The other side

If I am allowed to anaesthetise again, I'll share a few quiet reassuring words with my patients

I had spent the past 25 years working in hospitals, intensive care units (ICUs) and theatres. So many thousands of operations on so many patients, and yet here I was, fearful and frankly embarrassed. I lay motionless, face fixed in an unconvincing grin for the benefit of former colleagues as I floated past them, a single off‐white sheet covering my goosebumps. Just another patient this time. Paraded down the corridor; relatives and staff trying to guess whether you were haemorrhoids or a vasectomy. I was no longer the operating room DJ, “gasman” and “wannabe comedian”. Rather than choosing a playlist and sipping the first of many espressos that morning, I had stiffly, illegibly signed a consent form and wet my parched lips from a plastic cup.

The last time consent for surgery had been requested, it had been during an emergency helicopter flight, given by my shell‐shocked wife, thousands of miles away. She had tearfully agreed to the trauma team's plans to stabilise my broken neck and jaw, sew my ear back on and drain my exploded right chest, ruptured lung and kidney. The good news was that the pulverised hands and multiple lumbar fractures could wait for another day. It hadn't been clear at that stage if walking was going to be an option, nor whether the brutal deceleration would take a longer term toll upon my brain. It would be a week in the ICU, ventilated and restrained, plus many months of interminable rehabilitation before anyone would know for certain.

I remembered accelerating down that long steep hill into Apollo Bay, tucking low on the frame, not even having to pedal to gain speed rapidly, looking ahead for the group I had lost contact with. I flew past other riders, cautiously feathering their brakes on the descent. My eyes watered in the chill jet stream and the bike's carbon wheels chattered on the gleaming tarmac.

Then darkness. Silence. Darkness.

A large, calloused hand gently, insistently squeezed mine. Like waking from a deep restful sleep, I realised that I had been aware of the pressure on my palm for some time before I understood to try to respond. Slowly, hesitantly, I opened my eyes. The voice was deep, resonant and strangely familiar. It was my son.

The brain damage that I sustained on that cold morning in Melbourne, head on into a street pole at 65 km/h tossed me onto the other side of life's road. Each of us doctors spends our training and junior years formulating our own personal and crucially professional identity. Born from repetitive, regular crises of confidence through patient deaths, personal errors and sometimes just promotion to the next terrifying level of responsibility. It wasn't so much learning what to do to be a competent doctor; it was more learning what it was to be a doctor, how we saw ourselves and how society regarded us. I realised that I could no longer muster that theatre blues’ confidence, that surgical squad strut. Laying on a theatre trolley, in a queue for the lifts, I was just another tremulous punter, nervous about the loss of control. I was most afraid of the drug‐induced, return to the darkness. The maxillofacial surgeon had asked me, many weeks after the plates and metalwork had been screwed in, between loosening yanks on the wires holding my face together, if I remembered the accident. I gargled denial noises, my mouth jammed open.

“That's a good job,” she laughed. “What a mess!”

Operating lists had been my working day and I missed them and my colleagues too, diligent and quirky, good‐hearted and generous. I watched them quietly busy around me, hushed and focused as they made their last detailed preparations. Part of me was ashamed that I knew so little about each of them individually, especially since so many had spontaneously sought me out, given me support and warmth during my months in rehabilitation. Perhaps there was more to medicine than just caring for people. Health teams build something together. Trust, empathy, a united resolve to do the best we can. It looked simple enough when you saw staff doing the same operation a thousand times, but it was the commitment to excellence and good outcomes that defined these humble, generous people. Many of the staff knew me that day as I arrived in the cool clinical space, air conditioner humming, the last stop before the deep dive. A familiar face checked me in for the final time. Knowing her well as I did, I was fleetingly relieved that it was my arm, and not some more delicate area that had been crushed as I was catapulted from the bike. I lay there quietly and felt the emotions rise again, tears welling up. The crash trauma and the rehabilitation had made me afraid of the absence, the journey into that anaesthetic void.

I could picture the theatre scene on the day of the accident. Probably not much different to today really. Relaxed, professional and all quite routine. Shredded Lycra, chest drains, ruptured organs and the rest. Sometimes, when I had been the boss, patients would get worried when I told them that things were routine. That wasn't to say we weren't concentrating, it's just that we had done it many times before. I would deliberately avoid the patient's back story just to keep my own anxiety at bay, ignore the injustice and bypass the random cruelty of their situation. Just put an airway into them and keep them asleep while the damaged bits got sorted. No doubt, when they lay my broken body onto a theatre table after the crash, it was much the same. Maybe some passing banter about the weekend's footy results, the crappy Melbourne weather and “middle‐aged men in Lycra” who really should know better.

How ironic it would have been had I not hit the pole with my chin, but with my forehead and pithed my brain. Imagine the plaudits for the State Medical Director for DonateLife who felt so impassioned about saving other people's lives through organ donation, that he selflessly became a donor himself. Surely at least an Order of Australia for me? It could have been one of my team informing my family, hands held tight, that their husband and father was not going to make it but that he could save other people's lives.

Drugs now flowed into a vein.

I often tried to excel at the flippant and the ridiculous in the face of the worst of emergency situations, but not today, not on the other side, a scared patient. “Another one bites the dust” had always got a giggle if I played it from my Spotify favourites, just before sleep time. I used to jokingly tell patients before I put them under that being worried was quite understandable and that if anything bad happened, they would never know because they'd be dead. Strangely, that didn't seem funny anymore. Perhaps if I am allowed to anaesthetise again, once my brain is straight, I'll just share a few quiet reassuring words with my patients, tell them that it's okay to be frightened, that they're safe and that I won't leave their side until they awake.

I used to pat myself on the back when a patient left my ICU. Now I have seen that leaving the ICU is not the end of the journey but the start of a new journey. I tried to explain through the mist of my confusion to the nurse caring for me that without her company and support, I wouldn't have survived. She started to cry. I hadn't meant to upset her but I wanted her to know that I was grateful. The outpatients’ clinic since then has been shocking and revelatory. I was the only one not in a wheelchair and for that I felt terrible guilt. Proper patients with proper injuries, courage and optimism by the bucketload have been a sombre reminder of what might have been. I have no memory of those first few steps, my wife's tears or the cheers from my hemiplegic room‐mate as I edged back onto my bed for a well earned rest.

Because of the brain injuries, the thought of anaesthetising someone now fills me with an unfamiliar fear. It took me all my waking hours to craft this cast‐iron professional identity of mine and an instant to fatally fracture it. I even had the Rod of Asclepius tattooed on my biceps on my 50th birthday just to affirm a life's commitment to medicine. The supreme irony that I may never practise again and the loss of that coveted persona have been the most traumatic part. Who am I now? I used to be a doctor until that day on the Great Ocean Road. Not anymore. Perhaps one day I will accept the crash and its consequences; move on with my life.

Not quite yet.