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centrino

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I decided to spend the last three months of my year long internship in anaesthesiology. The main reason for this choice was that I want to get into residency in anaesthesiology, so I thought it would be a good idea to get some basic training in anaesthesiology before starting my residency. Now it has been a month and a few days of my internship in anaesthesiology and was enjoying it alot but an incidence in the OR today actually shocked me.

Since my start, I have been working in the Gynae/Obs OR. Most of the gynaecological and obstetrical surgeries are done under spinal anaesthesia so after a month I actually got quite comfortable with spinal anaesthesia. Since I am the only intern on this floor so I have quite an experience with spinals even after one month. The residents and attendings are very friendly and teach me alot of things. Mine is a large 1000 bedded tertiary level teaching hospital.

There are three Gynae/Obs units in the hospital and each gets to do their elective surgery lists on 2 days a week.

Today a case of Total abdominal hystrectomy was scheduled to be done by one of the residents of this particular unit. while the patient was being preloaded for spinal anaesthesia, I asked the senior anaesthetist if I may do the spinal, who agreed whole heartedly and left me with a senior anaesthesia technician to do the spinal. That was an easy spinal, I went straight into the space, got free flowing CSF in the needle. Checked , confirmed the presence of CSF with gentle aspiration into bupivicane containing syringe. Even the senior anaesthesia technician, congragulated me after observing it. Injected the drug in, put the patient supine and waited for the drug to act. While I was doing this, two gynae/obs residents, 8 medical students and senior anaesthesia technician were present in the OR. Even after five minutes the patient was able to lift up her legs and could feel pain on pinching the abdomen. After some time , but before the starting of surgery,the technician told me that spinal has failed, we will have to redo it.
While we were putting the patient back into position for spinal, the consultant gynaecologist, head of the gynae obs unit responsible for running the OR today, came up to check upon the progress of the surgery. Seeing the surgery hasn't started yet she asked the reason of the delay and was told by her residents that the spinal is in effective. She then asked very harshly " Who did the spinal?". She was told it was me. She rudely asked me to come up in front and asked :" who are u? an intern?" I replyed yes I am an intern. She then asked how much time have I spent in anaesthesia? I said its been a month and a few days.
She then asked in a very insulting tone:"Do you think you are capable of doing this? Will you give anaesthesia to ur grandmother or mother or aunt, at this stage?" She then asked the medical students present in the OR:" Will any one of you trust a one month trained intern to give anaesthesia to a relative of urs? No you wont"
She then turned to me and told me harshly: "You should only be doing this(giving spinals) after atleast 6 months of internship. From now on, you will not anaesthetize any of the patients on my units OR day"

All I said was " yes madam"

Then she called upon the senior anaesthetist and told her about the failed spinal by me. The senior anaesthetist told her that I am capable of doing good spinals and something must be wrong with the drug may be.


In short except for the last yes, I didn't say anything. I could have told her that this is a teaching hospital and not your private setup. People come here to learn. If your resident can do surgeries, why cant' I give spinals? If I don't touch any procedure for six months then how will I know how to get them right. There always has to be a first time and proficiency comes with experience. Why do you allow your residents with surgeries? If I wouldn't want a one month trained person to give anesthesia to my relative, I would definitely not want a junior resident to do the surgery anyway.

But I didn't say anything, cause I knew it would be worthless. She will not listen and make a much bigger issue. But I was hurt really very hurt. I had to work hard to fight off my tears. I was humiliated in front of so many people including medical students. No one ever had told me before that I was not competent or I was in capable of doing something.

The Surgeons of the other two gynae/obs units are really nice. One even gave me good tips on spinal while I was having trouble with one in the earlier days. They are encouraging. But the head of this particular unit made me feel bad about myself. She shook my confidence. I am still so depressed and hurt.

What do you people say about this?
 

Bertelman

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If you continue into an anesthesia residency, expect more treatment like this. My biggest complaint about how you were treated is that I assume the patient was stil awake at this point. That's despicable behavior on the surgeon's part, because it undermines the trust the patient has in the care team.

Get over your feelings of "hurt" and "depression". Don't take these rants personally. This sounds like the kind of surgeon that needs to blame a poor outcome on the most vulnerable person in the vicinity. The most telling characteristic of this poor behavior is how much more respectful they behave when the attending is present.

Forget about the spinal. It happened to me 4 months into my residency, the one time the attending wasn't present for the spinal. Everything looked great. Aspirated CSF, injected, again aspirated CSF. Luckily, the OBs at our hospital are pleasant. Just last week, my attending had a failed spinal. Not much you can do. Make sure your hand is steady on the spinal needle when you inject. If it fails, she goes night-night.

For your own benefit, it would help to have the attending in the room when you perform the spinal.
 

coprolalia

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I decided to spend the last three months of my year long internship in anaesthesiology.

