BeyondTheMedspeak: Don't trust if you can't verify

Once upon a time, in the anesthesiology department at UCLA, after finishing my cases for the day, I'd wheel my anesthesia cart back to the workroom and line it up alongside all the other carts to be cleaned for the next day.

Except I did something none of my fellow residents did, namely, I cleaned my own cart and then set it up for the next day's cases.

Everyone else set up their carts in the morning: I liked to do the setup the night before because:

1) It was quiet and peaceful as I was all alone

2) I could set up my syringes just so and fill them with the various drugs I'd be using for the next day's cases

3) Most importantly, because I'd done my setup the night before, I could sleep in an extra 15 minutes, then upon arrival simply wheel my cart into my O.R. without having to be part of the hurly-burly of 20 anesthesiology residents buzzing around the workroom looking for what specialized equipment they'd need for their cases: I'd already done that the night before.

All well and good and I never caught any flak for doing things my way nor did my methodology ever result in a problem.

But I would never do today what I did then.

Why?

It only occurred to me recently — nearly 50 years later — that someone could have easily switched drugs in my pre-filled syringes and put succinycholine, the ultra-fast-acting paralytic agent I used on a daily basis, into any of my drug syringes, such that when I injected what I thought was fentanyl or ephedrine or droperidol, instead I'd be giving a potentially lethal dose of a paralytic.

Then when the patient suddenly stopped breathing in the middle of a case, I'd never have thought of the actual cause but rather would have pursued an entirely different set of differential diagnoses which could well have resulted in patient harm or death.

Almost all the cases of nurse and doctor-related murders over recent decades — and there have been many — involved surreptitious administration of drugs.

Today I wouldn't use drug-filled syringes if they hadn't been in sight since being filled.

Note red cap used to warn of potentially fatal drugs.