Nick Crombie,
BMedSci BMBS FRCA FIMC RCSEd RCPathME,
Associate Medical Director (Governance);
Consultant Trauma Anaesthetist;
Honorary Researcher, National Institute for Health Research SRMRC:
Clinical Lead for Resuscitation Services, QEHB, UK.
E: Nicholas.Crombie@uhb.nhs.uk
Plastic surgeons think we do endless crosswords. Orthopaedic colleagues think that we exist to ensure the antibiotics are pumped around. Laparoscopic surgeons think we are there to relax the abdominal wall. Urologists hope the patient does not cough. To be fair, there is more than a grain of truth in these examples. In all forms of surgery, there is a particular relationship between the surgeon and the anaesthetist, but very few match the level of understanding reached in the ENT theatre.
This is what drew me to ENT as a specialty – the feeling of partnership at the same end of the table. However, that slightly superficial desire to emerge from behind the ‘blood-brain-barrier’, to put down the crossword and to interact with the surgery being performed quickly became replaced with a genuine love of the challenges and complexities of operating on the one area of the body most anaesthetists truly understand.
I am by nature somebody that finds a day without a challenge a dull day, and I have been fortunate enough to work with some surgeons who have presented me with some real challenges. Complex airways, burns, obstructing tumours and stenosis, intricate base of skull work – this is the sort of anaesthesia that interests, challenges and intrigues me. I must admit to feeling a little defensive about anaesthesia – the very broad knowledge and practical skills that are required to anaesthetise any age, with any comorbidity, for any surgery, are often lost on colleagues who see us as ‘technicians’. Actually, it really annoys me. The reason we appear to be doing nothing is often exactly because of those learned skills. It is a well-worn analogy, I accept, but I would rather see the pilot of my airliner sitting calmly during smooth stable flight than wrestling the controls in a sweaty panic.
It is for those very reasons that I was, and remain, drawn to ENT surgery. I have yet to meet an ENT surgeon that does not share the anxiety when the pulse oximeter beep begins to change to a lower tone. I have yet to meet an ENT surgeon that works in quiet solitude whilst the suction cannister fills with blood. I have yet to meet an ENT surgeon who does not devote 50% of the team brief to what the anaesthetic plans are. For me, ENT offers a shared sense of pride in our shared work. When things go well, it is fantastic. When things go wrong, they can go catastrophically wrong in seconds, and that is where the appreciation of the other’s abilities is so vital.
I was delighted to be asked to guest-edit the content for the Nov/Dec 2019 ENT & Audiology News, and I have tried to bring a mix of contributors from across the UK to discuss some of the things I have just mentioned. Kate Prior is, I think, another colleague for whom a day without a challenge is a dull day. Adel Hutchinson describes the art of looking calm during complex cases, and Andrew McTavish certainly illustrates the shared nature of our work in one of the most challenging groups of patients. Scott Russell has written a fantastic piece on what is, without doubt, the single biggest advance in ENT anaesthesia in the last 30 years, and finally, James Bates and Chris Frerk have appropriately come together to co-author a fascinating piece on how the appreciation of teamwork and communication drives safety. I hope that you enjoy this anaesthesia-themed content for Nov/Dec 2019!
