As a CA-1

[GassiusClay]

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I'm sure its too early to b#tch about how anesthesia is treating me so far since I can say most days are pretty good (6-6) with free weekends.

However, I'm finding the catering business to be a little annoying. Last year, I catered to patient's unreasonable demands. Now, it's dumb***** surgeons telling me the patient is not relaxed when clearly 0/4 twitches, ETCO2 waveform doesn't show anything suspicious, and I gave 10 of vec like 10 minutes ago during the induction period. Then I give a placebo. Let me give 2 more. Blatantly not. And suddenly the patients relaxed 3 minutes later. I think this pisshole just does it on purpose because he sucks at putting trocars in and resistance = not relaxed.

This catering to surgeons who are stupid is starting to get annoying. I know when I joined the anesthesia club, that I wouldn't get credit for a lot of stuff like thanks for fixing me up doc, but I'm SORT of okay with that. I don't demand that. I however demand that I am treated like a peer when you take 3 hours to do the case and not listen to stupid talk about your mediocre understanding of physiology. It's not just fluids.

Sure prelim medicine was Q4 with social support issues, but I felt like I had equal input maybe since most of attendings at the private hospital knew less than me. And the CRNA issue doesn't help because I don't want to be b#tch just to be one of them 4 years down the road.

I read the BOW YOUR HEAD thread, and found some inspiration. What about the rest of you CA-1s? And CA-3s? And attendings?

Then again, I can't see a place in medicine that offers any degree of real independence. Anybody up for starting a small business 🙄?

 

[coprolalia]

However, I'm finding the catering business to be a little annoying.

Get. Out. Now.

-copro

 

[9french]

I'm sure its too early to b#tch about how anesthesia is treating me so far since I can say most days are pretty good (6-6) with free weekends.

However, I'm finding the catering business to be a little annoying. Last year, I catered to patient's unreasonable demands. Now, it's dumb***** surgeons telling me the patient is not relaxed when clearly 0/4 twitches, ETCO2 waveform doesn't show anything suspicious, and I gave 10 of vec like 10 minutes ago during the induction period. Then I give a placebo. Let me give 2 more. Blatantly not. And suddenly the patients relaxed 3 minutes later. I think this pisshole just does it on purpose because he sucks at putting trocars in and resistance = not relaxed.

This catering to surgeons who are stupid is starting to get annoying. I know when I joined the anesthesia club, that I wouldn't get credit for a lot of stuff like thanks for fixing me up doc, but I'm SORT of okay with that. I don't demand that. I however demand that I am treated like a peer when you take 3 hours to do the case and not listen to stupid talk about your mediocre understanding of physiology. It's not just fluids.

Sure prelim medicine was Q4 with social support issues, but I felt like I had equal input maybe since most of attendings at the private hospital knew less than me. And the CRNA issue doesn't help because I don't want to be b#tch just to be one of them 4 years down the road.

I read the BOW YOUR HEAD thread, and found some inspiration. What about the rest of you CA-1s? And CA-3s? And attendings?

Then again, I can't see a place in medicine that offers any degree of real independence. Anybody up for starting a small business 🙄?

It takes a while to earn respect. As a CA-3, you will find that you have more respect then you have now. Once out in the real world, you will have to earn that respect once again. If you are sharp, hard-working, and competent, you will be treated as a peer by most surgeons (Even in the real world there is the occassional surgeon who thinks you are only there to be his servent.)

 

[dannyboy]

I'm also a newly minted CA-1. However, prior to switching to anesthesia, I was a general surgery resident, until I discovered my true passion in medicine. The truth is, most surgeons like to think they're in control in the OR... or pretty much anywhere for that matter. But in reality, when sh** hits the fan, you as the anesthesiologist are really in control. Let them play their games and inflate their egos. But when things go south, they'll have to look to you. Most of the time, they're talking out of their a** when they want more paralysis. And you're right, I think they displace their own inability to operate and make it seem like it's your fault. I know because I was there. Inserting trocars doesn't take relaxation. Closing fascia can be achieved with a bit more propofol... or a good epidural. We'll change the face of anesthesia over time.

I don't mind it when surgeons think they can push me around. When it comes down to it, no matter how much they complain or pout, they can't make me do what i'm doing any faster. It initially annoyed me when the whole surgical team would be hovering during induction & intubation. Once the tube was in, they'd get all anxious to start positioning and prepping, even though sometimes all we'd have is a krappy 22g PIV and there would be more lines to place and Alines to do, etc. It used to bother me that they'd get all uppity about my taking the time to do all this. But I've come to realize that no matter how much they complain, there's absolutely nothing they can do to make it go any faster. Besides, at the end of the day, you go home... and they're still stuck there.

