Friday, June 22, 2007

Have You Hugged Your Anesthesiologist Today?

That’s it. I’ve had it. I’ve read yet another piece of writing that demonstrates a complete lack of understanding of what anesthesiology is and entails, and I need to vent.

So allow me to lower the mysterious drapes for a moment and let you into my world.

No one gets up one day and says, “I want to be an anesthesiologist when I grow up.” I wanted to be a ballerina, or a bookstore-café owner, or an artist of some kind – someone who was required to pay close attention to the world, take real notice of it, and take creative and compassionate action. But I am neither a ballerina nor a bookseller. I am an anesthesiologist.

Frequently people ask me a version of “What on earth made you choose that?” I try to explain that I love the way anatomy and physiology come alive moment-to-moment in daily practice. Or I try the concrete approach and admit that I actually enjoy placing intravenous lines and breathing tubes. The response I get is usually a glassy-eyed “Uh-huh” or, occasionally, a nose-wrinkling “Eew.” If the conversation progresses beyond “eew,” the more people talk to me about what they think I do – that is, if they think I actually do anything in the first place – the more bewildered I get over how difficult it is to convey to others an understanding of my work.

One time I visited a patient the day before her planned surgery. After I explained what she could expect, she exchanged a few words with her family in her native language. They clearly assumed I couldn’t understand them. An older woman instructed my patient not to bother asking me too many questions, saying, “She’s just an anesthesiologist; what do they know?”

After years of annoyance at many people’s assumptions that I was not a physician because of my gender or my young appearance, this remark – not the first I’d heard along those lines – made me take stock. I realized that not even other physicians understand what we anesthesiologists do, sitting back there in our little cockpits behind some blue drapes (“the blood/brain barrier”), periodically looking up at large machines but appearing otherwise idle. One doctor asked me once, “You have to take an oral exam? For anesthesia? Is there enough material in anesthesiology for an oral exam?” Considering the profound suffering the ordeal of the orals caused me, and causes many anesthesiologists, I felt like shaking the guy by the hair – except he didn’t have any. If other doctors don’t get it, how could I hope to find anything but murkiness and misunderstanding in the perceptions of non-doctors?

I did a little experiment. I constructed a detailed questionnaire about what kind of physician people would want to come to their rescue if they collapsed in a public place. No one wrote down that they would be glad if an anesthesiologist were around.

I figured out about four broad, wide-spread misconceptions about anesthesiologists:
-we are not doctors
-what we do is easy
-we don’t establish rapport with our patients
-if anything goes wrong, “it’s Anesthesia’s fault.”

Then I realized something else: because people have absolutely no idea what to imagine about our work, they decide to make stuff up. It’s amazing.

People react to the mysterious in one of three ways: with fear, with fabrication, or with efforts to deepen their understanding. The fear I see daily. The fabrication – well, let’s just say if I hear one more person declare that all I do is put people to sleep, then sit next to my anesthesia machine and—what? Daydream? Wait for the patient to wake up? Twiddle my thumbs?—that will be one person too many. But that is what people say.

I have heard more times than I can count, “Well, all you do is knock people out. How hard can that be?” My hairdresser asked me when we first met, “So, once you put the patient to sleep, do you leave the room since your job is done?” Excuse me? My job is done? Then who did he think was keeping the patient alive while the surgeon was mucking around with his vital organs and causing all sorts of dangerous disturbances to his vital signs? Who was going to make judgments about what was specifically appropriate for that patient’s particular brand of heart defect, or lung disease, or neurologic abnormality? And then there’s my personal favorite: “You mean, anesthesia for appendicitis is different from anesthesia for heart surgery?” Hmm. 1-inch abdominal incision versus sawing through a person's chest. Yes, it's different.

My husband once tried to mollify my irritation by pointing out that people just couldn’t be expected to know about anesthesia. “Do you know what a machinist does? Or a gaffer?” To which I replied, “Of course not. I have no idea. But I don’t assume that their jobs are easy, and I don’t presume that their work can be summed up by one simple task.” Even my lawyer husband had to admit I had a point. “Well,” he said, “what DO you do, and what do you want people to know about it?”

