Word: patiently
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...patient Bob has a "bone-on-bone" knee - no cartilage at all between his femur (thigh bone) and his tibia (leg bone). Common arthritis looks white on an on X-ray; Bob's X-ray is a snowstorm. He's as bow-legged as a cowboy, the inside of his bones have ground each other down. Although his cartilage is all gone, there's something even more important missing in his case. He has no pain. Bob, 70, actually comes in this time because he has pulled a muscle. When I examine him, I'm careful...
...Patching the Safety Net A series of clinic visits by one patient made me realize just how broken the current health care system is ? and what can be done...
Since each patient's response to anesthesia can be different, as San Francisco's Miller was reminded last summer, the guidelines are intended to ensure that whoever administers the drugs should be able to rescue a patient from one level of sedation deeper than the level intended (see chart). "Our job is flying in bad weather," says Zapol. "A fair number of hearts stop in operating rooms, or people stop breathing. The key thing in training is to make people confident at resuscitation...
...hard-and-fast rules. In general, operating on the extremities offers more options than operating on the body's core, but the dividing lines between levels of anesthesia can be blurry. Once you get away from major surgery, pain control and sedation are often mixed and matched according to patient preference. Says Dr. Ronald Pearl, chairman of the department of anesthesia at Stanford: "It's not uncommon when we do a spinal anesthetic, say for knee surgery, to ask the patients whether they want to be awake or asleep for it." Those who choose sleep do so not because they...
...choosing to stay awake doesn't mean a patient is free of the risks of anesthesia. "We can get in trouble with a local anesthetic," says Zapol. "We can get in trouble with a spinal anesthetic," which keeps pain signals from getting to the brain but doesn't make the patient sleepy. "We can overdose you in all of those places." Someone, whether it's an anesthesiologist, another physician or a fully trained nurse, has to be ready to deal with that possibility. "Surgeons are experts at kidneys and ureters and coronary arteries and lungs. They're skillful people," Zapol...