Nervous About Choosing Anesthesiology

DrBB · Sep 1, 2012

I'm currently deciding between Anesthesia and IM. I really like anesthesia because of the procedures and instant results with interventions, along with the physiology and pharmacology that is used on a daily basis. During my rotation however, I was overwhelmed with the very fast pace, the various equipment, and the occasional high stress (i.e. those moments of sheer terror). Sometimes, I feel like I have no idea what the hell is going on and it's hard to imagine myself doing the things that the resident/attendings do with such proficiency.

I am kinda nervous about choosing anesthesia and feel that I might be more comfortable going into IM. Was anybody else having these feelings before deciding choosing anesthesia?

gasattack3 · Sep 1, 2012

DrBB said:
I'm currently deciding between Anesthesia and IM. I really like anesthesia because of the procedures and instant results with interventions, along with the physiology and pharmacology that is used on a daily basis. During my rotation however, I was overwhelmed with the very fast pace, the various equipment, and the occasional high stress (i.e. those moments of sheer terror). Sometimes, I feel like I have no idea what the hell is going on and it's hard to imagine myself doing the things that the resident/attendings do with such proficiency.

I am kinda nervous about choosing anesthesia and feel that I might be more comfortable going into IM. Was anybody else having these feelings before deciding choosing anesthesia?

I often reflect on just how crazy it can be in the OR. I do think that at least some residents have underestimated the stress and fortitude you need to be GOOD at this profession. If you're the type who's affraid of their own shadow, then this is not the career for you.

It is indeed a procedural field, and this is not for everyone.

Even the routine act of flipping a 140 kg, endless comorbidity patient, into the prone position for a laminectomy can be a bit harrowing at times.....

Ignatius J · Sep 1, 2012

A few things that are just my opinions:

1. You are correct: Anesthesiology can be terrifying, challenging, and overwhelming at times. That's part of the challenge. And with that challenge comes reward and satisfaction in overcoming.

2. Life is too short to be "comfortable". It's about challenging yourself, your fortitude, and your intellect, and getting better every day. That's what makes it worth living. That's what I like about anesthesia. For a lot of your cases if not the majority, you can revisit and ask "What could I have done better? What could I have done more efficiently? How can I take this case and become better for the next patient I encounter? It's a field of constant refinement, and I love that.

3. Lastly, a lot can be said about being the guy that keeps someone alive. Watch you know what hit the fan and your colleagues start backpedaling where you know you can't. Often, you cooperate with surgeons in getting a patient stabile. But when it comes down to it and someone is crumping, you are the guy that needs to prioritize, organize, and know what to do. It's a good feeling when it works out.

Just my .02.

pgg · Sep 1, 2012

DrBB said:
During my rotation however, I was overwhelmed with the very fast pace, the various equipment, and the occasional high stress (i.e. those moments of sheer terror). Sometimes, I feel like I have no idea what the hell is going on and it's hard to imagine myself doing the things that the resident/attendings do with such proficiency.

[...]

Was anybody else having these feelings before deciding choosing anesthesia?

Everyone did, if they were paying attention.

The med students who think anesthesia is relaxing and easy were either
a) getting cut loose and told they could go home at 10 AM after doing a couple of tubes
b) oblivious to what was actually going on

Anesthesia isn't like IM. Med students don't get lectures on anesthesia, except for a day or two at most of pharmacology when the drugs are mentioned in passing. Med students don't have group discussion sessions to talk about anesthesia the way they sit around and talk IM. The simple flow of patient and case movement, and the way the OR works, is totally alien to every med student when they start a MS3 anesthesia rotation. It's not like IM and surgery where the disease processes that make up 90% of admissions have been studied and discussed a lot during MS1&2 lectures and small groups. The other fringe specialties that don't get much MS1&2 time (like radiology, or path) may be foreign to MS3s but that's not compounded by the pace or time pressures of anesthesia.

Don't let being overwhelmed during a 1 or 2 week MS3 anesthesia rotation dissuade you from picking anesthesia.