I hope you're not in the U.S. You won't get credit from the ABA for your internship year. (But, judging by the way you spelled anaesthesiology, probably not.)

What do you people say about this?

Get over it. Don't take it personally. This will happen from time to time. You've got to develop a thicker skin, which will come with time.

Now, me, on the other hand, probably would've told this gyn doc to f*** off or do the spinal him/herself. But, that's just me. I don't tolerate bullies very well.

-copro
 
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dhb

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She shook my confidence. I am still so depressed and hurt.

What do you people say about this?

Anesthesia i all about confidence but no one is going to have that for you. When things don't go your way it's normal to get frustrated but depressed and hurt :confused:

Some people like to pick the weakest link to vent their frustrations sometimes you have to tell them to go f*ck themselves and they'll back down. Although it's hard to do as an intern.

Get over it it'll happen again.
 

coprolalia

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On second thought...

You should've told your attending about the situation and had him/her address this "surgeon" privately. Your attending should've told her that it was completely inappropriate for her to dress you down in front of an entire room full of people, including an awake patient. And, your attending should've demanded that this "surgeon" apologize to you.

That's what I would've done if I'd been your attending.

-copro
 

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On second thought...

You should've told your attending about the situation and had him/her address this "surgeon" privately. Your attending should've told her that it was completely inappropriate for her to dress you down in front of an entire room full of people, including an awake patient. And, your attending should've demanded that this "surgeon" apologize to you.

That's what I would've done if I'd been your attending.

-copro

Being only a lurker I won't add much as I don't feel I'm in a position where I can say to much BUT as it has been said get used to it. You need to come down where I'm at and listen to what some of our residents and interns go thru here. You're everyone's bitch and you are always wrong. Expect that until you are done. It's not an intern issue either. Some of our nursing staff deal with this type of God attitude and type A personalities and thats the way it is a lot of the time.
As Copro said tho and I will agree with him, whoever was supervising you, should have backed you up or had a "chat" with this physician, but then again I doubt you are the first one she's done this to in which case no one sais anything, ignores her and moves on.

Tho my knowledge base is in the pre-hospital field, from what you posted and from the replies others have posted it doesn't sound like you were in the wrong. A lot of people have been there, gone thru it and should unfortunately continue to expect it from other physicians that are PMS-ing or IMS-ing.

(...I would give her a cracker next time)
 

GuP

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Most academic anesthesia folk are p-u-s-s-i-e-s. Hope this isn't news to you.
 

cockblockandrun

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Most academic anesthesia folk are p-u-s-s-i-e-s. Hope this isn't news to you.

I agree. I actually feel sorry for most in OBGYN so whenever they go on one of their rants, I look at them with only pity.

I also suggest a technique I learned from Happy Gilmore. Just tune out and go into some "happy place". It has worked like a charm as a med student and as an intern. Yell and rant all you want... I am chilling on the beach in Zanzibar
 

jennyboo

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You did nothing wrong. You responded appropriately (with civility) to the surgeon when she behaved inappropriately and made demands expecting to be obeyed when the decision is not under her jurisdiction. Surgeons answer to surgeons, anaesthetists answer to anaesthetists. Anaesthetists do not answer to surgeons.

An anaesthetist determines who may deliver an anaesthetic or do an anaesthetic procedure under his/her medical direction. A surgeon does not. In fact, with few exceptions, we cannot really choose each other or request a consultant-only case with no residents. Exceptions that make it reasonable to request a no-resident case in an academic hospital include, for example, high-stakes surgery such as famous singer having vocal cord surgery, professional athlete having orthopaedic surgery, surgery on a nurse or physician who works in the theatre or recovery room and is therefore pollitely allowed to not have a resident in the room. In all other cases the surgeon can choose who assists the surgery and the anaesthetist can choose who assists the anaesthetic.

A small percentage of neuraxial anaesthetics do fail and must be either repeated or converted to general anaesthetics. This is a reality that cannot be changed. Some anaesthetists are better than others and some fail more often than others. Those who are good at spinals still fail sometimes.

A certain number of surgeons think they're the boss of everyone. This is probably one of the few major cons about our field. Some surgeons are difficult to get along with. Gynaecologists are, as a group *ahem* frequently mean-spirited, think too highly of themselves, hacksaw surgeons, and at the same time none too bright to boot -- dangerous combination. You didn't hear me say that. :eek:
 
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Planktonmd

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In residency you should not allow anybody to "hurt" you or make you cry.
Even if you are a chick (which I think the OP is), you just don't get hurt or cry in residency, NEVER!
If you do, there are many sharks around you who will smell your fear and will definitely eat you alive.
In this business anesthetics sometimes fail even in the best hands, but if they fail in the hands of an intern you should not be shocked if everyone would think that the failure was due to your inexperience, you would have the same prejudice against an intern trying to do surgery unsupervised wouldn't you??
It's natural that they will blame you but the good news is that you will not be an intern forever, so if I were you I would just move on.
 

centrino

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If you continue into an anesthesia residency, expect more treatment like this. My biggest complaint about how you were treated is that I assume the patient was stil awake at this point. That's despicable behavior on the surgeon's part, because it undermines the trust the patient has in the care team.

