Colin Black is an accidental author, which is coincidental, because he didn't really plan to be a doctor either, the consultant paediatric anaesthesiologist explains in his new book, Gas Man, which hits the shelves this week.
Gas Man: Observations of an Anaesthetist (Harper Collins Ireland, published September 2nd) tells the tale of Colin's road to becoming a consultant paediatric anaesthetist at the largest children's hospital in Ireland, the people he's encountered en route, and the daily laughs and quandaries he experiences.
“I didn’t intend to write a book for public consumption which is a cliched answer but it’s genuinely true,” he says. It was Colin’s friend’s father’s advice to “jot down memorable things that happened to me throughout my career, some memorable patients or memorable moments. Funny moments – because the hospital is actually a hilarious place to work most of the time,” he explains. This led to Black keeping a diary of life as a doctor.
“After two weeks of writing a diary, I realised I was having a lot of interactions with children, or having conversations with other staff that were funny or explaining anaesthesia to patients or parents. It was a lot about them as opposed to me so I decided there and then that it might be useful if I used the medium of my diary, as a new consultant, to explain what happens in an operating theatre, what exactly anaesthesia is – because that’s what I spend most of my day doing.”
Black says anaesthesia fits his personality. “When you pick your speciality, most people do it by a process of elimination,” he adds. “Very few people know exactly what they want to do so it’s kind of like ‘oh I don’t like that, I don’t like that’. And then when I came across anaesthesia, at the start it looked very boring. When you get to see it as a medical student you don’t really get the nitty-gritty of it – you just look at somebody in the operating theatre who doesn’t appear to be doing very much.
“It kind of suits personalities who enjoy instant gratification. It’s effectively applied pharmacology and physiology so it’s a very basic medical sciences thing . . . It’s all very logical and you can predict, for the most part, exactly what’s happening.”
Shirt and tie
Not having to wear a shirt and tie also attracted Black to the job too. “You have to think of these things when you’re getting ready in the morning,” he laughs.
He has a 17-month-old daughter and his wife is pregnant with twins. Becoming a father himself has helped him understand a little, he feels, how parents might feel handing over their child to the care of doctors. “We’re doing this every day, multiple times a day. We take someone’s kid, put them asleep, finish the operation, then just do it all over again so for us, it’s not a big deal. But for every single parent it’s handing over their precious child to a complete stranger . . . A lot of parents get upset, understandably.”
If you’re wondering whether you dream or not when under anaesthetic – well you don’t, Black confirms. “It’s not the same as normal sleep. It’s completely different. Your brain is effectively just switched off. There’s no connections happening between your brain and any of your neurons, so there’s no perception of time passing. There’s no memories being made or no dreams that you would experience when you’re having normal sleep.
“It’s a completely altered state of consciousness. It’s not a dream and you wouldn’t be expected to remember anything about it. Which is good – that’s our main job, that you remember nothing, you experience no pain, you have no recollection really of the whole theatre journey.
“Most people seem to be more scared of the anaesthetic than the actual operation they’re having,” Colin says. “Probably because they’re delving into the unknown. They’re letting go of their own facilities to somebody else. They don’t know what’s going to happen.”
Overweight patients
In an age of childhood obesity, Colin explains that it can be more technically challenging to put in various drips of lines or epidurals when you are dealing with someone who is overweight or obese, just because everything you need to get at is under a thick layer of fat. It’s trying to hit a small vein, that’s absolutely tiny and will be tricky enough in a skinny person, but if it’s under a lot of fatty tissue it can be next to impossible to hit it.
“When you see it so early – I did work in adult hospitals for most of my training – and we see how difficult it is in the adult realm to anaesthetise people who are overweight . . . it just puts it into perspective. And it can be a little bit disheartening to see kids that are already extremely overweight, under the age of six and what that might mean for their health and things like that in the future.”
Nearly half the job of an anaesthetist is trying to convince somebody to come in and have their anaesthetic, Black says. “That’s the hardest part of the job. One that stands in my mind was doing a heart transplant in Great Ormond Street, obviously an emergency operation with a very small window.
“I remember one kid in London, he knew he was on the list for a heart transplant but when it came to show-time he just wasn’t up for it. He was just flat refusing to come in.”
Black says there was a lot of “coaxing” and “bargaining” required. “There were a lot of phonecalls to various people that he wanted to talk to before accepting that he needed to go asleep at that stage.
“That was one that really stands out in terms of acuity sometimes in trying to get someone asleep in a timely manner.”
Coping with the death of a patient is never easy, Black says and speaks of a paediatric patient whose death in ICU left him in tears. “A very young kid, who was perfectly fine, ended up having an accident and required emergency surgery and died a couple of days after that. That one was difficult to deal with,” he says. “It doesn’t get easier, but I just accept it as part of medicine and part of the job and I just try to be as realistic as possible about things.”
