October 22, 2005
Let me backtrack a little for those of you who don't do airway management in paralyzed people on a routine basis.
After you put a patient to sleep, most of the time you put an endotracheal tube in to enable easy and safe ventilation during surgery.
The endotracheal tube has a collapsible plastic cuff at the end inside the trachea.
A little tube runs alongside the endotracheal tube and carries air from the outside into the cuff to cause it to inflate and seal off the airway from the outside world.
The tube ends outside the mouth in a little balloon to which you attach an ordinary 10cc plastic syringe.
That balloon is called the "pilot balloon" (above).
The syringe is called the cuff syringe because it inflates the cuff.
Makes sense, doesn't it?
After you've intubated the patient you remove the cuff syringe and put it in the connector hole in the breathing mask you've used for induction and will be using again at the end of the case.
Note: all this will become much clearer once joeTV goes live and you can watch me do these things — yes, on real live patients in real time, you betcha.
Sure hope I don't kill anyone on camera — that probably won't play very well with my state medical board, not to mention my malpractice insurance company.
But I digress.
The cuff syringe disappears in the frenzy and excitement of induction more often than not.
Where does it go?
I realized early on in my career, after dozens of cases in which I spent precious seconds searching for it, that it simply vanishes — into anesthesia hyperspace.
And ever since then I've been completely comfortable with that concept and simply opened a new syringe to use for the cuff at the end of the case, forgetting about the original.
Sometimes it reappears; more often than not it doesn't.
OK, cut to now and my wonderful treadmill, on which I spend many happy minutes and hours each day reading the day's newspapers.
As I finish sections I toss them over my shoulder (below).
But every now and then I need to go back and have another look at a story or picture, perhaps because another paper mentioned the same thing in a different light or because I'm just a little slow.
The point of this post is that there is a treadmill hyperspace into which stuff I've just read — and I mean in the last 5–10 minutes — disappears.
I wade through the piles of discarded paper looking for the section I've just read
and it's not there.
How else can I characterize this other than that it has vanished through a wormhole similar in character and function to the one in the OR?
But wait a minute: there's another way of looking at the above, isn't there?
Because maybe — just maybe — the wormhole's in my brain.
There are those who believe my brain is a wormhole.
Or a worm–equivalent.
A "W.E." — I like it.
But I digress.
I believe that the universe and our reality is a calculation, nothing more — and nothing less.
Talk about the ultimate zero–sum game.
Ceaselessly we calculate — and thus create — the world around us, until one day our battery expires.
We call it death.
So if, every now and then, we can't locate a syringe or an article we want, hey — it's not lost, it's simply "over there" — in the deepest, most profound sense.
October 22, 2005 at 04:01 PM | Permalink
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