 

[huktonfonix]

I don't mind it when surgeons think they can push me around. When it comes down to it, no matter how much they complain or pout, they can't make me do what i'm doing any faster. It initially annoyed me when the whole surgical team would be hovering during induction & intubation. Once the tube was in, they'd get all anxious to start positioning and prepping, even though sometimes all we'd have is a krappy 22g PIV and there would be more lines to place and Alines to do, etc. It used to bother me that they'd get all uppity about my taking the time to do all this. But I've come to realize that no matter how much they complain, there's absolutely nothing they can do to make it go any faster. Besides, at the end of the day, you go home... and they're still stuck there.

That may be true. however, as it has been alluded to earlier, efficiency is important. After intubation a lot of the other work (aline, extra PIV) can be done concurrently or after they are prepped and draped. No need to hold up the surgery, unless its something you feel is urgently needed in which case it can be done preinduction.

 

[GassiusClay]

Get. Out. Now.

-copro

If I should get out, then what should I go for in medicine? Anything minus derm that wouldn't place me in such a position.

 

[lotsapain]

Well as someone mentioned it takes time to earn respect from surgeons.. All cief residents and most general and even ENT surgeons talk to me with respect but I earned it through saving a number of their patients.... ORthopds are a different lot of mostly dumba***es... who are mo carenters then anything else.... and I have been a surgery intern myself, and at that time did not pay attention to anesthesia yet never belittled anyone.....

Sadly the less skill the surgeon has the more bitching they do... also in NY/NJ area thre are more a**holes per square foor then aywhere else in the world so I am somewhat used to it.... while you should be able to tolerate surgeons to some respect what upsets me is hte nursing care or the lack thereof... not so much from OR nurses but from PACU/ICU staff, now THAT is a problem you should be concerned with.

 

[Mista Suprane]

Now, it's dumb***** surgeons telling me the patient is not relaxed when clearly 0/4 twitches, ETCO2 waveform doesn't show anything suspicious, and I gave 10 of vec like 10 minutes ago during the induction period. Then I give a placebo. Let me give 2 more. Blatantly not. And suddenly the patients relaxed 3 minutes later. I think this pisshole just does it on purpose

i hate this. happens at least once or twice a week.

how do you those of you that are further along than us lowly CA-1s handle this?

 

[periopdoc]

i hate this. happens at least once or twice a week.

how do you those of you that are further along than us lowly CA-1s handle this?

Pick your battles. When a surgeon asks for more relaxation don't tell them there are no twitches or tell them you dosed 5 minutes ago. They don't have a clue how to interpret twitches or a clue about the pharmacology of paralytics. Just say, "Yes sir/ ma'am I will get the patient fully relaxed for you right away." Shuffle a few syringes and open and close a couple of doors. They will think you did something to help them out.

Now if they are working in the belly and say they can see the diaphragm contracting, listen to them. I can't tell you how many times I have been convinced that the patient is fully relaxed (no twitches or curare notching) only to look at the diaphragm and see it contracting away like crazy. It really is true that the diaphragm is much more resistant to paralysis than other muscles. This doesn't mean you have to give them more paralytics, just get the diaphragm to stop contracting. Increase ventilation, give some opiates etc.


Save your heartburn and arguments for things that really matter. If you have proven yourself to be a helpful team player, and not a snotty know it all CA-1, they will be more likely to listen to you when you say hey dude I am very concerned about this patient and I think you should close now and stage the procedure.

If you can't swallow your pride like this when the time is right, you may want to consider whether anesthesia really is the correct specialty for you. If you really have to ALWAYS be right, you may want to consider a surgical career.


pod

 

[pd4emergence]

I'm sure its too early to b#tch about how anesthesia is treating me so far since I can say most days are pretty good (6-6) with free weekends.

However, I'm finding the catering business to be a little annoying. Last year, I catered to patient's unreasonable demands. Now, it's dumb***** surgeons telling me the patient is not relaxed when clearly 0/4 twitches, ETCO2 waveform doesn't show anything suspicious, and I gave 10 of vec like 10 minutes ago during the induction period. Then I give a placebo. Let me give 2 more. Blatantly not. And suddenly the patients relaxed 3 minutes later. I think this pisshole just does it on purpose because he sucks at putting trocars in and resistance = not relaxed.

This catering to surgeons who are stupid is starting to get annoying. I know when I joined the anesthesia club, that I wouldn't get credit for a lot of stuff like thanks for fixing me up doc, but I'm SORT of okay with that. I don't demand that. I however demand that I am treated like a peer when you take 3 hours to do the case and not listen to stupid talk about your mediocre understanding of physiology. It's not just fluids.

Sure prelim medicine was Q4 with social support issues, but I felt like I had equal input maybe since most of attendings at the private hospital knew less than me. And the CRNA issue doesn't help because I don't want to be b#tch just to be one of them 4 years down the road.

I read the BOW YOUR HEAD thread, and found some inspiration. What about the rest of you CA-1s? And CA-3s? And attendings?

Then again, I can't see a place in medicine that offers any degree of real independence. Anybody up for starting a small business 🙄?

