observations. need to choose career. pls. dont flame

[ALTorGT]

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Hi
Before I begin, a disclaimer: My views are not intended to put budding anaesthesiologists offside. Here goes,

I know this topic comes up ad nauseum: Isn't anaesthesia boring?

I'm currently doing my vascular surgery rotation and on 3 seperate ocassions have seen my anaesthesia attending doze off, like you would on a moving train. Now I'm not saying that surgery doesn't have its dull moments; pulling retractors for hours does get tiring. But at least you stay awake. The draw to anaesthesiology is the opportunity to play with applied phys and pharm like in no other discipline in medicine. But looking further into your career, when you are no longer a resident, does it really get so routine that your'e struggling to keep awake on your backless OR stool?

 

[Mman]

Hi
Before I begin, a disclaimer: My views are not intended to put budding anaesthesiologists offside. Here goes,

I know this topic comes up ad nauseum: Isn't anaesthesia boring?

I'm currently doing my vascular surgery rotation and on 3 seperate ocassions have seen my anaesthesia attending doze off, like you would on a moving train. Now I'm not saying that surgery doesn't have its dull moments; pulling retractors for hours does get tiring. But at least you stay awake. The draw to anaesthesiology is the opportunity to play with applied phys and pharm like in no other discipline in medicine. But looking further into your career, when you are no longer a resident, does it really get so routine that your'e struggling to keep awake on your backless OR stool?

That's for you to decide. Pick a career that interests you. If keeping people alive day after day while surgeons try to do otherwise is interesting, then go for anesthesia. If you have a burning desire to go on rounds for hours and hours every single day, go for medicine. If you enjoy cutting things and putting them back together, perhaps surgery is for you.

Is it boring? Depends on the person. For example, I love going to baseball games. But NBA regular season games? Man I practically fall asleep during those. I'm sure other people are different.

If you think that the majority of an anesthesiologist's career is spent sitting in a backless OR stool twiddling their thumbs, then you just don't have a good enough understanding to make a decision. There are lots of career paths. You could just pick a practice where you supervise 4 CRNAs (or AAs or whatever) and all you do is run around from room to room all day long, barely ever having time to sit down.


Boring is a subjective term, it's up to you to decide if you like it. Given that this is an anesthesia forum, I'll go out on a limb and guess that most here do not find it boring or they would have gone into something else. As for your vascular surgery experience, I'll say it's not the norm. At my med school the anesthesia attendings are hardly ever in the room. With residents running the show, they've got plenty of time for reading the paper and checking their email

 

[soon2bdoc2003]

anesthesia is like flying a plane.. takeoff and landing are critical, but sometimes you get to cruise on auto pilot. Everything I need to know i can tell from the beeping of the pulse-ox and looking up at the bp every few minutes.. when things are going well that is. Sometimes though, you hit a little low pressure pocket at cruising altitude and lose 10,000 feet in a matter of seconds.. thats when training and preparation are key. I've had a couple of days where its just an absolute struggle to keep my eyes open, and days where my butt never even hits the chair hanging up multiple pressors, blood products, pushing iv's with both hands.. you get the picture. BTW, my morning setup includes finding myself a nice comfy padded chair with good back support.. no cold metal backless stool for me!

Anesthesia is a very different job than surgery.. surgeons work with an audience, you are all alone behind a drape and whether you struggle the entire case to keep the patient alive or sit there doing crossword puzzles nobody knows the difference, not even the patient. You have to be real comfortable working strictly for your own satisfaction because it wont be coming from anybody else, especially not from the surgeon. The OR's at my hospital have aux. monitors so everyone in the room can see the vitals, most people turn them off "i dont want everyone getting in my business" but I make sure they are always on so when the pts taching away with a systolic of 60 nobody will ask me to answer the phone or grab some sutures from the cart. One other point of interest, I have really come to appreciate how nice and understanding surgeons are toward us in the OR.. I'm in the icu now and the same guys who patiently stand by while i take 30 minutes to get an epidural in the OR send their entire team to chew me out for giving a patient the wrong diet.

 

[jetproppilot]

anesthesia is like flying a plane.. takeoff and landing are critical, but sometimes you get to cruise on auto pilot.