I don’t think of myself as a doctor whose function is to induce sleep. My primary function is to resuscitate those who need resuscitating. Yes, about 1% of what we do does involve calculating the appropriate dose of the appropriate drug, drawing it up into a syringe, and injecting it into the veins of people who would like to avoid feeling pain or hearing unfamiliar noises during surgery. But I spend most of my energy making sure that I can bring them back. Designing an anesthetic is a thoughtful act. My resuscitation of my patients often begins the night before I meet them, when I am going over safety plans in my head.

Most of my training, in fact, was focused on becoming an expert at resuscitation in its various forms – reviving patients who were dead or near death; intubating those who could not breathe; rehydrating the dehydrated; unparalyzing those I had paralyzed chemically for surgical purposes; awakening the unconscious with judicious use of anesthetic drugs and gases; creating pain relief and anti-nausea regimens for the afflicted; and making sure failing heads, hearts, or lungs functioned well enough to ensure survival of a given surgical procedure.

Late in my training, I realized our level of expertise when I asked a resident in a different specialty – one whose members also take pride in their resuscitation skills – how many intubations she had done after two years. I was expecting to hear perhaps half of my quota of about 1200. “I’ve logged about 84,” she replied. And this was the physician-type people wanted nearby if they collapsed in a public place and needed a breathing tube to stay alive.

Anesthesia affects consciousness, blood pressure, heart rate, respiration, and a whole host of other body processes. If I am not there to watch over you, that first injection can harm you. And that’s just the first step. I should be breathing for you if you stop (and you will), administering fluids when your surgeon nicks a “bleeder,” and giving you the medications you need to wake up safely and comfortably. This can mean a lot of scurrying around, checking, and readjusting within the confines of my “cockpit.” Is the IV running too fast? Is the machine blowing in enough air with each breath? How’s the urine output? Oh, they’re closing – should I turn the gas down now, or will he take a while? Is that heart rate a little too high for his aortic or mitral valve problem? Did I give the drug to slow it down? Let me dive down under the drape to make sure his eyes are still protected…This is all behind-the-scenes, largely unacknowledged work, but it makes even the tiniest task a meaningful act, and I love that about my job.

And that’s just in the O.R.

I've written elsewhere about my E.R. and I.C.U. intubations, but I haven’t even addressed the expertise anesthesiologists bring to laboring women, not only in placing and ensuring the safety of epidurals for labor and spinals for C-section at any given moment, day or night, but also in caring for mothers when childbirth becomes dangerous. On occasion help is needed for an alarmingly sluggish newborn, and yes, we are useful for that too. The code that made my heart beat the fastest was when “Anesthesia, Stat” was paged overhead to the labor and delivery suite and I realized the person coding wasn’t one of the moms, but rather a minutes-old newborn. The family practice attending physician handed over the laryngoscope he was holding, and I intubated the baby so we could bring her oxygen saturation back up to liveable.

Many people have assumed that their limited understanding of our profession reflects a limited scope of medical practice on our part. Assumptions can be unfortunate, but I prefer to focus on the things that keep me coming back to the O.R. despite people’s colossal lack of awareness about what I try to do for them. I know what you’re thinking: it’s gotta be the paycheck, right? Never mind that childcare costs and six-digit educational loans eat up half of it. Sure, the pay is good, but it’s good because of what we are capable of doing for people, and the amount of sweat and tears it took to acquire and prove those capabilities. This is not a job you can commit to just for the pay and be truly happy. It’s too hard.

Nor can anesthesiologists be motivated simply by glamour and prestige – there’s too much ignorance about anesthesiology to allow for either. For me, real job satisfaction has to rest on tenacity, self-respect, humility, kindness, and happiness with the work itself. The big pay-off, in my mind, lies in my relationships with my patients, whom I may meet only briefly but during intensely significant moments in their lives, when they may need the most comfort. All the scientific gobbledygook that goes into the practice of anesthesiology has a chance to get sifted and transformed into a true human connection, into resuscitation that goes well beyond the needs of the body.

It’s my hope that someday, when a person collapses in the bookstore-café that I don’t own, or in the opera house in which I’m not dancing (or playing the oboe!), and an anesthesiologist responds, it will be common knowledge that the professional responding to the situation is providing expert care in the truest sense of the phrase.