I wet tapped the first epidural I ever attempted and remember thinking, I don't even know what I'm feeling, I don't know what I'm doing, how am I ever going to get proficient at this ... but that's what residency is for.

All CA1s are viewed as potential assassins. You'll have an appropriately short leash, and help, and supervision with cases early on, unless maybe you're at BobBarker's program or RussianJoo's program. 😉

DrBB · Sep 1, 2012

pgg said:
Everyone did, if they were paying attention.

The med students who think anesthesia is relaxing and easy were either
a) getting cut loose and told they could go home at 10 AM after doing a couple of tubes
b) oblivious to what was actually going on

Anesthesia isn't like IM. Med students don't get lectures on anesthesia, except for a day or two at most of pharmacology when the drugs are mentioned in passing. Med students don't have group discussion sessions to talk about anesthesia the way they sit around and talk IM. The simple flow of patient and case movement, and the way the OR works, is totally alien to every med student when they start a MS3 anesthesia rotation. It's not like IM and surgery where the disease processes that make up 90% of admissions have been studied and discussed a lot during MS1&2 lectures and small groups. The other fringe specialties that don't get much MS1&2 time (like radiology, or path) may be foreign to MS3s but that's not compounded by the pace or time pressures of anesthesia.

Don't let being overwhelmed during a 1 or 2 week MS3 anesthesia rotation dissuade you from picking anesthesia.

I wet tapped the first epidural I ever attempted and remember thinking, I don't even know what I'm feeling, I don't know what I'm doing, how am I ever going to get proficient at this ... but that's what residency is for.

All CA1s are viewed as potential assassins. You'll have an appropriately short leash, and help, and supervision with cases early on, unless maybe you're at BobBarker's program or RussianJoo's program. 😉

Thanks for your response. Just to clarify, I'm an MS4 and on my second 4 week anesthesia rotation. Also...residency apps are due in 2 weeks and I have to make my decision soon!! Leaning towards anesthesia 🙂

Dejavu · Sep 2, 2012

Let's just say that in all my time doing anesthesia I have seen lots of IM people change to Anesth, but I have never seen Anesth people change to IM.

Most IM's that I know are not as happy with their day to day life as I am.

Sign up for Anesth; just do it.

imfrankie · Sep 2, 2012

Probably pretty easy to go from Anesth to IM if you change your mind. Converse less true IMO.

DrBB · Sep 2, 2012

Dejavu said:
Let's just say that in all my time doing anesthesia I have seen lots of IM people change to Anesth, but I have never seen Anesth people change to IM.

Most IM's that I know are not as happy with their day to day life as I am.

Sign up for Anesth; just do it.

Can you elaborate on what makes you happy in your day to day life?

Ignatius J · Sep 2, 2012

RESULTS. You secured the airway, obtained IV access, managed the ventilator, controlled the patients pain, managed the anesthetic, judiciously monitored, titrated dogs, all resulting in you rolling out of the OR to the recovery room. When you leave, you have successfully brought that patient to death's door step and back. Going to surgery is as vulnerable as a lot of people can feel, and you take care of them in that regard every step of the way. It's a privilege, IMO.

narcusprince · Sep 2, 2012

You can have both. Looks like the aba abim have come up with a joint 5 yr curriculum. Leading to board certification in both in 5 years.

gasattack3 · Sep 2, 2012

Ignatius J said:
RESULTS. You secured the airway, obtained IV access, managed the ventilator, controlled the patients pain, managed the anesthetic, judiciously monitored, titrated dogs, all resulting in you rolling out of the OR to the recovery room. When you leave, you have successfully brought that patient to death's door step and back. Going to surgery is as vulnerable as a lot of people can feel, and you take care of them in that regard every step of the way. It's a privilege, IMO.

Agree 100%. Also, it allows you to feel empathetic towards some of the most obvious of body abusers or difficult personalities. At least more so than you otherwise would be able to muster when seeing them in the ER and then hand holding them through a typical BS medicine admission....