Get over your feelings of "hurt" and "depression". Don't take these rants personally. This sounds like the kind of surgeon that needs to blame a poor outcome on the most vulnerable person in the vicinity. The most telling characteristic of this poor behavior is how much more respectful they behave when the attending is present.

Forget about the spinal. It happened to me 4 months into my residency, the one time the attending wasn't present for the spinal. Everything looked great. Aspirated CSF, injected, again aspirated CSF. Luckily, the OBs at our hospital are pleasant. Just last week, my attending had a failed spinal. Not much you can do. Make sure your hand is steady on the spinal needle when you inject. If it fails, she goes night-night.

For your own benefit, it would help to have the attending in the room when you perform the spinal.

Yes the patient was still awake.
And I did aspirate the CSF again after injecting 1 cc. Wonder what went wrong? Just read in Morgan that if the the needle opening is half way through and not fully in the the Sub arachnoid space, then it is possible to get free flowing CSF but not injecting the drug into the subarachniod space. I was however using the cutting type of needle.

On second thought...

You should've told your attending about the situation and had him/her address this "surgeon" privately. Your attending should've told her that it was completely inappropriate for her to dress you down in front of an entire room full of people, including an awake patient. And, your attending should've demanded that this "surgeon" apologize to you.

That's what I would've done if I'd been your attending.

-copro

I would have done this if I were the attending. However she had a chat with me privately and told me that she didn't argue with the surgeon at that time becasue it was useless and she wouldn't have listened. Also she said that she will make me do a spinal in her presence on that particular gynaecologists OR list.
 

centrino

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A nice dinner with family, SDN Anaesthesia forum and a good nights sleep have actually made me feel much better.

Thanks for all this support. It has been much easier to cope with this issue with the help of this forum.

Well now the question is that day after tomorrow again is the OR day of that mean gynaecologist who says I must not anaesthetize any of the patients on her OR list. My attending on the other hand said that she will make me do spinal under her supervision on that day. I am however confused. I think I should not do any anaesthesia on that day. She might make another fuss. Moreover my self-esteem doesn't allow me to do it. The sufferers will be her residents though.

There is a shortage of Anaesthetists on our floor and often the anaesthesia people as well as the surgeons are glad that an intern is present on the floor to provide a helping hand.

I'm confused as what to do!!!
 

Planktonmd

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A nice dinner with family, SDN Anaesthesia forum and a good nights sleep have actually made me feel much better.

Thanks for all this support. It has been much easier to cope with this issue with the help of this forum.

Well now the question is that day after tomorrow again is the OR day of that mean gynaecologist who says I must not anaesthetize any of the patients on her OR list. My attending on the other hand said that she will make me do spinal under her supervision on that day. I am however confused. I think I should not do any anaesthesia on that day. She might make another fuss. Moreover my self-esteem doesn't allow me to do it. The sufferers will be her residents though.

There is a shortage of Anaesthetists on our floor and often the anaesthesia people as well as the surgeons are glad that an intern is present on the floor to provide a helping hand.

I'm confused as what to do!!!
It's not your problem, it's between your attending and the OB attending.
Stay out of it and do what you are told to do.
 

cockblockandrun

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A nice dinner with family, SDN Anaesthesia forum and a good nights sleep have actually made me feel much better.

Thanks for all this support. It has been much easier to cope with this issue with the help of this forum.

Well now the question is that day after tomorrow again is the OR day of that mean gynaecologist who says I must not anaesthetize any of the patients on her OR list. My attending on the other hand said that she will make me do spinal under her supervision on that day. I am however confused. I think I should not do any anaesthesia on that day. She might make another fuss. Moreover my self-esteem doesn't allow me to do it. The sufferers will be her residents though.

There is a shortage of Anaesthetists on our floor and often the anaesthesia people as well as the surgeons are glad that an intern is present on the floor to provide a helping hand.

I'm confused as what to do!!!

What I don't understand is why in the world are you still worried about this. If you are unwanted, say "f u" and go somewhere else where you are needed. I do understand you are trying to apply into anesthesia, but seriously bro... the ass kissing has to stop at some point and self respect has to come into play.
 

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To the OP:

Your story is a little confusing based on some of your terms. What country are you in?

During residency the attending was nearly always present during spinal placement.

You have to do your best to get over it. There are unfortunately a lot of malignant personalities in medicine. You have to suck it up and plow on through.