55 comments: said...

Hey, you can come to my rescue ANY time! I'm in awe of what you do. So there you go!

I know a lot of folks who don't understand what musicians do either. The verb "play" doesn't help. I actually had one woman get furious when she heard I was actually paid for playing. "I played clarinet in high school. I'm going to get into a symphony and play and get paid!" she nearly yelled. I was in shock as she got angrier and angrier.

And she was a realtor.

Of course I wanted to say, "You walk people through houses and get tons of money when you sell a home," but I knew that wouldn't go over well and I know that realtors do have to actually work at what they do.

So you and I could commiserate together. But I don't save lives. You do. So you win, hands down!

You'll laugh at what I did before our daughter's scheduled hand surgery -- she broke fingers roller blading at a young age. They said, "clear liquids only" so what did I give her? Orange juice. When our friend, an anestheologist, believe it or not, asked if she'd had anything to eat or drink I said proudly, "Only orange juice!" Sigh. With pulp of course. They rescheduled for the next day and our poor daughter went home with a needle in her arm. (THAT was a mistake too. She told me years later how terribly freaked she was all night long because of that thing. Of course she also told me, when she had the pin removed, that she now knew what it was like to have a baby ... so she had and has a tendency to exaggerate!)

But ... rambling over ... I'm sending you big hugs. For what you do. For your oboe endeavors. And for your excellent writing! :-)

Elaine Fine said...

Thank you so much for this beautiful explanation of what you do.

Unknown said...

As fas as I'm concerned you're the most important person in the OR.

Moreover, you deserve every cent you're paid. It's a very high stress job.

Filip M.G. said...

My wife is in anesthesia training. I absolutely loved your article as it helped me get a more clear understanding of what she does. I think the world of her and I have tried many times on my own to get a better understanding of what she does without looking ignorant. Your blog has helped me clear the rumors from the facts.

I personally have a very thankless job. I am a web developer. I basically create a digital medium through which other people and organizations make money. Don't feel too bad about the lack of unappreciation you get. When your judgment day comes you will realize how many lives you have saved. When I look back at my career I will realize the only thing I have done on this planet is help others make money. I guess the only way I can have any salvation is by taking care of my wife and my daughter.

Keep up the great work and be happy you don't do what I do.


Daniel said...

I wonder if we all don't feel that way about a variety of jobs we perceive as easy.

I'm a professional disc jockey (yup, the kind you see at weddings and parties) and believe all we do is push "play". Forget about staging a huge grand entrance, or emceeing in front of several hundred people, or technically getting $20,000 of sound gear hooked up and operational.

Now in no way am I saying the acumen of an anesthesiologist is as tough as being a DJ. I had a biopsy earlier this week that was supposed to be done under "conscious sedation". After the procedure began the anesthesiologist made the call that I was still in so much pain he put me totally under. We spent a few minutes chatting before the procedure and he explained everything to me. You don't have it easy at all!

I think those who think, "I could do that!" or "How easy is that?" should actually research what it takes to be a professional...anything!

Yuki said...

Sorry if my writing contributed to your irritation in any way. I'm just barely a med-student, school me!

T. said...

Thanks so much for your supportive comments! I truly, truly appreciate them all.

If I've learned anything about training for this job, it's to try not to take ANYONE's job for granted - not Barb who helps wash the floor in the O.R. at night and always gives me a smile; not (with a wink to Daniel, above) the DJ who made my wedding day 11 years ago so memorable, not the folks who shine shoes at Grand Central or do other, tough, barely-noticed jobs (my husband teases me that I worry so much when I see hard workers out in the world that if I were ever to be canonized a saint after I die, which is an impossibility, I'd have to be named patron saint of folks who make a tough living).

And filip, you sound like a gold-medal husband, like mine has been through all these years of medical work. There's NO WAY I'd be where I am today without him, and I know just reading your comment that your wife is truly lucky to have you supporting her. As for the job you do - I've always envied computer-savvy people. Please don't underestimate the talent and creativity you bring to your profession, or sell short the unseen value of it. It's like that song about the tapestry from Prince of Egypt - sometimes we feel like insigificant threads because we don't realize the part we play in a gorgeous weaving. You might be helping others make money who might put that money to some use that has a lasting impact in the life of some person unknown to you across the world, or in your own back yard.

