DAVENPORT — It's 7:15 a.m. on a December morning at Genesis Medical Center, East Campus, and Dr. Shira Black is preparing an anxious woman for surgery. The enthusiastic anesthesiologist is a picture of brisk, sympathetic efficiency.
The patient has an intravenous catheter in her right arm to make it easy to introduce medications into the bloodstream. Although some medications can be given orally, the anesthetic medications are primarily given through the IV. So pretty much “all of our patients get an IV,” Black says.
Black uses an ultrasound machine to find the correct nerve to receive a nerve block along the 40-ish woman's neck, in advance of rotator-cuff surgery on her left shoulder.
The long-acting numbing medicine works for 24 hours. “She'll get some good sleep tonight, which is good,” Black says. For patients, this means that they then “don't require as much general anesthesia, or as much pain medicine, so less chance of nausea.”
The numbing medicine for the nerve block doesn't go through the IV, but the sedation medicine to help the patient relax, as well as IV antibiotics to help prevent infection, do, she explains. The nerve block causes nerves to “not fire” for a temporary period of time, and “blocks the brain from realizing what is going on downstream. It is numb; it is amazing,” Black says.
“Part of our expertise is understanding the nerve anatomy, and what our surgeons need,” she says. “It's bridging the gap of what the surgeons need and what the patients need to make all that happen.”
Each surgery and patient is unique, and the anesthesia plan is tailored to meet everyone’s requirements safely.
“Time management is key. Running an operating room is very expensive. We have all these people here for the one patient, and I really respect that,” Black says.
Including Black, there are eight medical staffers in the operating room for the arthroscopic surgery, during which the surgeon will insert a small camera, called an arthroscope, into the shoulder joint. The camera displays live video on a screen, and the surgeon uses these images to guide miniature surgical instruments to repair the rotator-cuff muscles.
Black tells the patient, “Deep breaths, my dear; we're going to take good care of you.” She gives the patient sedating medications such as propofol and lidocaine through the IV. Moments later, the patient is asleep, and Black inserts a tube into the patient's mouth for transmission of oxygen and general anesthetic gases. The patient will be asleep during the entire procedure.
Black carefully calculated the amount of anesthesia needed based on her patient's medical condition, history, and current medications. She watches her breathing pattern, and monitors her transition to unconsciousness.
“The cool part is we have an awesome OR team to work with, and they know exactly what they have to do,” she says. “That's why I like anesthesia — I deal with patients, but I have an OR team that works together. ... We all have to pay attention,” she says. “It's not so much a hierarchy as it is an integrated team.”
The OR air temperature is usually cool, in the '60s, “which is why I'm chronically cold,” Black says with a smile. The temperature helps with sanitary conditions, the barometric pressure decreasing moisture in the room. There are strong lights in the room, too, so that helps with comfort, she notes. “Thermostats are adjusted based on what we're doing,” she says.
Black compares anesthesia to flying a plane, when the most critical parts are takeoff and landing, and the ideal situation is to be stable, or on “cruise control.” She does safety checks during surgery to ensure the patient does well.
During the “landing,” she wakes the patient up by decreasing the amount of anesthesia. “No one wants to hear they died under anesthesia, like no one wants to hear of a plane crash,” Black says.
The patient may not remember any of the prep for the procedure, or much after its conclusion. “It's like when someone is drunk and doesn't remember it the next day,” Black explains.
"A patient is meeting you for the first time. They're scared out of their minds. They're literally putting their life into your hands,” she says of the job. “They feel very vulnerable and naked.”
Because this is the case, “it's not about length of time; it's about quality,” she says of interacting with her patients, understanding their conditions, and addressing their concerns. “The point is to make a connection, and that's cool.”
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Most of her patients have procedures done on an outpatient basis, and they go home the same day. Heart surgery or total joint replacements require overnight stays. “We follow up with them, if need be, but a lot of times we don't get to see them again,” Black says.
During Black's training, she specialized in cardiac surgery because “the heart room is the pinnacle” of the profession, she says. Those procedures require more people and equipment in the room, more expertise, and she does more follow-up with those patients.
“It's different every day,” Black says. “I never know until I get my schedule.”
She grew up in Rochester, N.Y., went to high school and college in New York City, and completed medical school at New York College of Osteopathic Medicine, on Long Island. Black chose her specialty after her rotation in obstetric anesthesia.
“I loved the idea of taking pain away, the patient interaction," she says. "I thought I could be very comforting, very understanding.”
“I thought it (anesthesia) blended well with my personality, so it was a good fit,” Black says, noting she did her residency at University of Rochester Medical Center in upstate New York, finishing in 2014, and then completing a yearlong cardiothoracic anesthesia fellowship at the world-renowned Cleveland Clinic. “I loved that,” Black says, noting she still speaks to her mentor often.
She's sometimes on call for 24-hour periodss for emergency surgeries, and she works with patients of all ages. The number of procedures she works on each day varies from one to six or more.
The shoulder surgery lasted about an hour, and in the OR she can see her patient's whole medical chart on a screen, which shows medications, allergies, procedure history, weight, height, other vitals, lab work and X-rays.
“What am I trying to understand or do?” Black asks, likening surgery and anesthesia to a dance. “It should be beautiful … having your things ready; I need a plan A, B and C. You have to know what you need. If there's an adverse reaction, it shouldn't be chaotic; the correction should be nice and smooth.”
Black usually starts work at 6:30 a.m., getting patients ready. Morning surgeries are preferable because many patients need physical therapy and treatments later in the day.
“They've got other stuff to do,” she says. “You've got to be early, be organized. That's why time matters. That patient doesn't want to get out of the OR at 8 o'clock at night. They need medication from their pharmacy. And complications can happen. You have to allot time for everything.”
Black recalls as a medical student, “I thought it was a boring profession initially — I didn't realize what we did.” Through training, she learned that anesthesia “really integrates the anatomy, physiology and pharmacology all in one place.”
She's been with Genesis for three and a half years, and she chose the Quad-Cities area partly because she has a big family and likes the small-town, affordable atmosphere. “This was a place that worked out really well.”
Black and her husband, Josh, who runs a farm on the outskirts of Bettendorf, have eight boys and two girls, ages 1 to 13, and she is pregnant with her 11th child.
The mean annual salary for anesthesiologists nationally is $265,990, according to the U.S. Bureau of Labor Statistics.
How does Black juggle a big job and big family? “I have the world's best husband, obviously,” she says with pride.