Are we one and the same? The answer depends on who is asking the question. For most of us, we ask because we want to know the differences from one human body to the next. They look different. But on a deeper level, in strictly physical terms, is everybody the same as far as a medical expert would say?
Would you agree that the practice of anesthesia gives a good look at the body in this depth? After all, anesthesia is given to each patient individually, and no two patients are alike. So what are the differences from one body to the next, in a physical way as it works ( the study of how the body works, and all of its chemical reactions, is Physiology. Anesthesia is called 'Applied Physiology' and also 'Instant Medicine' because of the powerful, fast-acting medications that are given during an anesthetic.).
There are many physical factors that are considered in the making of an Anesthesia Plan for each patient:
- Is there a pregnancy? Blood volume goes up, blood thins, lungs adapt to become more efficient, oxygen requirements go up, hormonal changes on the nerve structures themselves make the patient more sensitive to the effects of anesthesia. Doses are lowered for regional and general anesthesia because of this. Airway swelling takes place inside the throat--and mucous membranes that are engorged through pregnancy are more likely to bleed during insertion of the breathing tube. There is even a special short handled laryngoscope because in pregnancy the patients' breasts are almost up to the chin when lying flat and the standard handle has not enough room to fit!
- Are there the extremes of age? Pediatric anesthesia is an entire specialty that requires an extra year of fellowship training. Children's growing bodies are so different there are two extra CPR-type courses: Neonatal Resuscitation, and Pediatric Advanced Life Support. All health care providers must maintain current certification to work with children in those age groups. Geriatric Anesthesia is another extreme. It is like having too much 'mileage' on the body! The organ systems have little 'reserve'; everything is optimum, maxed-out physiology. Grandmother can't run a race because there is no additional physiologic reserve for her to tap into. When I give anesthesia to a ninety-year old, I earn my keep! And once the anesthesia is out of the system, all of the challenges disappear! No one knows how hard it is, technically, to give anesthesia to this age group unless they are in this line of work. But you can imagine the complexity it presents when you reflect on it.
- 'Is this boy blood or girl blood?' My anemic physician friend asked on transfusion. They didn't know. They had to look it up. It was boy blood. And she found that her interest in sports and TV snacks and beer mysteriously went up for ninety days after getting the transfusion. Is testosterone filtered out of packed red blood cells? Is estrogen removed from Fresh Frozen Plasma or cryoprecipitate or platelets? It is doubtful that hormonally neuter blood exists, except perhaps if the donor is a post-menopausal woman? It is a well-known fact in the heart room that cardiac bypass surgery on women is technically a bigger challenge than for men. Women are small, their cardiac arteries are smaller size in diameter than in men, and the disease load of atherosclerosis is heavier because women present with more advanced disease due to the lack of classic symptoms of angina like the pain to the jaw or left arm that is seen in men, the Little Red Dress project is a result of trying to raise the awareness in the general public that women s heart disease is not the same as men's.
- What ethnicity is the patient? Jews and Italians experience more pain than a stoic Scot would. African Americans have sickle cell, high blood pressure, and more tendency toward c-section (the shape of the pelvic outlet has a different bone structure. If you look good in jeans, you have hips more like a boy...and that is not the greatest thing in giving birth). Asians have less room in the airway at intubation because of smaller chins, and take less narcotic because they are more sensitive to this medication. Latinos have a very high risk of diabetes in the population. There is also a particular side to side head motion on emergence from anesthesia that is not seen in any group. It looks like a child turning away from a spoon of food or medicine that is offered. Once awake, the patient is like anybody else.
- What is the Body mass index (BMI)? Anesthesia in the morbidly obese presents a unique set of challenges. Basically, the lungs are small, the oxygen needs are higher, and there is less too in the upper airway and mouth for intubation. There is often a stronger gag reflex too.
- What disease is present? Coexisting disease with the kidneys or liver or lungs completely changes the anesthesia plan.
- What surgery is planned? For example, a dentist likes the breathing tube to be placed through the nose so they can freely work inside the mouth.
- Are there 'substances' on board or chronically used by the patient? A cancer patient might take fifty milligrams of morphine three times a day!it will take more to keep them co for table after surgery because of this tolerance to narcotic. Alcohol, cocaine, marijuana, nicotine, tobacco, speed, and anything else have to be taken into consideration so enough anesthesia is given.
Nw that we agree on the physical body and its differences due to age, body type, sex, and more, let us ask--what is the same from one patient to the next?
The answer is a heart that responds to Unconditional Love.
We are One. No matter where we come from, what our body is like...because our Spirit that is within is beautiful! Perfect! Struggling with this school called Life. And a heart that is touched by Lovingkindness, Compassion, Generosity of Spirit, and Love, the Greatest of All Forces in the Universe.
Any creature that is alive on this planet will respond to Lovingkiness. Even the fiercest of creatures in The Zoo will know who treats it harshly and who feeds it and tends to it. A recent study has shown crabs in the sea do avoid electrical shocks when in an experiment: therefore they are capable of feeling pain.
Our bodies are different. But our Heart-of-Hearts is the same. We are One. All of us.