And Doc Yuki - no worries! Please don't apologize. This post has been brewing for the last several YEARS. There have been COUNTLESS people asking the same questions about anesthesia, and I feel so relieved to have had the chance to get some of my thoughts about it out there.

Again, thank you so much!

Leslie Johnson said...

Thanks so much for your illuminating post. I've been billing and coding for anesthesiologists for the last several years and you're dead on.

I can't tell you how many times we have to educate the patients and the insurance companies on what you do & why your services are so vital.

Thank you & all like you who take care of us when we're at our most vulnerable spot we could ever imagine.

Patty said...

I would just love it if you would delete my stupid comments. :-(

I wrote about myself rather than the blogger, and of course I come across -- and am -- an idiot. Can you delete my post? I wonder!

Not only am I just an oboist, I'm a self-centered one at that.

T. said...

Patty, absolutely no self-flagellating allowed! Everyone KNOWS story-telling connects - and your stories are great!

Besides, there's a big difference between reflecting on oneself & being "self-centered" - the former can actually promote SHARING rather than self-absorption, and the latter you're so not! So no deleting.

Patty said...

Well, I guess I will have to deal with seeing what I see as rather self-absorbed rambling on my part.

I've really been attempting to listen more and speak less, or at least wait to speak (or, in this case, write). It's a tough thing for me. I react quickly to things. Go figure. So many words I wish I could take back ....

But you are very kind in your response. Thank you kindly.

Lisa said...

I always save my energy in pre-op for the anesthesiologist. Where other doctors would pull a blank re: addison's disease, adrenal crisis, pituitary malfunction, and a list of items normally glossed over, the most important person to me (read: you) perks up and pays attention.

You have my deepest respect! :)

Angie said...

I have a comment and a question. First, thank you for this post. I'm fascinated by all things medical and really enjoyed it.
Second, my question. I can't seem to find the answer to this - why are patients' eyes taped shut? Is it so they can't open them and see something that may be disturbing? Wouldn't it also be disturbing to not be able to open your eyes? Am I completely missing the point here? Thanks in advance!

T. said...

Hi, Angie - the patient's eyes are taped shut to protect them from corneal abrasions. So much activity goes on around the head during "take-off" and "landing" that there is a real risk of brushing against the eyes - with ID tags as we lean over them, suction catheters, warming blankets, intubating equipment, etc. Corneal abrasions when they occur are, at the very least, EXTREMELY uncomfortable for people. The tape is applied after the patient is completely unconscious and removed just before the patient is woken up. Thanks for visiting!

DraMaru said...

I'm an anesthesiologist also. I chose to be one when I learnt that I woulb be a bridge between pain and people, and also to be a kind of firefighter for life in the O.R. I loved true emergencies there, the rush, the life&death situations. Anesthesia is beautiful. complicated, demanding it eats us alive, but this is the price. Think about it: how could anyone tolerate a surgery without the anesthesia bridge? Many did, in the past, and it was like hell. Thanks God is very different today. And yes, we are full time doctors like surgeons or cardiologists. And we care. Pain is a dreadful thing.

Angie said...

Thank you SO much for the answer to my eyelid-taping question! Makes complete sense now!

Lisa Johnson said...

Great post! I read one too many articles about people waking up in the middle of surgery and feeling everything but not being able to move or speak. Before my surgery, I spoke to my anesthesiologist and said I was a bit freaked out and to please not let that happen to me. It didn't! I'm sure that was probably annoying for him, but I felt better just expressing my concern and that he took the time to listen to me. Thank you for all you do!

Supermark said...

I did wake up one day and decide I wanted to be an anesthesiologist. But then I decided it'd be too hard.

Anonymous said...

Thanks for posting this... I want to be an anesthesiologist someday and this was very enlightening.

Dr Shyam Madabhushi said...