Spoken like a true aviator. Couldnt've said it better myself. 😀

 

[Laryngospasm]

Everything I need to know i can tell from the beeping of the pulse-ox and looking up at the bp every few minutes.. when things are going well that is.

I hear that beeping in my sleep Boop...Boop...Boop...

 

[bell412]

I’m just a lowly srna so don't smoke my ass that bad but here how i see it. Why would an MDA want to do the intraoperative phase? Maybe some of you residents like this technical phase? i'm not trying to make anybody mad trust me. but think about it? the real job of an MDA at a busy medical center working with the crna is to play the MD role. what i'm saying is the MDA does ALL the preop work, puts out ALL the fires out during the intra-op phase while the crna is doing the technical aspect. then the mda has do deal with EVERY PATIENT in the post-operative phase. i remember one time during an induction (at 1000 am) the MDA was page, I’m not ****tin ya - 15 times! During the friggin induction! Folks the MDA works there friggin ass off!! there not sitten the machine, there doin **** that a doctor is trained to do! do you guys really want to sit the stool, chart vital signs, dump pee, and get bossed around by a surgeon?

 

[VentdependenT]

do you guys really want to sit the stool, chart vital signs, dump pee, and get bossed around by a surgeon?

.....Thats how I feel about my profession. 😴

 

[Monty Python]

I’m just a lowly srna so don't smoke my ass that bad but here how i see it. Why would an MDA want to do the intraoperative phase? Maybe some of you residents like this technical phase? i'm not trying to make anybody mad trust me. but think about it? the real job of an MDA at a busy medical center working with the crna is to play the MD role. what i'm saying is the MDA does ALL the preop work, puts out ALL the fires out during the intra-op phase while the crna is doing the technical aspect. then the mda has do deal with EVERY PATIENT in the post-operative phase. i remember one time during an induction (at 1000 am) the MDA was page, I’m not ****tin ya - 15 times! During the friggin induction! Folks the MDA works there friggin ass off!! there not sitten the machine, there doin **** that a doctor is trained to do! do you guys really want to sit the stool, chart vital signs, dump pee, and get bossed around by a surgeon?

As a former "lowly SRNA" myself, now with 10 years CRNA experience, I've worked in almost every possible employment arrangement: solo CRNA, CRNA-only group, CRNA with floating MDA supervision, and CRNA and MDA on separate stools. It all depends on how you look at your place in the world.
I don't look at it as simply charting VS, deflecting oh-so-cute surgeon comments, etc. I look at it as "this patient has put their entire trust and faith in my abilities to keep them alive and homeostatic while this surgeon cuts them open."

Stop for a moment and reflect on that. Do you really, I mean really, comprehend the depth and intensity of that personal interaction?

I take it one patient at a time, and I give it my all. When I leave in the afternoon, I feel tired both mentally and physically, but I feel I earned my pay and that I gave my pts my very best. I also sleep very well at night.

I take great pride in doing my best (which requires staying on your toes, observing what the surgeon is doing and saying, and ALWAYS STAYING 10 MINUTES AHEAD OF THE SURGEON MENTALLY). The vast majority of the time, my gameplan has me extubating as the dressings are being applied, and my pts are in PACU warm, not nauseated, with stable VS, pain-free, and asking me "when are we going to the OR?" That outcome requires planning before-hand, staying alert in the OR (even when on auto-pilot) and forcing yourself to focus. I also frequently play "what if" with myself, always having plans B, C, and D at the ready.

Same thing when I'm flying. Even when cruising on auto-pilot, I'm always checking the closest possible landing site in case my engine craps out, what's my fuel consumption, etc etc.

Do I hit "slack spots" during long cases? Of course. Will you find me reading Newsweek? Never. I'll pull my Mass Gen or baby Barash out of my backpack and knock some rust off. I'll review the ACLS algorithms. I'll check the schedule, and have my supplies/equipment all set up (as much as possible) for the next case to minimize room turnover time. The earlier we finish, the earlier we go home.

You can just go through the motions (chart VS, act bored, etc) and receive a paycheck, or you can *earn* your compensaion and the title PROFESSIONAL on a daily basis by being one. Maybe that's why at my particular hospital I've had numerous co-workers (RNs, orderlies, the people really in the know about the goings-on in the OR) request me to personally give their anesthetic. They know I give a damn about every single pt.