That is, at least until you are an attending and can be malignant:smuggrin:.
 

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...so, I was a fourth year medical student doing a visiting rotation at a program much more prestigious than my home program. I had met a young attending at one of my home program's hospitals who had just finished her training at the more prestigious program. She had told me that when I rotate at the prestigious program, I should read Dr. X's chapter in Miller, then work with Dr. X one day, impress him with my knowledge and maybe get a letter out of it. So as a fourth year medical student, I spent the $300 they wanted for a Miller and ordered it online.

So day one at the prestigious program was an orientation and the next day I am assigned to work with, you guessed it, Dr. X. I went home and cracked open the Miller that had literally just arrived like a week prior and was aghast that the chapter Dr. X wrote was like 100 pages :eek: I honestly tried to sit down and read this chapter (one of those less clinically relevant chapters in Miller) but to no avail. It was getting late and I had to get up very early the next morning...

Morning comes and I meet my assigned resident. Pretty cool guy and he warns me about Dr. X. We both meet up with Dr. X and he makes appropriate small talk. We get into the operating room and he asks if I had any anesthesia experience. I tell him that I did a two week rotation at my home hospital. He says fine. We are about to induce this patient with scraggly teeth and Dr. X asks me to draw up propofol. Well, I was pretty perplexed because the way this prestigous hospital drew up propofol was with one of those spike thingy's that has a vent that you hook up a syringe. The propofol vial had already been spiked with this contraption and there I was trying to get the propofol out with a needle attached to the syringe! (that's how we did it at my home program) Dr. X sees me struggling and starts mumbling crap about how I said I had anesthesia experience and it didn't look like I did. Now the patient is unconscious and Dr. X wants me to mask ventilate. We start making some more small talk and I inform him that I plan on matching for an anesthesia residency. Dr. X, with full knowledge that I am not a student from his prestigious program replies "Maybe. Anesthesia is pretty hot this year. We will be barely able to accomodate all our students let alone somone from an outside school." While I was mask ventilating, he started heckling me about my technique. He told me that I should squeeze the bag like I would squeeze a "(rude term for female breast)". He then said something to the effect of "I don't know how you guys squeeze (rude term for female breast) where you come from, but where I come from this is how we did it. He has the resident do the laryngoscopy because of the teeth, but lets me put the tube down (no big deal). So now the patient is intubated and everything is fine - or so I thought. Immediately after taping the tube, Dr. X asks "what was the peak airway pressure on induction?". For some reason I actually remember the pressure monitor bobbling between 20 and 30 when I was masking this patient. So I said "between 20 and 30". He says "No, I don't want to hear that. Thats like saying someone weighs between 100 and 150 lbs, I want an exact answer". Under pressure, I replied "okay, it was 30". He then gets like two inches from my face and says "It was nowhere near 30. It was 20 at the most." Then a pause... then comes "Don't you ever, ever bull____ me again". The rest of the day was extremely awkward as you can imagine. I managed to avoid him the rest of the rotation.

The next time I saw Dr. X was when I was a resident at Johns Hopkins and he visited to give grand rounds. I could tell he remembered me, but was unclear as to how we knew each other. I shook his hand and told him it was a tough choice for residency, but Hopkins was the best fit for me. He then congratulated me on my choice/match and went on his way.

There are some amazing people out there who are able to skate through life and get to the top of the mountain without any collateral damage. I am definitely not one of those people. However, I have found that the more difficult it is to get to the top, the more you appreciate it when you actually get there...
 

Arch Guillotti

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He told me that I should squeeze the bag like I would squeeze a "(rude term for female breast)". He then said something to the effect of "I don't know how you guys squeeze (rude term for female breast) where you come from, but where I come from this is how we did it.

That is classic, I am gonna rememebr that one for sure:cool:
 

centrino

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There are some amazing people out there who are able to skate through life and get to the top of the mountain without any collateral damage. I am definitely not one of those people. However, I have found that the more difficult it is to get to the top, the more you appreciate it when you actually get there...


Wow. Thats inspiring!
 

copacetic

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meh, their probably super worried about getting their pants sued off. it is OB/GYN after all.
 

New2Midwest

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I don't think it's an issue of academic anesthesiologists being p*****. There are plenty of PP guys that bend over just as well and keep their tails between their legs. Bottom line: If you know your stuff and have good skills, then go represent...
 

bluewater

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I don't think it's an issue of academic anesthesiologists being p*****. There are plenty of PP guys that bend over just as well and keep their tails between their legs. Bottom line: If you know your stuff and have good skills, then go represent...

Bingo, the most gruff surgeon can't argue with good logic, great skills and evidence based medicine (although some of the more stupid ones can.)

PS- It helps if you have a dominating personality and are 6'1" 230lbs, like a linebacker.
 
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