I am an anaesthesiology trainee too, the difference being that it is in India. But I appreciate what you have writte, for the situation is pretty much analogous here. Even my parents did not think that this was a good choice. But if we get to the basis of all medical practice, that is to relieve human pain, who can stand taller than an anaesthesiologist???

Gena said...

HI.Very awesome what you do. Thanks for the detailed explination. I schedule surgeries for a neurosurgeon/spine surgeon. When we send the patients for their pre-surgical assessment/pre-anesthesia appt, I give them a doctor's order for the pre-op. I was always told to check the box that says,"Diagnostic Labs per Anesthesia". Often the patients will ask me what that is for, and I tell them that its whatever the anesthesiologist thinks you need depending on your age,health,and surgery. Is this correct? What is this anyway?

T. said...

Hi, Gena -

Thanks for visiting! As far as I can tell, your answer is exactly right. Every hospital has different forms / check boxes / protocols for preop labs, and I can't say for sure what your "Diagnostic Labs per Anesthesia" would mean, but I would EXPECT it to mean just what you've been explaining - the tests an anesthesiologist would want to see done based on the patient's age, health, and type of surgery.

Mitch Keamy said...

Hey T. a fine post. Angie should know that anesthesia is really a drug induced coma and that the patient can't blink or even close their own eyes. I tell my patients this as a prelude to brief informed consent, Specifically, I say "sleep is what you do at night,and you don't need my expensive help for that. But if the surgeon were to creep into your bedroom and cut you with a scalpel, you would wake up and scream. What I do is place you in a drug induced coma, which I monitor and reverse when the surgery is over. If you are not carefully and continuously monitored, along with the effects of the surgeon's operating on your organs, it would be very dangerous. I will stay with you and protect you from the side effects of the anesthetic and surgery. I trained a long time and am good at this.Would you like to know more before agreeing to proceed?" This takes about 45 seconds. I frequently hold a hand while saying this, and I always maintain steady eye contact. Some people want to know more, Most say something like; "ok doc-let's do it." Nobody says no. Nobody is more scared at the end of that little monologue than they were at the beginning. Nobody ever is allowed to confuse sleep with anesthesia. Everybody takes me seriously, because I take what I do seriously (and because I have a grey beard and a bowtie; Sorry kid-you could wear a bowtie I suppose, but I wouldn't recommend the beard.) When you get old and wrinkly, like me, they'll take you (and what you do) seriously. Enjoy your youth, and walk tall (you probably do anyway, as you were a ballerina); you're an Anesthesiologist, and there's nothin' like it...

Erin said...

Can I just say "Preach it sister!" My husband is a second year resident (first year anesthesia) and I can totally understand and appreciate where this post comes from! It is very validating and also a great reminder to see the importance and hard work that goes into everyone's jobs. As a former first grade teacher and now a stay-at-home mom (married to an anesthesia resident with 2 kids under three - what were we thinking?!) - I can also understand the "your job isn't hard" comments. Thanks for the words - and keep up the great work!

Anonymous said...

Hello Dr. I certainly wish that I had had more concern for my anesthetist than I did before my operation. It's also too bad that patients can't interview their anesthesiologist/CRNA BEFORE they allow them to care for them. As somebody who recieved Versed and a GA in complete defiance of my refusing same and without discussion I absolutely am aware of a huge difference between anesthesia providers! (no informed consent either I would not have signed it!) I personally prefer awareness and moderate pain as opposed to Versed and GA. I wish that I had been allowed to hire an anesthesiologist who respected my desires, had no problems explaining what the drugs were REALLY for and who realized that the patient may have a different take on whether the risk outweighted the benefits! Oh well, hindsight is 20/20 and all that. Good Luck in your career!

ANIL said...

An excellent post! I am a cardiac anesthesiologist from India.. I fully agree with you, when you say there is an absolute lack of understanding of what we do amongst both the general public and the members of our medical fraternity. But who cares ! As long as you are a thorough professional,the money is good and you enjoy what you do, recognition from few ignoramuses doesn't really matter..

Ann of the Incredible Gift said...

I would be quite happy to hug my anesthesiologist, no, make that AnesthesiologistS, plural, as I have had more than one surgical procedure, but after the surgery, they mysteriously vanish.

