christie is a Consultant Anaesthetist for Dumfries and Galloway Health Board

13 thoughts on “What are you so scared of? by David Christie (@bagheera79)

  1. Really liked this blog Dave, it reinforces 2 key things; the importance of safety processes, even if it seems a bit procedure driven and the fact that each patient is a unique individual. We lose sight of that at our peril. Thanks

  2. Fantastic blog it reminds us of the importance of all these checks and the first and most important check in the chain is the patient.

  3. So very well put – we often forget that the our patient ‘s are real people with diverse, complicated and interesting lives. Is it just me who has experienced a high degree of fear and anxiety when they suddenly become the patient and no longer just an employee – I doubt it.

  4. EXCELLENT!! OUTSTANDING!!! LOVED IT!! I should send a translation back home to CROATIA!!! I agree with you 100%, humanity is the key!! I have been a patient many times and it has humbled me to totally understand what patients are going through!!! I do hope all my experiences have made me a better physician!!!

  5. great blog Dave and I bet wrote with a smile thinking of boys and toys at any age. I loved how patient centred this blog was and reinforces the safety both of which are of primary importance. Well done 🙂

  6. What an excellent blog..really good to reading.treating pts as individuals and realising how scary it can be being a patient.

  7. Fantastic… I laughed and cried… we are all folk at the end of the day, and great to see this story told in such a person centred way!

  8. To a surgical patient, the moment-of-no-return waiting just outside the theatre is confronting for a simple reason: you’ve just said goodbye to whoever is supporting you, and now you’re on your own in the system. You’re still awake, and acutely conscious that you’re in a busy workplace where everyone knows everyone, except you, and you’re the one with no clothes on. I’ve been grateful beyond words for human gestures in that small, weird pocket of time. Thank you so much for writing this, it’s really helpful for patients to read.

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