 

[jetproppilot]

As a former "lowly SRNA" myself, now with 10 years CRNA experience, I've worked in almost every possible employment arrangement: solo CRNA, CRNA-only group, CRNA with floating MDA supervision, and CRNA and MDA on separate stools. It all depends on how you look at your place in the world.
I don't look at it as simply charting VS, deflecting oh-so-cute surgeon comments, etc. I look at it as "this patient has put their entire trust and faith in my abilities to keep them alive and homeostatic while this surgeon cuts them open."

Stop for a moment and reflect on that. Do you really, I mean really, comprehend the depth and intensity of that personal interaction?

I take it one patient at a time, and I give it my all. When I leave in the afternoon, I feel tired both mentally and physically, but I feel I earned my pay and that I gave my pts my very best. I also sleep very well at night.

I take great pride in doing my best (which requires staying on your toes, observing what the surgeon is doing and saying, and ALWAYS STAYING 10 MINUTES AHEAD OF THE SURGEON MENTALLY). The vast majority of the time, my gameplan has me extubating as the dressings are being applied, and my pts are in PACU warm, not nauseated, with stable VS, pain-free, and asking me "when are we going to the OR?" That outcome requires planning before-hand, staying alert in the OR (even when on auto-pilot) and forcing yourself to focus. I also frequently play "what if" with myself, always having plans B, C, and D at the ready.

Same thing when I'm flying. Even when cruising on auto-pilot, I'm always checking the closest possible landing site in case my engine craps out, what's my fuel consumption, etc etc.

Do I hit "slack spots" during long cases? Of course. Will you find me reading Newsweek? Never. I'll pull my Mass Gen or baby Barash out of my backpack and knock some rust off. I'll review the ACLS algorithms. I'll check the schedule, and have my supplies/equipment all set up (as much as possible) for the next case to minimize room turnover time. The earlier we finish, the earlier we go home.

You can just go through the motions (chart VS, act bored, etc) and receive a paycheck, or you can *earn* your compensaion and the title PROFESSIONAL on a daily basis by being one. Maybe that's why at my particular hospital I've had numerous co-workers (RNs, orderlies, the people really in the know about the goings-on in the OR) request me to personally give their anesthetic. They know I give a damn about every single pt.

And he practices what he preaches, folks. Been in the trenches with Trinity many, many cases. 👍

 

[bell412]

trinityalumnus, i printed that reply. i strive for that!

 

[Trisomy13]

Now I'm not saying that surgery doesn't have its dull moments; pulling retractors for hours does get tiring. But at least you stay awake.

i know i can't be the only one out there who has actually fallen asleep while retracting. there's a fine art to hooking your thumb so that the pressure of the retractor balances your semi-conscious body as it pulls away from the table. don't worry about missing everything, the surgeon will wake you up eventually. "Cut. Cut! CUT THE DAMN STITCH! Mother of god is the medical student ASLEEP?"

ooooh yeah. watch out.

 

[Leukocyte]

i know i can't be the only one out there who has actually fallen asleep while retracting. there's a fine art to hooking your thumb so that the pressure of the retractor balances your semi-conscious body as it pulls away from the table. don't worry about missing everything, the surgeon will wake you up eventually. "Cut. Cut! CUT THE DAMN STITCH! Mother of god is the medical student ASLEEP?"

ooooh yeah. watch out.

I second that.

However, the surgeons were not as polite as they were to you when they woke me up.

 

[Furrball2]

i know i can't be the only one out there who has actually fallen asleep while retracting. there's a fine art to hooking your thumb so that the pressure of the retractor balances your semi-conscious body as it pulls away from the table. don't worry about missing everything, the surgeon will wake you up eventually. "Cut. Cut! CUT THE DAMN STITCH! Mother of god is the medical student ASLEEP?"

ooooh yeah. watch out.

I just chewed the inside of my mouth causing just enough pain that I didn't fall onto the OR floor fast asleep.

 

[soon2bdoc2003]

As an MS3 i learned the perfect stance for leaning back while retracting allowing me to drift off for brief intervals.. i also learned that i needed to modify my technique when my hands were wet after the first time losing my grip and going down HARD. Surgeons thought i syncopised but it was more like i got tired of waiting around >3 hours for them to get a gall bladder out.