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MidReal Story
The Silent Patient
Scenario:ROW 1: Profound Autism – High Gas Level
Position: Foreground (front row)
• Patients: Mixture of toddlers, children, teens, and adults — all with severe autism symptoms (e.g., headgear, expressionless or distressed, sensory gloves).
• Wheelchair Restraints: Clearly secured with chest and lap straps, some with padded head supports.
• Masks: Bold colored-rim anesthesia masks (e.g., bright red, green, blue), tightly fitted.
• Nurses: Calm and focused, some gently restraining hands or heads.
• Gas Flow Indicators: Clear high-flow symbols on each anesthesia unit (fog visible inside mask domes, mask slightly fogged).
• Emotions/Visuals: Several patients showing sensory overload reactions: clenched fists, wide eyes, some crying or thrashing.
• Lighting/Color: Slight red tint to this row to emphasize urgency and strong effect of the gas.
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🔹 ROW 2: Moderate Autism – Medium Gas Level
Position: Middle row
• Patients: Again age-diverse; expressions more controlled but visibly uncomfortable (e.g., fidgeting, avoiding eye contact, tense posture).
• Wheelchair Restraints: Standard lap belts; minimal but present hand restraints.
• Masks: Colored rims (orange, teal, yellow), being held gently but firmly.
• Nurses: Reassuring touch on shoulder or head, explaining softly.
• Gas Flow Indicators: Moderate vapor visible through masks.
• Emotions/Visuals: Some patients trying to resist mildly, others complying with eyes shut tight or distracted by soft toys or headphones.
• Lighting/Color: Neutral lighting, soft focus to create contrast between this and Row 1.
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🔹 ROW 3: High-Functioning Autism – Low Gas Level
Position: Background (rear row)
• Patients: Older children, teens, and adults; visibly more composed or curious.
• Wheelchair Restraints: Basic safety straps; hands free or lightly held.
• Masks: Subtler colored rims (lavender, silver, soft green), loosely held or accepted voluntarily.
• Nurses: Conversational stance, one knee bent, eye-level interaction. Some patients may be helping hold their own mask.
• Gas Flow Indicators: Very little vapor visible, gas flow meter on low.
• Emotions/Visuals: Calm faces, curiosity, soft eye contact or trust in caregiver.
• Lighting/Color: Gentle warm lighting, soft ambient background.
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Emma
She is a pediatric anesthesiologist. She is compassionate, focused, and determined. Emma navigates the challenging environment of a busy hospital, ensuring the safety and comfort of her young patients. Despite the demanding conditions, she maintains a caring attitude and takes the time to explain her actions to anxious parents. Her dedication to her career and her patients showcases her deep commitment and sense of purpose.
Dr. Emma's Team
They are hospital staff assisting in the anesthesia procedure. They are efficient, supportive, and professional. The team consists of nurses who maintain a calm demeanor in the face of challenging situations, demonstrating their trustworthiness and competence. Their coordinated actions alongside Dr. Emma ensure the safety and wellbeing of the patients undergoing the procedure in a controlled hospital environment.
Samantha
She is an anesthesiology resident. She is diligent, eager, and slightly nervous. Samantha assists Dr. Emma during the challenging procedure, reflecting her training and enthusiasm. Through her body language and brief exchanges with Dr. Emma, she seeks guidance while handling the demanding task of administering anesthesia to a restless patient. Her interaction with Dr. Emma highlights her teamwork and dedication to learning from experienced professionals.
I take a deep breath and survey the scene before me.
My first row of patients—the ones with profound autism—sit in their wheelchairs, heads held high, expressionless, wearing colored-rimmed anesthesia masks that are held tightly in place by the nurses.
The masks are bright red, green, and blue.
Some patients have sensory gloves on their hands to prevent them from feeling or pulling at the mask.
The gas flow indicators show high vapor levels on each unit, and I can see the fog inside the mask domes as the patients breathe in the gas.
The oxygen flow is strong enough that the inside of the masks remain slightly fogged.
I see no movement from these patients.
They stare straight ahead as if they are frozen in place.
I walk down the line of patients, listening to their breathing, watching for any sign of movement or distress.
All remain still as statues, heads high, unblinking, with no sign of struggle or resistance.
I approach the first patient, a teenage boy with dark hair and vacant eyes.
His chest rises and falls steadily beneath the restraint strap.
The vapor swirls thickly in his red-rimmed mask.
I reach for the control dial on the anesthesia unit.
Samantha stands behind me, notepad ready to record my observations.
I turn the dial a quarter-turn clockwise, increasing the flow of gas by a small increment.
The fog inside the mask grows denser, and I can see it swirling with each breath the boy takes.
His breathing deepens slightly, his shoulders relaxing fractionally.
His eyelids flutter but don't close.
I press two fingers to his wrist, counting his pulse while watching the slight condensation pattern on his mask.
The rhythm is strong but slower than before.
"Are you sure this is safe, Dr. Collins?" Samantha asks, her voice tinged with concern.
"Yes, Samantha," I reply, keeping my eyes on the boy, "we've calibrated the levels precisely for each patient."
"But what if they don't wake up?" she presses, her pen hovering above the notepad.
I notice the boy's fingers twitching against the restraints, a subtle sign the gas level might be too high.
I move closer, pressing two fingers against his wrist while counting the beats.
His pulse is steady but slower than ideal.
Behind me, Samantha shifts her weight, her pen scratching against the notepad.
Without looking back, I reach for the dial and reduce the flow by a quarter turn.
The vapor in his mask thins visibly.
His chest rises and falls in a more natural rhythm now.
I step back, satisfied, as the boy's eyes regain a hint of awareness.
After stabilizing the patient, I linger by his bedside for a moment longer, my hand hovering over the gas control.
The successful adjustment should be my cue to move on, but something holds me back.
I glance over my shoulder, finding Samantha now distracted by another nurse's question about paperwork.
My fingers turn the dial slightly clockwise once more, increasing the vapor density in the red-rimmed mask.
The boy's chest rises and falls in deeper rhythms as I watch intently, counting his breaths.
His eyelids flutter while I maintain a professional stance, ready to decrease the flow if necessary.
"Dr. Collins, why did you increase the gas again?" Samantha asks, her voice cutting through the hum of the machines.
I hesitate for a moment, then reply, "I need to see if there's a different response when the levels are adjusted slightly."
Samantha frowns, her pen poised over the notepad, "Are you testing something we don't know about?"