There is a point where most everbody in anesthesiology feels this way. I could have written an identical post a few years ago. The fact is these issues don't go away. We are caterers of sorts. Throughout your career there will be issues with surgeons. It's how you deal with these issues that determines how happy you will be in your career in anesthesiology. Does it really matter that a surgeon that you will only be working with for the next 2-3 years is a dumba**? You will have a long career. You will work with alot of different surgeons, some will be good, some will not be, some will be easy to work with and some not. The fact is these surgeons have brought these patients to you. We do have a symbiotic relationship with them. As has been said before, fight the battles that are worth fighting. Most of those battles center around patient safety issues. Those are the battles you will win. Most of the other battles you will not win. If they think the patient is not relaxed, and you know they are just act like you gave something. If a surgeon routinely does this draw up some saline, give it to the patient when they ask, and tell them it will get better in a minute or two. Remember there are alot of aspects in anesthesiology that make it attractive, but there are drawbacks. However, everything has drawbacks. Keep in mind the reasons why you went into anesthesiology in the first place. Keep in mind that residency doesn't last forever. Try not to let the little things get to you. Good luck.

 

[Idiopathic]

i find myself saying "okay" quite a bit to comments like that. its vague enough that people know you head them, and assume you are in charge of the situation

 

[loveumms]

I just love it when the surgeon ASKS if the patient is paralyzed. To me that means they actually have no idea and are struggling with whatever operation they are doing. I usually just say yes and see what the response is. Most of the time it's "OK". The end. On the few occasions where the surgeon insists they are not paralyzed enough, yet I think that they are, I just give them a little bit more ... they have no idea that 0.5mg of roc isn't a full dose.

 

[pgg]

Try not to let the little things get to you. Good luck.

Today's "little things" for me came at the end of a ventral hernia repair.

The surgery is done. Skin closed. The staples are in. I'm waking up the patient as they're reaching for the dressing. The surgeon decides he doesn't like the staples and without a word removes them and screws around in the wound for a bit. Naturally, the patient doesn't like this, because she's waking up. She bucks, the surgeon tells me the patient's awake (golly, really?) and thanks me for testing his repair so soon.

I knock her back down with some propofol, he restaples her, and as I'm waking her up the second time, I say her name. He sternly says "Don't calls my patient by her first name unless you're sleeping with her."

I bowed my head and did not stab the guy with the stick of succ drawn up and laying on my cart, even though I swear it was beckoning me, asking that its 16-gauge pointy end be thrust into his body. Jet would be proud.

 

[bananamed]

I knock her back down with some propofol, he restaples her, and as I'm waking her up the second time, I say her name. He sternly says "Don't calls my patient by her first name unless you're sleeping with her."

Are you serious??

I'd snap.

 

[pgg]

Are you serious??

100%

I'd snap.

The last time I shrugged off the meek persona and stood up to an abusively inappropriate attending surgeon it bought me painful, tedious, and distracting talks with my anesthesiology attending that day, the program director at the hospital I was rotating through, and my program director back home.

It doesn't matter if you're right and they're wrong. It doesn't matter if the surgeon is a known screamer, troublemaker, instrument thrower. It even doesn't matter if the surgeon's hackery leaves the patient bound for a rehab facility instead of home. Some battles can't be won by residents. 🙁

 

[andwhat]

I'm sure its too early to b#tch about how anesthesia is treating me so far since I can say most days are pretty good (6-6) with free weekends.

However, I'm finding the catering business to be a little annoying. Last year, I catered to patient's unreasonable demands. Now, it's dumb***** surgeons telling me the patient is not relaxed when clearly 0/4 twitches, ETCO2 waveform doesn't show anything suspicious, and I gave 10 of vec like 10 minutes ago during the induction period. Then I give a placebo. Let me give 2 more. Blatantly not. And suddenly the patients relaxed 3 minutes later. I think this pisshole just does it on purpose because he sucks at putting trocars in and resistance = not relaxed.

This catering to surgeons who are stupid is starting to get annoying. I know when I joined the anesthesia club, that I wouldn't get credit for a lot of stuff like thanks for fixing me up doc, but I'm SORT of okay with that. I don't demand that. I however demand that I am treated like a peer when you take 3 hours to do the case and not listen to stupid talk about your mediocre understanding of physiology. It's not just fluids.

Sure prelim medicine was Q4 with social support issues, but I felt like I had equal input maybe since most of attendings at the private hospital knew less than me. And the CRNA issue doesn't help because I don't want to be b#tch just to be one of them 4 years down the road.

I read the BOW YOUR HEAD thread, and found some inspiration. What about the rest of you CA-1s? And CA-3s? And attendings?

Then again, I can't see a place in medicine that offers any degree of real independence. Anybody up for starting a small business 🙄?

Ummm maybe change careers?

 

[Bertelman]

i find myself saying "okay" quite a bit to comments like that. its vague enough that people know you head them, and assume you are in charge of the situation

I say the same thing. Then 2 minutes later I ask if it's better, after reaching for the gas dial or some such nonsense. By then they've been floor-paged for some critical lab value, or the next admission.

Sometimes surgeons just want to be acknowledged.