Most of you are familiar, I believe, with the concept of vitamins. They are compounds that are essential (or at least damn useful) to the physical well-being and development of the organism taking them. Many of us take vitamins. Some take them religiously. They have been seen as possible cure-alls for almost everything. My husband superstitiously takes magadoses of Vitamin C whenever he feels like he is getting sick, which I think is a crock, but it probably won’t hurt him. The problem is, when I feel like I might be getting sick, he tries to foist them upon me too, and he becomes indignant when I refuse to take them. My dad, in the past, has dabbled with mega-doses of various vitamins and minerals. Usually when you take hyperdoses of vitamins, your body takes out what it needs, and dumps the rest into the toilet, wasting your investment
I will stand on my Doctor Soapbox for a moment, and remind my gentle readers that it is actually dangerous to take excessive doses of the ADEK vitamins (a mnemnotic for vitamins A, D, E, and K), which are the fat soluble vitamins, and they can actually hurt you in excess. It has been discovered that Vitamin E, taken in dosages higher than recommended, can cause heart problems.
Among other things, excessive vitamin A can cause birth defects in a fetus who is conceived when Mom is on megadoses. The acne medicine Accutane is actually a form of extremely high-dose Vitamin A, and they medically recommend abortion if you become pregnant while taking it – it often results in babies born without brains, which, needless to say, is an extremely undesirable outcome. Physicians are required not to prescribe Accutane for a female of childbearing age unless it is verified that she is on a reliable form of birth control. Accutane has been linked to suicide in some users. I don’t like Accutane. It is nasty stuff.
Then there are “medical vitamins”. These are not actually vitamins, but are very useful medications. Anything we medical types jokingly call “Vitamin” is usually a drug that gives immediate results, typically for a patient who is anxious, in need of immediate intervention, or a pain in the ass.
Vitamin K is a good one. There is an anesthetic drug out there called ketamine. Some of you may know of it. It was initially used as a veterinary anesthetic, because when they tested it on humans, it caused pretty intense hallucinations. It is seeing more widespread use now in people. My specialty uses it frequently to boost pain control in an awake patient who is having some discomfort during her c-section with a poorly functioning epidural. This results in the patient saying some pretty darn amusing things. I was actually given it during my c-section, because I had a hot spot in my epidural and was in a lot of pain. I watched the anesthesiologist squeeze something into my IV really fast and then I was out. When I awoke a few minutes later, the pain was gone, but all I could see were blue brains. Fortunately, I am not easily rattled and pretty much realized they had just dosed me with ketamine. The blue brains turned into blue triangles, and then I realized it was just the blue surgical drape that was placed over me. I couldn’t remember what I was doing for a minute. “Oh,” I thought, “I’m having a baby. Is it a normal delivery? No. It’s a c-section. What’s a c-section?” We also use it to quickly sedate uncooperative patients who need to undergo anesthesia. We hit them with something called a ketamine dart, usually in a sneak attack on the shoulder. Most typically this is used for patients who are unable to understand or cooperate, or who may be outright combative. I have a fairly large group of patients in a state facility who need annual pelvic and breast exams, but they may be violent or scared and unable to be awake for them. They are brought in, given a ketamine dart, and then their IV is placed after they are asleep. In one particularly funny episode, we were sedating a large and dangerous mentally handicapped female patient who struck fear and respect into everyone she came into contact with. She is missing one eye, and legend has it that she is so mean, she removed it herself. At any rate, she bites, spits, and hits anyone who comes near her, and she packs a mean wallop. Our anesthesiologist danced around her like a prizefighter, trying to sneak up on the side of the missing eye to administer the ketamine dart. She caught sight of him anyway, and administered a massive blow before he could duck away. She was finally successfully sedated, but not without a lot of expletives from the nurses and the anesthesiologist. Ketamine is also a street drug, prized for both its general anesthetic and its hallucinatory properties. On the street it is known as Special K.
Vitamin A is Ativan, which is a drug in the same class as valium and it works great on addled little old ladies who are in the hospital and causing a fuss. Typically the anxious patients are placed on this medication, or others in its class, as outpatients, to calm nervousness and the bad habit of calling the office daily with imaginary problems.
Vitamin H is Haldol, which is less commonly used, but extremely useful in the case of a violent or psychotic patient as it is a rapid acting antipsychotic and has an almost immediate sedating effect. We will frequently call for “a butt full of Haldol” for an out-of-control patient, because they aren’t going to cooperate with any pills given them, and pills wouldn’t act fast enough anyway. The key is to, well, corral them enough to pin them down and administer the aforementioned Haldol Butt Shot.
Vitamin V, or Versed, is also an antianxiety drug that is extremely potent. It is used for situations where a patient needs to remain conscious but sedated for a procedure, and combined with a good pain med, it keeps them calm and comfortable. Vitamin V is used routinely in the OR holding area, where the patients waiting for their surgery are almost certainly anxious, whether they seem so or not. Versed also has a powerful amnestic effect – that is to say, once you are given it, you will almost certainly not remember what transpires in the next few hours. This is handy, because the patients will not remember the ride back to the cold OR, the positioning on the table or preliminary and potentially frightening discussions about instruments or other such. Best of all, should a patient have an extremely rare consciousness experience under general anesthetia, which I understand is terrifying, they will probably not remember it. Having been given Versed myself, I can testify that the stuff is AWESOME.
