For as long as he can remember, growing up in Witchita, Kan., Doug Goracke wanted to be a doctor. More specifically, he wanted to deliver babies as an OBGYN doctor.
“I thought there would be no bigger thrill in the world than to deliver babies,” he muses. “I looked at a variety of schools, knowing I didn’t want to do research—just good old clinical medicine.”
After eight years of pre-med and medical school at Kansas University and during his residency there for four more years, he said he grew tired of residents that didn’t know how to insert IV’s (intravenous therapy) into a vein.
He said there was a group of residents that were always successful with the process, getting the insertion right the first time.
“Those were the anesthesia people,” he said. “I thought, ‘That’s pretty cool—they get to do all these procedures.’ I did anesthesia for a month and fell in love with it.’”
That was during his third year of medical school. He enjoyed the physical process, placing a breathing tube, IV’s, placing central lines—there’s a lot of mechanics with anesthesia. He says it is part of “the art of medicine.”
Dr. Goracke MD is a board certified anesthesiologist and pain management physician who practices at Hermann Area District Hospital (HADH). He has worked with HADH’s Chief Surgeon Dr. Donald Swayze DO, at the Atchison Hospital in Atchison, Kan., before coming to Hermann.
In person, Dr. Goracke has rugged good looks and speaks with a natural kind, trusting voice, the type that makes for a good bedside manner to put scared patients at ease. Maybe he’s just Midwestern nice, but he also speaks in a way an engineer might—specific, measured and thorough. You believe him.
The Advertiser-Courier asked him to tell our readers about his practice at HADH.
He says anesthesia is inducing the right amount of drugs to someone, based on their weight, to relax the muscles and induce an amnestic state of deep sleep, so the surgeon can do his job. Dr. Goracke adds it’s a careful balance and he enjoys this kind of precision while at the same time, getting to use his full medical background.
“As my practice has developed, I have a certain combination [of drugs] that I use,” he explains. “It’s a little pain medicine up front, you give a little something for amnesia, something to put them to sleep. You paralyze them to make sure they are perfectly relaxed and it can involve placing a breathing tube through the mouth, down into the trachea to assist their breathing.”
He says he is literally inducing a state of unconscious coma.
“The trick is the awakening process,” he adds. “The two most critical times for an anesthesiologist are when you put someone to sleep, so you are rendering them helpless—meaning they’re not breathing on their own—to the awakening process and making this timely in fashion.”
Dr. Goracke says this is where the art of what he does comes into play. He has to know the timing of an operation procedure, have a sense of the complications that could arise and know when a patient needs to wake up, because you just can’t wake someone up with the snap of the fingers, like a hypnotist. If there are several operations scheduled for the day, you want everyone waking up fairly quickly so the surgeon can move on to the next operation.
Before an operation that requires some type of anesthetic process, he tells patients a little about the procedure based on need.
The drug procedure he works with is flexible and depends on many variables. It is “a little of this and a little of that.”
“I give them a little narcotic, I give them a little benzodiazepine (i.e. valium), a little something for pre-emptive nausea—and that has worked very well for me,” he says.
Everybody that comes into the operating room (OR) is hooked up to an electrocardiogram (EKG), blood pressure cuff, a pulse oximeter and quiet possibly a device so the anesthesiologist can listen to sounds in the chest cavity area. Stimulators might also be fitted to check for muscle function as well.
“The pulse oximeter is worth its weight in gold,” he says. “It fits on your finger and measures what your blood saturation of oxygen is—meaning how well are you ventilating?”
This becomes important for people under a general anesthetic, such as during a colonoscopy, where the patient is breathing on their own.
“You push them just far enough, so the patient is still breathing, so you don’t have to insert a breathing tube,” he explained.
Looking at his skill and knowledge set currently from when he started, Dr. Goracke says the medicines used today haven’t changed too much, but he notes the experience a doctor gains with years of practice can make a big difference in how each individual anesthetic process is approached and implemented. Efficiency and thinking several steps ahead helps in the OR when the anesthesiologist is attending to a surgeon’s needs. Teamwork is therefore critical among the doctors and their nurse assistants.
“If you’re disassociated with your surgeon or you don’t have a good team, you’re in trouble,” he says. “Up front, you want to make sure your [induced] muscle relaxant is timed right. If your surgery is going to last an hour and a half, you have a little more leeway than something that is going to last 10 minutes. You don’t want to give the patient a dose of medication that will last 45 minutes if the procedure is only 10 because you’re sitting there waiting for the muscle relaxant to wear off.”
Dr. Goracke says you have to make sure the patient stays asleep because then they would have conscious recall—awake, but unable to breath on their own and immobile—a frightening scenario. This is where his experience comes into play.
“I can’t tell you the number of times I’ve counted on my nursing staff to be my right-hand,” he says.
He illustrates this team dependency with a verbal picture of a small team at work and the serious organization and speed needed, should surgery complications arise; and at some point, they do for everybody that has ever performed surgeries for decades. It can be like tearing into the wall of an old house—you may not know what you’ll find until you get in there, or a patient’s physiology reacts in unexpected ways to a surgery procedure.
“You’re in there (the OR) by yourself,” he starts, and hangs on to those words “by yourself,” because the patient and the others in the medical team are waiting on you to perform. “Lonely” carries a new meaning, because everyone is depending on your training and years of experience and only you and your team can fix it—fast. Everyone has to think and act as One, so communication is paramount.
Dr. Goracke says they have great teamwork at HADH. He currently rotates duties (on duty two weeks and off two weeks) with a certified nurse anesthetist, who has a supervising physician in the operating room during surgeries.
The AC asked the doctor about the local needs and competition from Mercy in Washington and St. Louis or Columbia hospitals.
“It seems no matter where I go, the local hospital never satisfies the needs of those people,” he explains. “Washington people have to go to St. Louis, Hermann people say they have to go to Washington or St. Louis.”
He said he always hears about anecdotal adverse events, concerning Hermann.
“I’ve been here almost two years and I don’t think I’ve ever seen a major adverse event,” he counters. “I think it is due to the safety of the practitioners that are here. It comes down to knowing what you can treat and what you can’t treat—staying within your limits.”
He says you want to provide all the care you can, especially for local people and keep that care within our area. He thinks the staff at HADH has good discernment when it comes to referring patients to the next level for further treatment.
“This is the kind of balance we need to hold the trust, within ourselves and our community,” he noted. “It’s to know my local hospital is going to do what’s right for me and my family.”