I was a resident on pain service. I had this poor lady after knee replacement surgery on Dilaudid PCA (?). Of course, her dose was set at 0.2 mg every 10 minutes or so, no continuous infusion, and she was in a world of pain at 11 pm. I sat down next to her, unlocked the PCA pump and started bolusing. At around 6 mg of Dilaudid, we reached bliss. I reprogrammed her PCA to higher intermittent and continuous doses, saw her next morning with a smile on her face; she had slept through the night. I was a CA-1 and that was my first big success in acute pain management.
Another time, I had a tween with CRPS, with h/o opiate dependence, s/p ketamine coma in Mexico, who flared up big time after a D&C. Obviously dear professor put her on some minor ketamine infusion, low opiates and adjuvant medication that did exactly nil for her. So I talked to the patient and went up on the ketamine. And up... Until I reached 1 mg/kg/hr at which level she was pain-free and conversational. What I did not know is that I was way above the maximum dose "prescribed" for a regular floor, so a couple of hours later I get an alarmed call from dear professor. Apparently he had been called by the chief of staff, oops. The patient ended up on the same dose in the step down unit, and left after two days, opiate- and pain- free; everybody was happy, except my attending of course.
Another time I was called to intubate in the ICU a 40 year-old male who had chewed and sucked his fentanyl patches. He was bradypneic and unconscious. The ICU team (absent the attending) was adamant about intubating him. So I gave him Narcan and about 200 mcg later he woke up. When I told them to set up a Narcan drip and call it a day, they looked at me like I was from another planet. I ended up calling their attending and he agreed with my plan of non-intubation. Always do what's right for the patient.
Taking away pain on OB... those patients are so grateful... except when they are not. I can understand why some people love OB or blocks.
Getting a claustrophobic super anxious obese patient sedated just enough so she can sleep but not obstruct through her cataract surgery, with the patient screaming "I love my anesthesiologist!" all the way to and in the PACU. This kind of incident happens mostly in outpatient and interestingly gave me more satisfaction than saving a 60 year-old with aortic dissection, too drunk to even feel the pain, or navigating through a 12-hour liver transplant with a sick patient.
We could tell stories for days, if we really tried. The specialty should be beautiful for any clever person who can take decisions in seconds. All those little or big fires we put out intraop everyday, without anybody knowing, not even the patient. But nothing is more satisfying for me than seeing the patient or the family understand and appreciate what I just did for her. It's so rare, when the patient is not sick preop, because people take us for granted. I get more satisfaction periop than intraop because of that.
