Your words are half of your anaesthetic

You don't get taught this

We learn a lot of facts about physiology, physics and pharmacology. We learn how the equipment works, and why extubating on PEEP is mandatory/heresy/completely pointless depending on the consultant and the day of the week.

We get told the latest guidelines on how much opioid to put in our spinal, which lower limb blocks are now considered 'gold standard' and the correct proportions in which blood products should be infused in major haemorrhage.

But we don't get much advice on how to talk to our patients. We just kind of figure it out as we go along.

It was only when I was on the receiving end of emergency healthcare that it hit me just how important it is to get the communication right. I knew semantically that it was a necessary part of the job, but I hadn't felt the gravity of how much our words can matter until I was on the other end of the needle.

So here are all of the tips and tricks for the non-pharmacological side of our job that we can think of.

Let me know if you have any others.

Why are they scared?

Most patients are nervous before an operation, and some are utterly terrified. Many hold it together admirably, and some break down in floods of tears as soon as you show them the mask.

We're used to this, but do we think about why they're so scared?

I get anxious in an unfamiliar hospital when I'm tired and hungry and not sure of what I'm doing next, and that's as a member of staff.

So add in pain, exhaustion, the indignity of having clothes removed and replaced by a flimsy gown and then having to use a commode or bedpan - I'd be pretty upset too.

And that's before you consider the fear of what will happen to your children if you die on the table.

It's a combination of:

• Giving up control to total strangers
• Uncertainty of what's happening next
• The instinctive fear of being in an unfamiliar environment
• Dislike of being touched and poked when they already feel vulnerable

And you can alleviate all four of these to at least some degree just by talking to them.

Loss of control

"How are you doing Steve?"

"I'm okay," he lied, huffing between painful gasps of preoxygenation, his words condensing on the inside of the mask as he desperately held back tears. His bulky six foot frame somehow looked feeble and frail lying exposed on the operating table.

"We've got you buddy, we're right here with you, and we're going to take very good care of you alright? You've got this."

His panicked eyes darted to meet mine as he nodded fervently.

"Thank you, thank you."

I took hold of his sweating hand and he clung on, siphoning as much reassurance as he could until the rocuronium relaxed his grip and he slipped into the blissful ignorance of oblivion.

• I then tried twice, unsuccessfully, to intubate and my consultant had to step in and take over
• After positioning him for a spinal, I failed that too
• Then of course I couldn't cannulate
• At least I got the arterial line in

Thanks to my consultant's picking up the slack, Steve had a beautiful anaesthetic, never desaturated or dropped his blood pressure and four hours later he woke up in recovery alive, comfortable and feeling much better than before.

I felt utterly miserable, as if I'd totally failed him. Of course he had no idea of my incompetence, being unconscious and whatnot, but still - It sucked.

"How are you doing Steve?" I asked once more.

"I cannot express how grateful I am for your reassurance and looking after me. I was losing it man, I'm never not in control and I was terrified. The pain I can take, but the loss of control is horrendous. You made it so much more bearable."

Every single piece of positive feedback I have received from a patient, be that on intensive care, obstetrics or any other area of the hospital, the theme is always the same: