anesthesiology isn't for the trepid

[gasattack3]

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So, probably in every class there's that person who can't seem to shake that deer in the headlights look. Sure, residency is an evolution. People grow and adapt all the time.

But, crazy things will happen, and not always anticipated. Things CAN go bad fast, and it requires action. Procedures are not just "fun", but usually they are necessary, and sometimes critical. You realize this when you need to do these things under very real pressure. Patients (if not GA), and others in the room may be freaking out, and in not-so subtle ways. Can you hold down the fort?

Can you act? Do you fumble f.ck around with procedures? I don't care about your board scores. Can you LEAD in a deteriorating situation?

The problem is that this field does require a certain "type". Too often, however, it's perceived as a lifestyle field where you can have slightly above average or average boards scores, do a 4 (not 5 or more) year residency, and make good money.

I would think twice about what it takes to be a good anesthesiologist. Make sure you are suited for this job. I've seen at least a few people shaken up by the stress of the training (not even the responsibility of an attending). I wonder if they chose (or even fully appreciated) the right field.

Too many people are going into this career that probably would be better doing IM and rounding all day on sick but not critically ill patients.

Not being discouraging. I think this career can be very fun. Very challenging and also rewarding in many ways, and I'm just a CA-2. I love it. I'd just make sure you know what it takes to do more than punch into a GI suite or surgicenter doing ASA 1's and 2's and minor surgery.

 

[MD Dreams]

So, probably in every class there's that person who can't seem to shake that deer in the headlights look. Sure, residency is an evolution. People grow and adapt all the time.

But, crazy things will happen, and not always anticipated. Things CAN go bad fast, and it requires action. Procedures are not just "fun", but usually they are necessary, and sometimes critical. You realize this when you need to do these things under very real pressure. Patients (if not GA), and others in the room may be freaking out, and in not-so subtle ways. Can you hold down the fort?

Can you act? Do you fumble f.ck around with procedures? I don't care about your board scores. Can you LEAD in a deteriorating situation?

The problem is that this field does require a certain "type". Too often, however, it's perceived as a lifestyle field where you can have slightly above average or average boards scores, do a 4 (not 5 or more) year residency, and make good money.

I would think twice about what it takes to be a good anesthesiologist. Make sure you are suited for this job. I've seen at least a few people shaken up by the stress of the training (not even the responsibility of an attending). I wonder if they chose (or even fully appreciated) the right field.

Too many people are going into this career that probably would be better doing IM and rounding all day on sick but not critically ill patients.

Not being discouraging. I think this career can be very fun. Very challenging and also rewarding in many ways, and I'm just a CA-2. I love it. I'd just make sure you know what it takes to do more than punch into a GI suite or surgicenter doing ASA 1's and 2's and minor surgery.

Couldn't agree more! That's why we're bad ***🙂

 

[DrBB]

So, probably in every class there's that person who can't seem to shake that deer in the headlights look. Sure, residency is an evolution. People grow and adapt all the time.

But, crazy things will happen, and not always anticipated. Things CAN go bad fast, and it requires action. Procedures are not just "fun", but usually they are necessary, and sometimes critical. You realize this when you need to do these things under very real pressure. Patients (if not GA), and others in the room may be freaking out, and in not-so subtle ways. Can you hold down the fort?

Can you act? Do you fumble f.ck around with procedures? I don't care about your board scores. Can you LEAD in a deteriorating situation?

The problem is that this field does require a certain "type". Too often, however, it's perceived as a lifestyle field where you can have slightly above average or average boards scores, do a 4 (not 5 or more) year residency, and make good money.

I would think twice about what it takes to be a good anesthesiologist. Make sure you are suited for this job. I've seen at least a few people shaken up by the stress of the training (not even the responsibility of an attending). I wonder if they chose (or even fully appreciated) the right field.

Too many people are going into this career that probably would be better doing IM and rounding all day on sick but not critically ill patients.

Not being discouraging. I think this career can be very fun. Very challenging and also rewarding in many ways, and I'm just a CA-2. I love it. I'd just make sure you know what it takes to do more than punch into a GI suite or surgicenter doing ASA 1's and 2's and minor surgery.

Interesting post. Although I agree that Anesthesiology is a stressful field - can't this stress become routine after doing it for a while? Regardless of personality, can't one adapt to the rigors and stress of day-to-day work? I feel like anesthesia is in a fairly controlled environment. On the other hand, when a patient in IM crashes, it's not as controlled (drugs are not always available instantly, intubation is not as automatic) and codes can sometimes be more stressful.

 

[gasblaster]

Interesting post. Although I agree that Anesthesiology is a stressful field - can't this stress become routine after doing it for a while? Regardless of personality, can't one adapt to the rigors and stress of day-to-day work? I feel like anesthesia is in a fairly controlled environment. On the other hand, when a patient in IM crashes, it's not as controlled (drugs are not always available instantly, intubation is not as automatic) and codes can sometimes be more stressful.

OP is not talking about the day-to-day stuff of being an anethesiologist. He's talking about the complex, sick patients that are becoming more and more commonplace.

Experience when things go bad in both fields and would definitely say that the OR is crazier. When things go south in the OR, it's completely different compared to the floors. When a patient codes on the floor, I would say it's actually more controlled environment. There are a plethora of people to help, resources at their disposal, it's very algorithm based, etc. In the OR, it's the anesthesiologist that runs the show on a patient that's opened up on the operating table. Not only do you have the patient's underlying medical problems, but you're throwing on top of that everything that encompasses the surgery.

 

[MD Dreams]

The stress does become more manageable with experience. However, it's the old nature and nurture argument. If you don't have the right personality for it you will not be able to handle the stress no matter how much experience you have. To be a good anesthesiologists you have to be aggressive, energetic, think and act quickly under great duress with limited information and be able to remain calm and in control when a pt is trying to die on you. You go from zero to a hundred miles per hour in seconds. When you get paged for something it's not to correct a potassium of 3, rather its because the pt is blue and they needed you there five minutes ago and no one knows how to bag the pt correctly much less intubate. Imagine that scenario in the middle of the night when you are dead asleep in your call room. If you don't get there quickly that pt will die! With regards to codes, most Pts don't do well on the floor in the first place. Also there have been several instances where I have helped intubate, secure a line, resuscitate, etc in a manner of minutes while the folks on the floor are freaking out🙂. I think to be a good anesthesiologists you almost have to have a surgical mentality and mindset. It really bothers me when folks come into anesthesia thinking its gonna be sitting around a surgicenter filling out cross word puzzles. It is much more than that and if you don't have the "right stuff" than please consider a more predictable, less stressful specialty. I LOVE anesthesia! I try to bring honor to my specialty every single day. I think the OP makes a good point in that people should enter the field with a true understanding of what it's all about. If I'm not mistaken the OP is a CA 2. That's about the time when you realize just how much responsibility the specialty demands. That's when you become humbled.

 

[urge]

I feel like anesthesia is in a fairly controlled environment. On the other hand, when a patient in IM crashes, it's not as controlled (drugs are not always available instantly, intubation is not as automatic) and codes can sometimes be more stressful.

Agreed. A code in Anesthesia is controlled chaos. A code in IM is just chaos.

The difference is that in anesthesia the patients have to end up well, no matter how sick they are. Everybody is watching, and scrutinizing you & your record. With electronic records every vital sign is charted. People look a those things second by second trying to point fingers at you.

In IM, the pt codes and you get to find out 5 min later if the pt is lucky. Sometimes you find out after the pt is in rigor mortis. No vitals signs to be found anywhere. If you bring the pt back then you are good. If he does't then he was too sick. The expectation is not there.

The need to be need to be perfect all the time, every time, cracks some people. It doesn't happen in IM or other fields.

 

[OB1🤙]

OP is not talking about the day-to-day stuff of being an anethesiologist. He's talking about the complex, sick patients that are becoming more and more commonplace.

Well, it's not just that, because you can see those coming and can prepare. The OP is talking about situations you DON'T see coming, because it's in those situations that the calm, cool, and collected separate themselves from the frantic wing-flappers.

Routine case, routine day, la la la la CRISIS. From zero to DEFCON 1 in a second. What you got, hotshot?

Some do well in those situations, and some don't. Some can see the Matrix like Neo, make the world slow down, do what has do be done, and do it in the right order.

Some run in circles and scream. Sometimes even literally.

 

[pgg]

Interesting post. Although I agree that Anesthesiology is a stressful field - can't this stress become routine after doing it for a while? Regardless of personality, can't one adapt to the rigors and stress of day-to-day work? I feel like anesthesia is in a fairly controlled environment. On the other hand, when a patient in IM crashes, it's not as controlled (drugs are not always available instantly, intubation is not as automatic) and codes can sometimes be more stressful.

The stress does become routine, manageable, and part of you, so in a word, yes to what you wrote.

And here's why - there are lots of differences between OR crashes and IM crashes.

The biggest difference between the SHTF in the OR and on the ward, is that in the OR there are people there to see the S H'ing TF and the cause is usually obviously evident (sometimes the people ARE the cause). Whereas on the ward, people notice there is S all over the floor well after it has HTF, and often there's no obvious reason why.

Then there's the difference between having all the right people present and actively engaged in something they do every day (the OR), and a housekeeper calling for help and whoever shows up, shows up (the ward).


Another thing that factors into this is the fact that ACLS tend to be gospel on the ward, but just guidelines in the OR. ACLS guidelines were developed mostly with data from unwitnessed cardiac arrests ... artery clogs, dysrhythmia strikes, cardiac arrest. The algorithm makes the most sense for these patients - drugs to improve coronary perfusion, chest compressions to circulate blood, electricity for the arrythmia. Codes in the OR are usually iatrogenic airway issues and hypoxic arrests. Or hypovolemia. Or the surgeon's fault. When the cause is obvious, as it usually is in the OR, the right thing to do is fix the cause first, not go down the ACLS list.

So mishaps in the OR are fundamentally different events, with different people, and (usually) different outcomes compared to IM mishaps. Trying to make comparisons of stress levels between the two is kind of futile because everything is so different.


Panic/deer-in-headlights/code-stress comes from confusion, not having a grip on what has happened, not knowing what to do. IM codes are usually a 'figure out what happened' circus with a backdrop of ACLS. The reason OR codes are so controlled is because (usually) everyone knows exactly what happened, exactly when it happened, and exactly what to do. Urge had it right

A code in Anesthesia is controlled chaos. A code in IM is just chaos.

I find that the stress from anesthesia stems from the constant vigilance needed. From the focus and awareness of what's happening all the time, and the active thinking about what might go wrong and what you're going to do about it when it does.

Actually handling a crisis is certainly busy and intense, but the stress and success lie in what led up to it.

My perception, anyway.

 

[Guillemot]

Ive seen a lot of stupid **** go down in the hospital because of authoritative decisions made by confident people

I dont give a damn if you can lead a deteriorating situation. Can you lead it in the right direction?

Confidence and leadership ability dont mean **** if you dont know what the **** you are doing.

Not targeting anyone in particular, but Ive seen too much stupid **** happen already even as a medical student.

 

[HollywdAnesth]

Ive seen a lot of stupid **** go down in the hospital because of authoritative decisions made by confident people

Not targeting anyone in particular, but Ive seen too much stupid **** happen already even as a medical student.

You haven't seen alot of anything. You're a medical student. Its really easy to call out someone for being stupid when you're the low man on the totem pole. You have little to no responsibility. Nobody is going to die or be injured if you don't do your Guiacs.

Just wait a few years. You'll be making decisions without a safety net that affect people's lives and well being. We'll see if you throw insults out as liberally as you do here.

 

[Guillemot]

You haven't seen alot of anything. You're a medical student. Its really easy to call out someone for being stupid when you're the low man on the totem pole. You have little to no responsibility. Nobody is going to die or be injured if you don't do your Guiacs.

Just wait a few years. You'll be making decisions without a safety net that affect people's lives and well being. We'll see if you throw insults out as liberally as you do here.

Most certainly I will have the same attitude in a few years. No exceptions. I guess you couldn't tell since this is the internet and what not, but I made my statement in a confident fashion. I looked you straight in the eye with a smile on my face and told you exactly what I had seen. Therefore I am right. That is what this thread is all about.

 

[periopdoc]

I have never known as much, or been as certain of my knowledge, as I did/was in the last half of 3rd year and the first half of 4th year of medical school.

- pod

 

[periopdoc]

BTW good on you for being the cocky, med student who isn't willing to just sit around looking at areas that you believe need improving without saying something. Reminds me of a post I made at a time that seems an eternity ago. See the bolded part.

It's 2300 on a call night at a slow hospital and I am thinking back over the last few years about the different events and patients who stick in my mind.

I remember walking into this place, a little cocky, thinking how superior I felt to the CA-2 I worked with when I was on my MS-4 on my anesthesia elective. Could she really have forgotten all of this important stuff? I didn't even have a clue that I didn't have a clue.

My first day in the OR, my attending was the chairman of the department. He was close to retirement and I thought, "this old boy probably will be impressed if I try to do things the old fashioned way." I learned quickly that I didn't have a clue.

I will never forget the 3-year-old I cared for in the PICU. His mother couldn't stand for joint custody and so shot him through the head and then killed herself. It was hopeless, but we tried everything. It was my responsibility to consent the estranged dad for organ donation. That was the hardest thing I have ever had to do in my life. My son is 3-years-old.

I will never forget the 14-year-old with a low grade lung tumor. She was so scared, but her parents were even more scared. Never underestimate the value of a professional appearance and demeanor. I bet I had no more than 10 seconds to secure the trust of this family and I wonder how the interaction would have been with one of the more slovenly appearing providers. The thoracic epidural went in like butter and she did so well post-op. The parents were so thankful.

I will never forget the benign trauma patient I induced as a CA-1. We would later figure out that right about the time of induction he threw a PE that occluded a large portion of his left pulmonary circulation and, with the initiation of positive pressure ventilation, he developed a tension pneumothorax on the right. My world was going to s*** and my attending was already 2 floors up at an emergency intubation. Turns out, having a good clinical intuition and the balls to do something about it IS worth something. A 14-gauge angiocath to the right chest stabilized this guy just enough to get an x-ray and then get the surgeons in to put in a chest tube. Everyone else in the OR was standing around waiting for me. They didn't have a clue. A week later, I uneventfully anesthetized him for his ORIF. I was just starting to get a clue.

I started working regularly with one of the ortho attendings part way through CA-1 year. After a month or so he asked me what I was going to do next year after I graduate. I meekly informed him that I was not a CA-3. He still can't get over the fact that I am still in training. Don't ever forget that surgeons, nurses, techs, and janitors do note your professionalism and appearance.

I stayed late a couple of times to help out one of the residents who just wasn't quite getting it on their PACU rotation. It was only a few hours out of my life, but the attendings were astounded that I would take the initiative to help out like that. These attendings have since made sure to open doors for me. Professionalism pays off.

I won't forget the mistakes. Every one of them is still staring me in the face. I am a little pathological like that. It drives me to do it better next time.

The only time I couldn't intubate/ ventilate and we had to trach her. I will never forget the look in her eyes as she went to sleep. She trusted me, that I would take care of her. Nor will I forget my attending turning to the surgeon and saying, "Do the trach, I don't need to look. If he doesn't see it, neither will I." It was a huge vote of confidence from one of the attendings that I truly respect.

The high spinal I had on my first OB call night. I will never forget the patient looking at me and mouthing the words, "INTUBATE ME" because she didn't have the ability to phonate anymore.

The only time I froze in the OR. My wife paged me with a 911 when I was about 10 min into a c-section. My 2-year old had gotten a hold of my wife's peanut-buttered toast. He was having trouble breathing. We didn't know that he is deathly allergic to peanuts. I knew the paramedics were only 5 blocks away and would bring him to the hospital I was working in, but I wanted to go jump in the car so badly. I could have stayed in the OR. I was doing all the right things. My attending was standing on the other side of the OR watching and didn't realize that anything was amiss with me. However, I asked him to step in and take over. I just didn't feel I could give her my best job with the distraction. I made the right judgement, but I wish I had more control of myself.

I am still learning.

I won't forget the CA-1 who made it just a short time before succumbing to the pressures of the job. I worked with him his first week and man was I ever worried about him. It turns out, I had good reason to be worried about him.

I won't forget the medical students, bright, knowledgeable, but without a clue. They will know soon enough. At times I am overworked and overtired. Even if they can't see that and they think, "man how can he have forgotten all this important stuff," I like having them around. It reminds me of the spunk I once had.

There are a lot more patients, more stories, but I won't bore you with them.
I am at the end of a long road and the beginning of another. Four plus years of college, four years of med school, four years of residency. It has cost so much and it may cost me even more if recent personal events bear out.

No I haven't always acted professionally, and yes once in a while I have not projected the best professional image. But the further along I get, the more important Professionalism is to me. It isn't just about fundamental knowledge and fundamental skills. And I am not talking about the touchy-feely professionalism bs that is going around lately.

If this change was brought about in a few short years. I can only imagine what I will feel like five years into practice. I suspect I will be looking back saying, "Yeah I was just starting to get a clue."

-pod

- pod

 

[soonerfrog]

Props to POD!!!!!! In roughly 7 years of following SDN, this remains unequivocally and undeniably the best piece of advice and anecdotal wisdom I've had the pleasure to read. Well written and spot on. Thank you.

 

[okayplayer]

Agreed. What a brilliant post. Proud to follow in your footsteps out here.

 

[Random Anesthesiologist]

So, probably in every class there's that person who can't seem to shake that deer in the headlights look. Sure, residency is an evolution. People grow and adapt all the time.

But, crazy things will happen, and not always anticipated. Things CAN go bad fast, and it requires action. Procedures are not just "fun", but usually they are necessary, and sometimes critical. You realize this when you need to do these things under very real pressure. Patients (if not GA), and others in the room may be freaking out, and in not-so subtle ways. Can you hold down the fort?

Can you act? Do you fumble f.ck around with procedures? I don't care about your board scores. Can you LEAD in a deteriorating situation?

The problem is that this field does require a certain "type". Too often, however, it's perceived as a lifestyle field where you can have slightly above average or average boards scores, do a 4 (not 5 or more) year residency, and make good money.

I would think twice about what it takes to be a good anesthesiologist. Make sure you are suited for this job. I've seen at least a few people shaken up by the stress of the training (not even the responsibility of an attending). I wonder if they chose (or even fully appreciated) the right field.

Too many people are going into this career that probably would be better doing IM and rounding all day on sick but not critically ill patients.

Not being discouraging. I think this career can be very fun. Very challenging and also rewarding in many ways, and I'm just a CA-2. I love it. I'd just make sure you know what it takes to do more than punch into a GI suite or surgicenter doing ASA 1's and 2's and minor surgery.

We did a lot of hearts this week during my elective, and there were definitely some pucker moments. Knowing my place and flowing with the OR team helped solidify my decision to become an anesthesiologist. I may not be the 240+ Step 1 stud during interview, but I'm going to work my ass off and make your program look great from a clinical POV, dear residency directors 🙂

 

[Osteoimperfecta]

..

 

[okayplayer]

By the way, am I the only one who is intensely bothered that the subject doesn't say "tepid"?

Edit: apparently trepid is also a word. I'm an idiot.

 

[IDBasco]

By the way, am I the only one who is intensely bothered that the subject doesn't say "tepid"?

Edit: apparently trepid is also a word. I'm an idiot.

I thought the same thing at first.

 

[bala1]

So, probably in every class there's that person who can't seem to shake that deer in the headlights look. Sure, residency is an evolution. People grow and adapt all the time.

But, crazy things will happen, and not always anticipated. Things CAN go bad fast, and it requires action. Procedures are not just "fun", but usually they are necessary, and sometimes critical. You realize this when you need to do these things under very real pressure. Patients (if not GA), and others in the room may be freaking out, and in not-so subtle ways. Can you hold down the fort?

Can you act? Do you fumble f.ck around with procedures? I don't care about your board scores. Can you LEAD in a deteriorating situation?

The problem is that this field does require a certain "type". Too often, however, it's perceived as a lifestyle field where you can have slightly above average or average boards scores, do a 4 (not 5 or more) year residency, and make good money.

I would think twice about what it takes to be a good anesthesiologist. Make sure you are suited for this job. I've seen at least a few people shaken up by the stress of the training (not even the responsibility of an attending). I wonder if they chose (or even fully appreciated) the right field.

Too many people are going into this career that probably would be better doing IM and rounding all day on sick but not critically ill patients.

Not being discouraging. I think this career can be very fun. Very challenging and also rewarding in many ways, and I'm just a CA-2. I love it. I'd just make sure you know what it takes to do more than punch into a GI suite or surgicenter doing ASA 1's and 2's and minor surgery.

great post!!!

 

[herkyMD]

This thread has further made me believe that anesthesiology is the right fit for me. also, awesome post by pod. Thank you.

 

[gasp]

Someone mentioned the difference between the floor and OR when **** hits the fan is chaos vs. controlled chaos. However, theres something to be said about this situation that most people don't think of unless they are in the field. In my opinion, controlled chaos is more stressful than chaos alone. WHY?
Because when someone codes on the floor and you get there, sure there's a bunch of stuff going on but the pt (usually sick) coded and you are there to help however you can. In the OR, even though its controlled, the Pt was just talking to you a couple minutes ago trusting their life with you and now you are unable to intubate/ventilate/whatever situation.. etc which is more stressful since you are the one that put them to sleep and promised to take care of them. Both of these patients will get your full undivided attention to bring them back to life but the latter is more stressful. Also, I believe that more people going into anesthesiology these days are that "type" the op was talking about than people who have gone into the field in the previous years.

 

[45408]

Experience when things go bad in both fields and would definitely say that the OR is crazier. When things go south in the OR, it's completely different compared to the floors. When a patient codes on the floor, I would say it's actually more controlled environment. There are a plethora of people to help, resources at their disposal, it's very algorithm based, etc. In the OR, it's the anesthesiologist that runs the show on a patient that's opened up on the operating table. Not only do you have the patient's underlying medical problems, but you're throwing on top of that everything that encompasses the surgery.

Disagree. It can be a 3-ring circus showing up to those. I agree that there's more help, but more != better. I'd much rather have a patient code in the OR with an anesthesiologist there (and another 1-2 of them immediately available most times).

I absolutely believe you that it is higher stress having an OR code than a floor code, because if the patient dies, all eyes will be on the anesthesiologist. Sometimes a floor patient dies, and it goes in the "Well, it happens" category. As long as a worrisome trend in their vitals wasn't being ignored or a nurse hadn't stopped by since the last shift, then c'est la vie. It's often not our fault the patient died.

Now, if someone dies in the OR, it either is or will feel like someone's fault - surgery/anesthesia/both.

By the way, am I the only one who is intensely bothered that the subject doesn't say "tepid"?

Edit: apparently trepid is also a word. I'm an idiot.

lol, I made sure to Google it before I said anything.

 

[gasflea]

Great post pod!

I must say as an IM R3 I mildly resent the comments about IM codes... But then I am doing CA1 next year, so my attitude towards codes and procedures may be a little different from IM residents in general.

I am expecting that OR codes will be more difficult because, as some have said, there is much for the anesthesiologist to DO. As an internist, I get to stand at the foot of the bed - giving orders, thinking, listening, directing action. It feels much more relaxed than I think it will when I have to do all these things AND manage airway/push drugs/etc. Am I right here?

 

[Sonny Crocket]

OP is not talking about the day-to-day stuff of being an anethesiologist. He's talking about the complex, sick patients that are becoming more and more commonplace.

