chocolate

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I'm a new CA-1 and I have to admit, I'm feeling concerned. Although I've been excited to start anesthesiology, now that the day has come I find myself very stressed out, and constantly feeling worried that I'm either going to harm my patients, or at the very least, be the worst resident out there.

My question is, did others have similar feelings at/near the start of their residencies? And if so, did they get over it? Did certain things help? Did anyone leave? I find myself nervous about administering drugs without running them by the attending, constantly stressing about the "what-ifs" of the OR, and in general, second-guessing my every move.... I'm worried I may have found myself in the wrong specialty.

Let me be clear, I am in a very supportive program -- it's not a malignant program that's making me feel this way. Any comments or links to helpful sites are greatly appreciated!
 

Laryngospasm

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chocolate said:
I'm a new CA-1 and I have to admit, I'm feeling concerned. Although I've been excited to start anesthesiology, now that the day has come I find myself very stressed out, and constantly feeling worried that I'm either going to harm my patients, or at the very least, be the worst resident out there.

My question is, did others have similar feelings at/near the start of their residencies? And if so, did they get over it? Did certain things help? Did anyone leave? I find myself nervous about administering drugs without running them by the attending, constantly stressing about the "what-ifs" of the OR, and in general, second-guessing my every move.... I'm worried I may have found myself in the wrong specialty.

Let me be clear, I am in a very supportive program -- it's not a malignant program that's making me feel this way. Any comments or links to helpful sites are greatly appreciated!
Normal first month feelings, if you feel like that at the end of the year its another story. Youll gain confidence. Someone who thinks they know what they are doing in the first month is ignorant.
 

DreamMachine

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2ndyear

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In your first few months just try to focus your anxieties and find out what scares you. I remember that patients moving was a big one. Easy, if you're using NMB's use your twitch monitor religiously. Also have a big syringe of propofol on you at all times. Hypotension- neo, ephedrine. There're right there so use them if need be. Cough on the tube? Take them off the vent. SpO2 drops-100% O2 and then find the cause. The biggest things you need to worry about are: 1) making a drug error, drawing up the wrong drug, not giving it correctly (there are only a few things that will burn you, ie pitocin, protamine, methergine) and 2) not recognizing when you need to call for your attending.
It's OK to second guess your every move, just do it before you do something and not after. Developing good habits and back up plans at this stage is key. You'll be fine.
 

DreamMachine

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usnavdoc

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2ndyear said:
In your first few months just try to focus your anxieties and find out what scares you. I remember that patients moving was a big one. Easy, if you're using NMB's use your twitch monitor religiously. Also have a big syringe of propofol on you at all times. Hypotension- neo, ephedrine. There're right there so use them if need be. Cough on the tube? Take them off the vent. SpO2 drops-100% O2 and then find the cause. The biggest things you need to worry about are: 1) making a drug error, drawing up the wrong drug, not giving it correctly (there are only a few things that will burn you, ie pitocin, protamine, methergine) and 2) not recognizing when you need to call for your attending.
It's OK to second guess your every move, just do it before you do something and not after. Developing good habits and back up plans at this stage is key. You'll be fine.

I appreciate the good advice. I had my first "machine failure" failure today. Kinda scary for a sec. Pt had a host of pulm complications to begin with. But after induction, which went well, the FIO2 monitor trended off to 0% very rapidly. Pt sats fell slightly but held at 92. We had FGF which was evident but ratios I wasnt sure about. Changed over to cylinder 100% and paged attending and an AT while I was bagging the patient. The O2 monitor continued reading very low to 0%. Turned out to be a faulty monitor which just picked that time to go out. Scared the heck out of me b/c it came out of nowhere. But I guess thats when things scare you when you arent thinking about them.
 

DreamMachine

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VentdependenT

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First month and half I had some component of anxiety which was out of proportion to my clinical knowledge and ability. I mean I was feelin way to nervous for my own comfort. Anypoops I saw a primary care fella about it and he put me on the good old lexapro.

Bam, good as new. No sexual side effects either.

Never the less, it is normal to be scared for the first 1/4 of your CA-1 year. Its a lot of responsibility and its completely different from that floor work youve been doing previously.
 

bubalus

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It's normal to be scared, and it's normal to feel stupid. You'll feel stupid over and over. Just when you get one thing down, it's on to another. You'll get much more comfortable in time.
 

usnavdoc

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DreamMachine said:
Navdoc, you alone already? We are all still paired up for a couple more weeks.

We learned about the diffficult airway algorithm today, or whatever it is formally called. Anyway...

Any upper levels or attendings ever have to do a surgical airway yourself?
No I was with a PA who was about a year out of school. We wont be alone for another week or two as I understand it. They say they want us all to progress together so they havent given us a date or anything but roughly 6 weeks from start. Needless to say Im a bit nervous about that but also looking forward to it as well.
 
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