On one occasion when the anesthesiologist came to talk to me before surgery I had to confess that I was totally freaked out by the fear that I would go under and never wake up. I have no idea why I was seized by that particular fear at that particular time as I had been under and woken up with no problem on previous occasions, but my heart rate was up, my mouth was dry, and my palms were sticky with cold sweat.

The anesthesiologist asked about my previous experiences, listened carefully, and said he didn't see any reason for me to be concerned. He paused, and then he assured me he would be monitoring my vital signs during every minute of my surgery to make sure I was OK.

He went over everything I could expect from the time I was wheeled into the OR until I woke up in Recovery.

The fact that he took my fears seriously made me feel a lot better. Bless the man.

Reading your post makes me realize that what he said he would do for me is exactly the same as he would have done if I had not been terrified, but hearing it out loud was so very reassuring.

Oh, yes. If I should happen to collapse someplace out in public, I would be more than happy to be rescued by an anesthesiologist.

T. said...

Ann, thank you for your comments! It's true, the two most common fears we see are a) fear of waking up during the procedure and b) fear of not waking up at all. I'm so glad you've had good anesthesiologists to keep watch over you, especially that one memorable one!

Anonymous said...

Ny ex-husband had a really good anesthesiologist as a mentor in med school (though he ultimately went into oncology. I still remember his saying that an anesthesiologist is someone you pay to poison you almost to death, and that getting the right anesthesiologist is more important than getting the right surgeon. Hugs to you and thanks for your good work.

Anonymous said...

I do feel people misunderstand the job anesthesiologist. I Want to become one, and people always say, "What is that?" or "Don't you just administer drugs?" "I all like no...there's more to it than that, besides adminstering the right amounts of anethesia isn't the same for everyone. I hope people get to know the importance of an anesthesiologist, their job is vital than the surgeon's!

Anonymous said...

Growing up with multiple disabilities meant lots of surgeries for me (more than 30 surgeries in 30 years). This was in the 70-90's. I was emotionally traumatized by the anesthesiologists and how everything was handled along with the use of the dreaded ether mask. :-( Finally, in 2005, I met an Angel in Scrubs, an anesthesiologist in Boston, who made a life changing difference for me and have positively changed my view of going through surgery and having anesthesia! I am 33 now and will need surgery every now and then for the rest of my life but at least I am not afraid of it anymore thanks to this one wonderful anesthesiologist in Boston.

Varsha said...

Wow, you said it all!

I am an anesthesiologist in the making and I so agree with all that you said.

We struggle to keep the patient all stable while the surgeon is fiddling with him.....and the patients wake up, thank the surgeons and go home.

We are behind the mask, behind our drapes. Others in medical field also fail to understand what we do, leave aside our patients. We need to know not just about anesthesia but about almost all other specialties!

But like my professor says "The Anesthesiologist's job is to make patients forget, which includes themselves too"

Anonymous said...

Varsha your profeesor scares me! The anesthetists job is NOT to make the patient forget!!! Its to make sure they are not in pain! You cannot justify giving amnesia instead of pain relief. This is a huge problem in anesthesia these days, that all you have to do is slip an armful of Versed and let'em scream. Bad advise for this person to give students.

Anonymous said...

Trust me, I've had Versed before and it has stopped me from screaming. It helped me calm down before surgery.

Steven McAllister said...

Hi. I have a question that I would really like answered. I am 17 years old, a senior in high school, and a someday anesthesiologist. It is what I have wanted to do since I met my first anesthesiologist when I got my adnoids out. Anyways, we all know anesthesiologist have a great salary. (around 200k?) what I want to know is... does the insurance cost a big chunk of that paycheck? Sorry if I sound like a complete moron right now! Your answers are GREATLY appreciated. Thanks.


Anonymous said...

I am a 17 year old student fixing to complete my senior year in high school..
I have had a life long dream of becoming an anesthesiologist. Someone asks me everyday what I plan on doing after school... I smile and say.. "hmm after 4 years of undergrad and 4 years of Meds school at Loma Linda, I would like to be an anesthesiologist"
And as usual they have no idea what it is.
It is a VERY important job, and you are right. they tend to be underestimated. I wish you the best of luck and hope all goes well

sharonrstevens said...