Virtually all patients presenting to surgery are very nervous which seems to edge out much of any existing malignancy in their personalities. Sure, anxiety manifests in different ways (not all great to deall with), but you can easily see through that.

Just the other day we took a patient to the OR. The dude called me a "real American hero" :laugh:

, though admitedly under the influence of Versed. He was crying, praying (really really sick young fellow) and thanking us in advance....

We got into the room and the surgeon says "this guy's a real *******". His difinitive cure was surgery and he had apparently been giving the surgeon a hard time. It then comes out that he was abusing the nurses on the floor.....

A far cry from what we saw before taking this guy back to have his chest cracked open...

This difference is a not insignificant part of what allows me to really enjoy this job. It's easy to be non (or less) judgemental when all you have is the brief preoperative interview/exam and then all you see is a helpless/vulnerable human being...

RussianJoo · Sep 2, 2012

I think there's definitely a right and wrong person for anesthesia. Most people only see the relaxing side of anesthesia, pretty healthy patients undergoing everyday surgeries, where vital signs hardly ever change and with little skill everything is made to look very easy and boring. Very few see the rare emergencies that can happen, the reason they seem overwhelming is because they are. But you learn to be quicker and better.

To start however, you need to be tough. You can't hesitate or second guess yourself in an emergency, sometimes you have to be loud and tell someone to stop what they're doing. So if you're always scared to act, or was picked on as a kid then you'll have a tougher time learning how to be faster and more confident. You also have to always be ready because you really never know when you have to act as quickly as possible to save a life. A lot of times you don't even have time to think, That's why you prepare yourself mentally by going over scenarios and always have everything you need ready to go.

Everyone thinks that anesthesiologists are relaxed and easy going people, and I say it's an act, and in reality they're OCD and strong type A personalities, they just learned to hide it well.

gasattack3 · Sep 3, 2012

RussianJoo said:
I think there's definitely a right and wrong person for anesthesia. Most people only see the relaxing side of anesthesia, pretty healthy patients undergoing everyday surgeries, where vital signs hardly ever change and with little skill everything is made to look very easy and boring. Very few see the rare emergencies that can happen, the reason they seem overwhelming is because they are. But you learn to be quicker and better.

To start however, you need to be tough. You can't hesitate or second guess yourself in an emergency, sometimes you have to be loud and tell someone to stop what they're doing. So if you're always scared to act, or was picked on as a kid then you'll have a tougher time learning how to be faster and more confident. You also have to always be ready because you really never know when you have to act as quickly as possible to save a life. A lot of times you don't even have time to think, That's why you prepare yourself mentally by going over scenarios and always have everything you need ready to go.

Everyone thinks that anesthesiologists are relaxed and easy going people, and I say it's an act, and in reality they're OCD and strong type A personalities, they just learned to hide it well.

Yeah, you can be "laid back" but if you can't also act and assert yourself when needed, you're probably not going to be good. Can you get by the training? I'm sure. But, I submit that you can't be really good if you are unable to to take the bull by the horns which isn't everyone's gig.

That being said, I'm not suggesting overly asserting yourself for no reason. You'll just piss everyone, including the surgeons, off. So, you also need a very flexbile personality.

Things change on the fly. Productions pressures don't let up. You have to deal with it. Plain and simple.

urge · Sep 3, 2012

narcusprince said:
You can have both. Looks like the aba abim have come up with a joint 5 yr curriculum. Leading to board certification in both in 5 years.

What is the goal of that? Good pre ops?

OP, I would suggest IM for you. Nice slow pace and bunch of good subspecialties if you decide to keep training. In anesthesia you have to be fast to be successful in a competitive city. Granted, there is always the bundocks...

Nervous About Choosing Anesthesiology

DrBB

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gasattack3

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Ignatius J

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pgg

Laugh at me, will they?

DrBB

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Dejavu

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imfrankie

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gasattack3

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urge

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