Freaked out by an OR case

[LemonLime]

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I am a new surgical prelim who recently saw a simple OR case go sour from an anesthesia point of view. I am starting my anesthesiology residency next year and was a bit stressed by what I saw. I understand that we have alot to learn, hence the 3 years of residency, however, does this sense of doom ever go away even when you are done with residency? Do you feel as though you are able to deal with whatever comes your way and know how to handle situations in a calm manner or is life during work pretty stressful on a daily basis?
I have not seen a case this bad during medical school and it definitely made me wonder if I was cut out for this job. I think the field of anesthesia is great but I saw how tough it was for the attending and I wonder what other residents or attendings felt about this. Am I just an intern who is freaking out because I do not have the knowledge to deal with situations such as those yet? I just want to be able to feel confident in handling cases and not feel stressed everyday I walk into an OR. HELP!

 

[jetproppilot]

I am a new surgical prelim who recently saw a simple OR case go sour from an anesthesia point of view. I am starting my anesthesiology residency next year and was a bit stressed by what I saw. I understand that we have alot to learn, hence the 3 years of residency, however, does this sense of doom ever go away even when you are done with residency? Do you feel as though you are able to deal with whatever comes your way and know how to handle situations in a calm manner or is life during work pretty stressful on a daily basis?
I have not seen a case this bad during medical school and it definitely made me wonder if I was cut out for this job. I think the field of anesthesia is great but I saw how tough it was for the attending and I wonder what other residents or attendings felt about this. Am I just an intern who is freaking out because I do not have the knowledge to deal with situations such as those yet? I just want to be able to feel confident in handling cases and not feel stressed everyday I walk into an OR. HELP!

Thanks for your post, which is a great reminder to all of us that even the twenty year old ASA 1 knee scope can go awry at any minute.

As humans, we have an emotional component....and in the beginning of our training, FEAR raises its ugly head when you are involved in a critical situation. Fear paralyzes you. It distracts you.

But it is normal.

Thats what residency is for.

As your skills and knowledge base progress, and your confidence builds, good clinicians learn to control this medullary response so they can act quickly and effectively.

Another great tool is acceptance. Accept, right now, that during your career you will be challenged with difficult situations, and strive to prepare yourself emotionally,intellectually, and technically for those challenges.

Having confidence in yourself fosters the above. You will be able to handle bad situations if you prepare yourself clinically and emotionally.

I've been in private practice 11 years now. Bad things still happen.

The only difference between you and me is the level of our training and experience due to time.

Eleven years from now, you will see/experience "a simple OR case go sour from an anesthesia point of view."

But instead of being a bystander, you will be integrally involved in solving the problem.

And when it is over, you will be at peace with yourself that you did everything you could.

And you'll walk outta that room.

And walk into the next one.

I do it every day.

And so can you.

 

[Planktonmd]

Thanks for your post, which is a great reminder to all of us that even the twenty year old ASA 1 knee scope can go awry at any minute.

As humans, we have an emotional component....and in the beginning of our training, FEAR raises its ugly head when you are involved in a critical situation. Fear paralyzes you. It distracts you.

But it is normal.

Thats what residency is for.

As your skills and knowledge base progress, and your confidence builds, good clinicians learn to control this medullary response so they can act quickly and effectively.

Another great tool is acceptance. Accept, right now, that during your career you will be challenged with difficult situations, and strive to prepare yourself emotionally,intellectually, and technically for those challenges.

Having confidence in yourself fosters the above. You will be able to handle bad situations if you prepare yourself clinically and emotionally.

I've been in private practice 11 years now. Bad things still happen.

The only difference between you and me is the level of our training and experience due to time.

Eleven years from now, you will see/experience "a simple OR case go sour from an anesthesia point of view."

But instead of being a bystander, you will be integrally involved in solving the problem.

And when it is over, you will be at peace with yourself that you did everything you could.

And you'll walk outta that room.

And walk into the next one.

I do it every day.

And so can you.

Very well said.

On the other hand this field is not for the weak of heart, and it's better to know that early.

 

[epidural man]

Another great tool is acceptance. Accept, right now, that during your career you will be challenged with difficult situations, and strive to prepare yourself emotionally,intellectually, and technically for those challenges.

Having confidence in yourself fosters the above. You will be able to handle bad situations if you prepare yourself clinically and emotionally.

I've been in private practice 11 years now. Bad things still happen.

The only difference between you and me is the level of our training and experience due to time.

Thanks Jet. I think this is very true. Acceptance that bad things happen and it isn't your fault is a hard pill to swallow for a newbie. We tend to think everything that turns sour is somehow our fault. I remember a time when I was doing a case with a the most experienced anesthesiologist in our department (30+ years of anesthesia) - I was doing everything right, CVP was okay, CO seemed okay, there was no systolic pressure variation on the a-line, lactate and BE and Hbg were maintained (I don't recall the case but they were around the kidney) but the guy would not pee. It really stressed me out - like I was doing something wrong. My attending wisely said something like "look - you are doing everything you can. There is nothing more you can do. Just remember, it is the patient not making pee, not you. Relax." It was good advice, but again, when you are new, it is a hard pill to swallow.

At our program, we give an "up the creek" award to the attending who we would most want to walk through the door when bad stuff is happening. It usually is the guy that is CALM. I think, as you say, that takes some time to develop - and strangely, some develop it quicker than others. I know guys that after 1 yr of residency seemed very calm and comfortable in the OR - yet I don't think I really started felling somewhat comfortable until my mid CA-3 year, and some things still freak me out.

We are not a trauma hospital and we get little experience in trauma during residency (yet we get plenty when we "volunteer" for Iraq). I think trauma would help teach you calmness and help teach this idea that you do what you can but people die regardless.