Watching a patient being given Versed is a wonderful thing to see. At the bedside, in preop holding, your patient is trying to hold it together but it is obvious that they are tense and aprehensive. After your preop chat, where you address any final questions or concerns, it is nice to be able to then say to the patient, “Anesthesia is going to be coming in a couple of minutes, and they will be giving you the equivalent of at least 3 margueritas in your IV. Once you get that stuff, you will be grinning and telling me that you’re so psyched, you’re having surgery!” They look at you skeptically, and you hang around because it is so merciful and fun to see that stuff kick in. When anesthesia arrives with the syringe of Versed, you tell the patient, “Here come your margueritas!” They will eye their arm apprehensively and watch as the needle pushes the medicine into the IV. Then, about 30 seconds later, you can see them visibly relax, and almost sink into the bed. A lot of times they will look at you out of stoned eyes and slur, “Thish shtuff is AWESOME! I’m having Shurgery! YAY!” Gives me a kick every time! And a lot of times, they will tell you some REALLY funny things. One patient, after her Vitamin V, became convinced that the handsome CRNA was a doctor whom she needed to seduce and make her sugar daddy immediately. She pinched his ass repeatedly, making him yelp and jump every time he tried to check her vital signs. She kept offering him fascinating sexual favors, some of which are only available online, and he was so embarassed that he turned bright red, which was hysterical because he is normally an obnoxious and non-embarassable person.
My husband has a very funny history with Versed. After we married, for the first several years, he seemed to need a surgery almost every year, usually in November. For his first ever surgery, I accompanied him to the holding area because I am a doctor and I can. I also had some concerns. My husband, in his right mind, is a blabbermouth who cannot keep a secret even if he really means to, and has very little internal filter regarding whether something might be inappropriate to say. He has mortified me on numerous occasions. Rarely, I have seen him drunk, and am surprised he has not been arrested (or at least had the shit beat out of him) for some of the things he says. He loves women and doesn’t have any problems with discrimination against women, near as I can tell, but what he thinks is subtle sexual innuendo, out of his mouth, can be freaking AWFUL. No filter. Then he brightly looks around and says, “Oopsie! Was that my out loud voice?” I maintain that it is his out loud OINK.
At any rate, I had concerns about his behavior under the influence of Versed. It was entirely possible that he would began to disseminate details of our intimate personal lives, or the last awesome video he saw on YouTube, all of which would render me humiliated and my colleagues confused as to what kind of person would marry someone this awful. So I was there to police him, at least until he was wheeled back to the OR. Well, Vitamin V knocked him on his ass. I somehow kept him on track until they wheeled him back, but I am still worried about what he may have said on arrival to the operating room. The problem is, it may have been embarassing enough that my colleagues would not report it to me. I will never know.
After the surgery, my husband waxed lyrical about the amazing stuff they gave him on the way back to the OR. “I never understood how anybody could crave or be addicted to drugs, but I could sure see wanting more of THAT stuff!” He did remark, however, that he found it extremely disarming that he could remember nothing after the injection was given. That could be disturbing for a bona fide control freak, which he most certainly is. At any rate, despite that, he found the stuff quite enjoyable.
A year later, we were back in the holding area, getting ready for another surgery. My husband had told me that he was psyched, because he was looking forward to the Vitamin V, but that this time, he was DETERMINED not to forget events that followed its administration. I told him that was probably not possible. He insisted that his superior intellect would absolutely make memory of the event possible. I found this immensely reassuring, because, distracted by the work of recalling all events with his “superior intellect”, he would be unlikely to say anything inappropriate, because he would be focused on remembering everything around him. I also found this extremely amusing, because a fiendish plot was forming in my mind.
Prior to the administration of the Versed in the holding area, I pulled the CRNA, who is a friend of mine, aside. I explained to him the whole dislike of forgetfulness and loss of control thing, and about my husband’s determination to use his “superior intellect” to beat the amnesia. My friend, who is my friend because he catches onto things very quickly, smiled a sneaky Grinch-like smile at me. “I’m doubling the dose.” he told me. This did not concern me as it would not harm him – he was about to be put all the way to sleep. It would, however, be wicked funny as hell.
Sure enough, my friend loaded up enough Versed to drop a rhino and pushed it through my husband’s IV. He was WHACKED. I watched him ride back to the OR, pointing at objects on the way back to the operating room and slurring, “I’ll remember you DOOR and I’ll remember you WINNOW and I’ll remember you LADY and I’ll remember you DESK…”. Awesomesauce. Never laughed so damn hard in my whole life.
After the surgery, I asked him how his memory was. He was indignant, because somehow, the drug had overcome his superior intellect. He couldn’t understand it. Of course, at that point, the final stop in my plot arrived – I told him I had arranged to have him DOSED and he couldn’t have remembered his name if someone had asked for it at that point. He was downright incensed. And then he laughed. And laughed. Because he loves a good joke, even if it is on him.
So as a medical person, I must say, it is essential to remember your vitamins! And not just the ones that come in expensive bottles at the GNC…
Rants from the Crib 