A Crash course for Surgeons & Anaesthetists

( 1998 Quentin Bristow)

"Good morning to you all, and welcome to the first condensed practical course for surgeons and anaesthetists. I am professor of surgery at the University Medical School. You are all aware of the critical shortage of surgeons and anaesthetists which has developed, following the implementation of the government health care reforms.

"Of course you are, otherwise you wouldn't be here. When the government asked me to run this course my first instinct as a physician was to have nothing whatever to do with it. I was only persuaded to agree when they indicated that my continued tenure at the University might be a factor in my decision. You see in my day it was mandatory to have an M.D. before taking courses to qualify as a surgeon or anaesthetist. However I have been informed that under the new streamlined health care system, it will now be sufficient to show evidence of experience in a related occupation.

"May I ask you Sir in the fourth row, what is your occupation?... A veterinary surgeon, well now that is indeed very closely related. Now you Sir, back there in the tenth row?..... A meat packer, ah... I see, not as closely related as all that..... Oh yes, I don't doubt that it is in the little red book - I am beginning to wonder if there is any occupation that isn't. You Sir?.... A plumber... yes of course, there are some superficial similarities.

"The older gentleman over there, yes you Sir in row five, may I ask how old you are?.... One hundred and twenty seven, my goodness..... You were told that there would be no age discrimination in selecting candidates for the course?... Page 37 of the little red book, naturally, nothing surprises me any more. You've always wanted to be an anaesthetist you say, really, since when?... Ever since you saw the first demonstration of laughing gas as a little boy. Well it seems that the long wait is over, and tell me, what is, or more likely what was your occupation? A municipal rodent exterminator, well, well.... so of course you've had lots of gassing practice.

"Well I think that it is time to begin the class. This morning we shall be conducting triple bypass operations on your patients, which is in the category of open heart surgery. If this seems a trifle ambitious for beginners, I have to tell you that it is a lot less ambitious than the program the health ministry officials wanted me to do, which was simultaneous heart, lung and liver transplants. The only reason that they changed their minds was that they couldn't find fifty sets of matching organs, ready to go, for fifty patients. So instead they agreed to lower the bar to triple bypasses, which don't require donor parts.

"We begin by putting the patients under with sodium pentathol, delivered intravenously. What's that? No, not under the table., we render-them-unconscious. At the same time we administer gas to keep them that way until we have finished. Once that step has been completed you can take the gags and restraint straps off the patients. These people are public employees who have volunteered for this duty under the new government incentive program for people to continue being employed. Some of them actually do need the operation, and those that don't will avoid the probability that it might have to be done later on.

"How are we doing? You Sir, the would-be anaesthetist, your patient looks a little blue round the gills..... which valve did you open on the gas panel? Oh dear me no, not that one, that just gives pure nitrogen. Try the third one from the left..... Now he seems to be trying to walk away with the table still strapped onto him, that must be pure oxygen..... You can't read the little labels, even with your glasses? Well, get your surgeon-in-training to read them for you.

"Now it seems you have all managed to get into the chest cavities of your patients. Looking around I see that some incisions were unnecessarily large. Oh by the way, Mike-the-meat-packer, it is really much easier to go in through the front, and you are supposed to cut, not chop.

"Now it is time to switch the patients blood supply to the mechanical artificial heart by the two tubes marked IN and OUT. What was that?.... No, I am afraid that the arteries won't have matching OUT and IN labels. You will need to refer to the diagram on the black board behind me to identify the arteries you need to cut to attach to the tubes. For God's sake don't connect them up backwards, otherwise you will be forcing the blood supply backwards and your patients brain will be last in line for fresh blood instead of first. I must say I begin to wonder if some of you haven't been connected up backwards all along.

"You there in the fourth row..... I can see what appears to be a red tide advancing towards me from under your table. What the hell have you done, your patient is starting to look distinctly deflated. What's that tube dangling down. It's the return tube you idiot.... quickly! Get it reconnected to the poor devil's artery while there's still some point in doing it.

"O.K. now for the bypass installation. First of all you cut out the clogged portions of the three arteries that lead to and from the heart as shown in the diagram in your manuals. After that you cut off just the right length of the new government approved artery replacement tube from the roll attached to the end of your table. You then stitch each section into place using surgical thread. I will walk round while you are doing this and check you out individually.

"Yes, nice job, but then you are the Vet, so you should be O.K...... Let's see here, Peter-the-plumber, No, No! Never use teflon tape, just the surgical thread. No I really don't think that weekly injections of 'Liquid Plumber' would avoid the necessity for heart bypass operations, it's a different kind of clogging.

"Now what's going on here......Sorry, I'm afraid you'll have to start again, you didn't make the tubes long enough, if you close him up like this, all his arteries will be stretched like guitar strings every time he raises his hands above his head. So when his heart pumps really hard you'll hear something like the Funeral March coming out of his chest, and pretty soon that's the tune that would be needed.

"How are you doing?..... Nice job actually, very neat, what is your occupation?... Seamstress, of course I should have guessed that it would be a related occupation.... Only one problem, you've got a couple of tubes crossed. This way the blood would be pumping round-and-around-and-around the ventricles inside his heart in a closed loop without going anywhere else.

[The next morning]

"Well now that its all over I have to announce the results. It seems that over fifty percent of the patients survived, which meets the ministry target for this course. Of that fifty percent, almost a quarter will not need remedial surgery, which according to the ministry guidelines means that the trainees who performed the operations on that twelve percent will now be licenced to conduct surgery. Congratulations to those, and commiserations to the others and condolences to the families of their patients who didn't make it.