Experience when things go bad in both fields and would definitely say that the OR is crazier. When things go south in the OR, it's completely different compared to the floors. When a patient codes on the floor, I would say it's actually more controlled environment. There are a plethora of people to help, resources at their disposal, it's very algorithm based, etc. In the OR, it's the anesthesiologist that runs the show on a patient that's opened up on the operating table. Not only do you have the patient's underlying medical problems, but you're throwing on top of that everything that encompasses the surgery.

It can be the healthy patients that are the most stressful. The sick patients are of course challenging but these are the patients that have been trashing their bodies for years and now it's your problem. What a healthy patient begins to do to deteriorate, that to me is the most stressful thing in anesthesia. I think it's what puts a lot of people off of doing pediatric anesthesiology.

 

[Laryngophed]

BTW good on you for being the cocky, med student who isn't willing to just sit around looking at areas that you believe need improving without saying something. Reminds me of a post I made at a time that seems an eternity ago. See the bolded part.

It's 2300 on a call night at a slow hospital and I am thinking back over the last few years about the different events and patients who stick in my mind.

I remember walking into this place, a little cocky, thinking how superior I felt to the CA-2 I worked with when I was on my MS-4 on my anesthesia elective. Could she really have forgotten all of this important stuff? I didn't even have a clue that I didn't have a clue.

My first day in the OR, my attending was the chairman of the department. He was close to retirement and I thought, "this old boy probably will be impressed if I try to do things the old fashioned way." I learned quickly that I didn't have a clue.

I will never forget the 3-year-old I cared for in the PICU. His mother couldn't stand for joint custody and so shot him through the head and then killed herself. It was hopeless, but we tried everything. It was my responsibility to consent the estranged dad for organ donation. That was the hardest thing I have ever had to do in my life. My son is 3-years-old.

I will never forget the 14-year-old with a low grade lung tumor. She was so scared, but her parents were even more scared. Never underestimate the value of a professional appearance and demeanor. I bet I had no more than 10 seconds to secure the trust of this family and I wonder how the interaction would have been with one of the more slovenly appearing providers. The thoracic epidural went in like butter and she did so well post-op. The parents were so thankful.

I will never forget the benign trauma patient I induced as a CA-1. We would later figure out that right about the time of induction he threw a PE that occluded a large portion of his left pulmonary circulation and, with the initiation of positive pressure ventilation, he developed a tension pneumothorax on the right. My world was going to s*** and my attending was already 2 floors up at an emergency intubation. Turns out, having a good clinical intuition and the balls to do something about it IS worth something. A 14-gauge angiocath to the right chest stabilized this guy just enough to get an x-ray and then get the surgeons in to put in a chest tube. Everyone else in the OR was standing around waiting for me. They didn't have a clue. A week later, I uneventfully anesthetized him for his ORIF. I was just starting to get a clue.

I started working regularly with one of the ortho attendings part way through CA-1 year. After a month or so he asked me what I was going to do next year after I graduate. I meekly informed him that I was not a CA-3. He still can't get over the fact that I am still in training. Don't ever forget that surgeons, nurses, techs, and janitors do note your professionalism and appearance.

I stayed late a couple of times to help out one of the residents who just wasn't quite getting it on their PACU rotation. It was only a few hours out of my life, but the attendings were astounded that I would take the initiative to help out like that. These attendings have since made sure to open doors for me. Professionalism pays off.

I won't forget the mistakes. Every one of them is still staring me in the face. I am a little pathological like that. It drives me to do it better next time.

The only time I couldn't intubate/ ventilate and we had to trach her. I will never forget the look in her eyes as she went to sleep. She trusted me, that I would take care of her. Nor will I forget my attending turning to the surgeon and saying, "Do the trach, I don't need to look. If he doesn't see it, neither will I." It was a huge vote of confidence from one of the attendings that I truly respect.

The high spinal I had on my first OB call night. I will never forget the patient looking at me and mouthing the words, "INTUBATE ME" because she didn't have the ability to phonate anymore.

