Yaffa's Salad

Yaffa means "beautiful".  She is an OR nurse. She also makes "the greatest salad in the world" (tm).  She makes enough salad to feed the entire delivery room staff. It is worth being on-call on Sabbath eve just to taste a sample.  The salad is deceptively simple. Just a raw vegetable salad. I could list the ingredients, but it would do you no good. The main ingredient cannot be bought in any market, nor found in any garden.  For Yaffa's salad is imbued with love. I have just partaken of this gastronomic romance.  

If you could see our faces right now, you would see people who have attained Nirvana.

Now I'm ready for anything.

Shana Tova

After 30 hours on call, it's time for the holidays. Yay!
Shana Tova!
!שנה טובה! כתיבה וחתימה טובה

The Singer

Airway management is an important part of anesthesia. We give drugs which cause respiratory depression and often, muscle paralysis. So the anesthesiologist must be an expert in maintaining a patent and functioning airway. Like many other technical subjects, the best way to stay out of trouble is recognizing the existence of a problem before it occurs. This is why the anesthesiologist will always examine a patient's airway beforehand. This includes inspecting the range of motion of the neck, dentition and the oral cavity. The latter basically means that the patient is asked to open the mouth wide, stick out the tongue and say "ahhhhhhhhhhh" (although there is some evidence that saying "ahhhhhhhhhhh" is not necessary).

At this point I have a running joke: I ask the patient if he/she is a singer. No matter what the answer, my reply is always applicable: "I can see that." Some patients ask wide eyed "really?" I usually just wink.

During the airway examination of a recent patient, I deviated from my usual joke and said, "I can see you are not a singer". As luck would have it she was a singer. So I explained the joke and she thought I was all the rage.

As I prepared to anesthetize her I asked what type of music she sings. She is a singer/songwriter of the folk-rock variety. I told her that I like almost all music but my favorite is jazz.

She began singing "Round Midnight" for me. She has a beautiful voice and is obviously a professional singer. As I administered the anesthetic she lost consciousness. This is the first time in my experience that a patient sang herself to sleep (with a little help from my friends ;P )

The Pancake

Two patients from the last few weeks stand out.

The first because of an unsual tattoo. The patient, a middle aged white collar type presented for minor surgery. He turned out to be a typical Tel Aviv Bohemian. After anesthesia was induced I exposed the chest to auscultate (i.e. listen to the breath sounds) after intubation. I was surprised to see an anatomically correct tattoo of the heart, the great vessels and the coronaries. The tattoo was similar to this one:

Without hesitating, I shouted, "Get the boys from cardiothoracic surgery in here stat, they might learn somethin!"

The next patient was also scheduled for minor surgery in a nether region. This is surgery that is performed in the prone position.
After performing a saddle block, we positioned the patient. At some point, the patient said he was dizzy, I glanced at the monitor which showed a heart rate of 34 and then he flat lined. "Asystole, we need to start CPR."
The surgeon asked if we should turn the patient back supine and I answered in the affirmative. The patient was no lightweight and neither was the surgeon who could have played linebacker on any NFL team.
Within seconds he flipped the patient over like a pancake. Luckily the patient started breathing again immediately on the position change. He probably developed a vasovagal response due to anxiety. The pressure of his abdomen on the vena cava probably didn't help either. Since the patient was feeling nauseous, we decided to postpone the surgery.

Afterwards I told the surgeon that it was a good thing he was there instead of an itsy bitsy 50 kg surgeon.