I loved this too! I am currently doing my undergrad and I hope to become an anesthesiologist someday. Everything you wrote made me feel even more certain that what I want to do is right for me. Thank you for that! I am amazed at your accomplishments and your passion!

Anthony Fragola said...

Wonderful post! I'm a pre med student and I'm really interested in pursuing anesthesiology. I only recently started finding out how much there is to it though. From the title, to the information to the personal anecdotes, I thank you for every part of this post. It was truly inspiring.

Anthony Fragola said...

Wonderful post! I'm a pre med student and I'm really interested in pursuing anesthesiology. I only recently started finding out how much there is to it though. From the title, to the information to the personal anecdotes, I thank you for every part of this post. It was truly inspiring.

Anonymous said...

It's great that you make light of anesthesia........Patients are put at great risk every day because anesthesiologists who are supposed to suerviing CRNA's would rather goof off and read their email instead of really supervising cases. I recently had GA and the CRNA let eh sevo vaporizer run dry; 15 minutes of totally agony until the surgeon noticed that I was awake, sweating and aware. The CRNA finally called the anesthesiologist and they eventually refilled the sevo. Then, post-op they lied about what happened. Fortunately the surgeon spoke up; such absolute medical malpractice shouldn't happen. The anesthesiologist lost a lawsuit and is not in a drug-diversion program; if she's caught diverting fentanyl, she loses hwe licence forever. The CRNA is working a a floor nurse.

Unknown said...

i am a junior in high school, and ever since 7th grade this is what i have wanted to do.
i think this job will be very intense and challenging and i will love that.
but i have a few questions..
1. how did you get used to intubation?

2. is this job difficult to have if you have a family? like is it hard to make time for a family?

3. what is the best part about the job?

4. if a patient dies, whow does it affect the anesthesiologist?

thank you for your time, and by the way, if i was passed out or hurt or something, i would much rather have an anesthesiologist there!


T. said...

Hi, Lauren! Thanks for stopping by. In answer to your questions:

1. I love intubating. It's my favorite task as a physician. Reaching a reliable level of competence takes a lot of practice, so the best way to get comfortable is to just keep doing it over and over and develop some real expertise to fall back on when things get tough and the situation's not exactly "textbook."

2. I would say combining medicine with family life is challenging but people do it successfully all the the time. It's a matter of clear priorities and hard work. During medical training it's very, very hard, then it gets a little easier. Some careers in medicine are harder than others for making time for family - anesthesiology can be flexible or it can be grueling depending on where you end up working.

3. The best part about the job is knowing you've really been there for each patient, right by his/her side, during moments when they truly need a helping hand or comforting presence, and also knowing that each concrete task you do has tangible meaning and often immediately visible helpfulness.

4. I think for any dedicated physician, a patient's death means a lot of grief and darkness and need for healing. If it doesn't, that physician should think about doing something else that requires a little less personal care and respect for others.

Hope this is helpful!

Ashley said...

First of all - thank you so much for your blog! It's very interesting!

I'm in grade 10, and I know for a fact I want to pursue medicine as my career. I applied to volunteer at a hospital nearby over the summer, and they said my qualities were "impressive" but I lacked experience. So, to prove them wrong for next year - I am now shadowing a cardio surgeon, as well as my family doctor.

Anyways, I am thinking of anesthesiology as a specialty, but I am not exactly set on it yet. Speaking as a an anesthesiologist - what are the pros and cons?

Also, what advice would you be able to give me for becoming a MD?

Thanks in advanced,

T. said...

Hi, Ashley -

Here's my advice about preparing for medicine:
Do well in school. Work hard. Never lose your integrity. Don't lose your soul either. Follow your passions - and that includes majoring in something NON-premed, like art history or Russian studies or whatever you are intellectually passionate about, if that's really what you want.

As for anesthesiology pros and cons:

Cons - medical work environments can be toxic; the training is grueling; the hours can be long and hard even after training is done; call STINKS.

Pros - interesting, satisfying, meaningful, life-saving work; good pay; potentially flexible career options

Have a great Thanksgiving!