The only time I froze in the OR. My wife paged me with a 911 when I was about 10 min into a c-section. My 2-year old had gotten a hold of my wife's peanut-buttered toast. He was having trouble breathing. We didn't know that he is deathly allergic to peanuts. I knew the paramedics were only 5 blocks away and would bring him to the hospital I was working in, but I wanted to go jump in the car so badly. I could have stayed in the OR. I was doing all the right things. My attending was standing on the other side of the OR watching and didn't realize that anything was amiss with me. However, I asked him to step in and take over. I just didn't feel I could give her my best job with the distraction. I made the right judgement, but I wish I had more control of myself.

I am still learning.

I won't forget the CA-1 who made it just a short time before succumbing to the pressures of the job. I worked with him his first week and man was I ever worried about him. It turns out, I had good reason to be worried about him.

I won't forget the medical students, bright, knowledgeable, but without a clue. They will know soon enough. At times I am overworked and overtired. Even if they can't see that and they think, "man how can he have forgotten all this important stuff," I like having them around. It reminds me of the spunk I once had.

There are a lot more patients, more stories, but I won't bore you with them.
I am at the end of a long road and the beginning of another. Four plus years of college, four years of med school, four years of residency. It has cost so much and it may cost me even more if recent personal events bear out.

No I haven't always acted professionally, and yes once in a while I have not projected the best professional image. But the further along I get, the more important Professionalism is to me. It isn't just about fundamental knowledge and fundamental skills. And I am not talking about the touchy-feely professionalism bs that is going around lately.

If this change was brought about in a few short years. I can only imagine what I will feel like five years into practice. I suspect I will be looking back saying, "Yeah I was just starting to get a clue."

-pod

- pod

Note to self.

 

[Laryngophed]

Note to self.

Huh, I suppose I couldn't think of a better 1000th post.

 

[Gern Blansten]

Most certainly I will have the same attitude in a few years. No exceptions. I guess you couldn't tell since this is the internet and what not, but I made my statement in a confident fashion. I looked you straight in the eye with a smile on my face and told you exactly what I had seen. Therefore I am right. That is what this thread is all about.

I'm not sure I follow your thinking here. Are you saying you will never make the mistakes that you have seen others make?

 

[DreamMachine]

It's not just pent sux tube coffee trade stocks?

 

[gasp]

The only time I couldn't intubate/ ventilate and we had to trach her. I will never forget the look in her eyes as she went to sleep. She trusted me, that I would take care of her. Nor will I forget my attending turning to the surgeon and saying, "Do the trach, I don't need to look. If he doesn't see it, neither will I." It was a huge vote of confidence from one of the attendings that I truly respect.


-pod

Hmm, I wonder if he was a CA-1 when this happened. Ballsy move by the attending, although very cool.

 

[Gern Blansten]

Hmm, I wonder if he was a CA-1 when this happened. Ballsy move by the attending, although very cool.

I had an attending that did that once for me as well, although, we went to a fiberoptic, not a trach, because the patient was more stable. Not quite the same vote of confidence, but it made me feel good at the time.

 

[ketap]

great post! i think anesthesia is not that "simple". u need to have a "planner" attitude and besides leading in deteriorate petients, you should be able to make a good interpersonal relationship..i think taht is what makes someone a great anesthesiologist..thx🙂

 

[chomskytool]

long time lurker. im a internist by training.
when i meet med students who always tell me they want to go into anesthesiology for the life style and money. i kind of laugh. i always explain to them its true you may have alot of downtime with easy cases, but the whole point of your training is to be ready when the **** hits the fan.

i really cant think of another field where you can go from a completely stable patient one moment to absolutely the most terryifying clinical scenario in the next. thats why what you guys do is not easy, and another reason that CRNAs cant do your job.

kudos to my gas brethren. 🙂

 

[Gern Blansten]

long time lurker. im a internist by training.
when i meet med students who always tell me they want to go into anesthesiology for the life style and money. i kind of laugh. i always explain to them its true you may have alot of downtime with easy cases, but the whole point of your training is to be ready when the **** hits the fan.

i really cant think of another field where you can go from a completely stable patient one moment to absolutely the most terryifying clinical scenario in the next. thats why what you guys do is not easy, and another reason that CRNAs cant do your job.

kudos to my gas brethren. 🙂

Awesome. Thanks. We, likewise, have respect for the internists. Some of the brightest people I have met.