Cons - medical work environments can be toxic; the training is grueling; the hours can be long and hard even after training is done; call STINKS.

Elizabeth said...

I just wanted to drop by and say, that when I first read this blog about a year ago, I found your thoughts so interesting, they always seemed to stick with me about how you should thank the anesthesiologist. Recently, I underwent a surgery & I thanked my anesthesiologist. I don't think I have ever seen someone smile like that before. She mentioned that the patient rarely thanks her (especially since I'm a teenager!) & about how much she appreciated it. Thanks so much for your blog, I think that I at least made one anesthesiologist smile. Also - I highly respect you for your job! I personally believe that you deserve far more recognition than you receive! I've always found anesthesia to be so interesting, I hope that one day I'll be able to practice it!

Best wishes,

T. said...

Elizabeth - thank you so much for your thoughtfulness! I know you made her day - and mine too! :)

Anonymous said...

I underwent my first ever operation last June. It was not a complex procedure, but as all surgeries carry some amount of risk, it was unnerving knowing that I could be one of the unlucky few encountering complications from it.
It did not help that I met the anesthesiologist only minutes before being wheeled into the OR. And he was the person I was going to entrust my life to.
So I was very relieved when I was woken up. Groggy but certainly alive, I could still remember what I had planned to do if I woke up alive from the procedure - I called the anesthsiologist "Doctor XX?" I was too weak to open my eyes but I could hear him beside me," Yes, yes?" And I thanked him for keeping me safe "Thank you, Doctor XX." There was immediate outtburst of exchanges in the OR but I couldn't recall anything that was being said. I like to think that the anesthsiologist and nurses were pleasantly surprised because they did not come across a lot of patients like me who thank their anesthesiologist the moment they woke up. But it is true that I owe my life to him, besides my surgeon of course, but I could jolly well thank my surgeon when I see him again. However it is unlikely I would see the anesthesiologist after that.

Dr. McBain said...

All that you have said has truly resonated with me. As an Anesthesiologist myself, I understand all to well the ignorance that people (including other physicians) have about our job. Sometimes it is extremely frustrating. I had a hairdresser say to me, "how can you be a doctor if you don't do the surgery?" And I responded, "I'm the one who keeps you alive while the surgeon is in there making a mess!". In the end, you are right. We must find satisfaction in our jobs by doing them well and realizing that at the end of the day, we are the unsung heroes in the hospital.

meludee said...

i've been browsing through anesthesia blogs and came across this post. i just want to say THANK YOU! you say it so beautifully.

i'm a medical student from the philippines and i am drawn to the field of anesthesiology. the other day, the senior anesthesiology resident "encouraged" me to go into anesthesiology with what seemed to be all the wrong reasons (basically easy lifestyle, easy money). i ended up discouraged by what seemed to me a lack of passion and understanding of the beauty of anesthesia.

your post truly encouraged me to pursue my dream. so thank you very much.

God bless you. :)

Leandro Cardoso said...

You said it all! I am an anesthesiologist in Brazil and I have the same thoughts and impressions as you have. Interested in the US market and researching about the profession in America.

Unknown said...

Nice article..i am from manila, philippines.. An anesthesiologist as well.... Iam editor in chief of our newsletter.. May i re- print your article?

T. said...

Of course naman!

Unknown said...

Omg! You are filipina! I am dr. Dulce agcaoili. You can send me articles too . I am excited to know you.. I had a chance to attend one of the pedia courses sponsord by harvard medical and all the other hospitals there in boston. Email me please..

Anonymous said...

I am so glad i stumbled across this blog ! I am currently an Undergraduate student, and have an interest in pursuing anesthesiology. I often struggle to vocalize my passion for anesthesia to my friends but you have transformed my feelings into words. I am truly intrigued by the essential role that anesthesiologist play in health care and how regardless of the lack of notification, many- or at least those that i have met- remain humble and are content with the gratification they receive for simply being their for patients in a time of need. thank you thank you thank you.

Anonymous said...

Thanks so much for this. I recently became curious about just what these Dr.'s do. It really is amazing, mysterious and even humbling to read about their work. I'll never take my anesthesiologist for granted again!