Starting CA1...does it getter better???

[surfdevl02]

So intern year has passed and like many of you i've prayed for this day to come when internal medicine was just a bad nightmare that is now over and done. Now onto the wonderful world of volatile anesthetics and epidurals. How grand life would get now...

Is it just me or does Anesthesia seem that much more stressful, overwhelming and tiring than what we remembered as med students??? I honestly have never felt as unconfortable with my patients as i do now. At the end of intern year i felt on top of the world, like i could handle almost anything that came to the ER door. Now it feels like getting kicked in the nads again....At times lost in the OR looking for tubing that seems to connect in infinite ways, looking at drugs that could literally kill pts if not given properly, trying to hang blood for the first time and missing the days when i could just order it and have the pt's Hct magically increase the next morning, getting yelled at by surgery attendings right after my anesthesia attending leaves the room - "Can we get a valsava?....(In my head-Hmmm, can the pt really bear down while unconscious?) Ummm...then moments of awkward silence...then call the attending and look like a *****. This feeling passes right??

Then there's the stuff you don't see as med students, getting there at 5:45 to set up your room, getting the evil eye by surgery when your inexperience delays the pt waking up at the end of a case, trying to turn over your room and do pre-ops in 5 min or less, wondering if you should do something about a spike in pressures or just wait and watch, getting yelled at when your pt moves even after your attending tells you the amount of gas to put on board
, coming home dead tired every day and then coming back for more the next morning, being anxious everyday just doing simple procedures such as IVs, not to mention a-lines or central lines.

This is probably the steepest learning curve i've had. Sorry if it sounds like i'm complaining because honestly it beats internal medicine 100 fold. We don't get calls about a K+ of 3.8, try to play social worker every day, or have to deal with drunk pts at 4 in the morning. I see now why we get compensated so well. It's just that i've never felt so much responsibility in such a short amount of time. I'm sure it'll get better, or at least that's what i'm telling myself.....

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[militarymd]

It'll get better.....................or not.

 

[Laurel123]

Welcome to CA1. I remember for the first few months, I would be completely wiped out by the end of the day, even though we got out everyday around 4 for CA-1 lectures and didn't even have to take any call. I had done some reading, I had observed some anesthesia residents when I was a student. But suddenly, when everything is your case and your patient for the first time, it was so intense and overwhelming. I remember just staring at the vitals and just hoping they didn't change and when the pulse ox went from 96% to 95% I would panic afraid that they were going on a downward spiral and I wouldn't know what to do. Sure, I had read algorithms for solving hypoxemia (not that 95% is a critical vital sign), but when it was happening in real life, I didn't know what to do during that first month.

One tip - after you intubate and it goes smoothly and you get a little rush of joy - don't forget to flip on the ventilator. (because some attendings will then proceed to spend the next 5 minutes teaching you the only 'correct' way to tape an ET tube)

 

[SleepIsGood]

Dude..

You're goign through what each and everyone one of us no matter HOW good has gone through.

Keep your head up hi. You will get crapped on by your attending, surgery attendings,etc. As pessimistic as it seems, you will at times feel like everyone's against you and pointing our your errors. You'll see that most attendings will only point out your flaws because that's all they see...since they're not in the room for the rest.

Anesthesia is not only a challenge on you intellectually but it also tests your character. I see it as when I was pledging for a frat. They will mess with your head and try to break you down. You just have to be resilient. Believe me man, I have no idea why some attendings are so harsh on people. In a few years you will be their colleagues!

Also I suggest you form a routine. For example...Ventilate pt, cover eyes with tape, ventilate more, intubate, listen for breath sounds, flip on vent...adjust flows/anesthetic.....flip on vent

Create a routine and stick to it. It's overwhelming at times...but you too will do well if you are vigilant.

 

[loveumms]

It does get better but, I still come home many days very tired. I love what I do though and feel so lucky every single day. You will become more and more comfortable with doing things and once you learn where all your supplies are and what they do it will become much easier. One attending told me that knowing where things are is half the battle.

I watch the newbies get nervous pushing just 1mg of midaz or freak out when the pressure is 90/60 after induction. You will learn quickly how to manage pretty much anything that is thrown at you. I'll never forget my second month of anesthesia I got a stat crani for a guy that fell down a flight of steps and had a huge subdural. He was in really bad shape and thank God the attending was in the room for most of the case. But, I got through it and the patient was still alive at the end of the case.

As a medical student you see only parts of residency. I never saw the residents go see pre or post ops (most of the time because they had let me leave by then). I never had to take call on my anesthesia month so I had no idea what it was like to be up all night and having to really be 100% the whole time. In our profession when you are on, you are on and most of the time you are "on" most of the day because things can change in an instant. But, that is the fun of it.

Good luck and try to just enjoy the ride.

 

[Hockeyguy]

It gets better. Everyones first few months are rough. The learninig curve is steep so hang in there. Learn from your srew-ups and keep moving forward. I think Anesthesiology is a very humbling field so try to remain humble. Everyone expects you to do everything right and fast the first time. It obviously isn't possible so I always try remember I'm there to take care of someones mom, dad kid grandpa whatever... Your obligation is to them not the whiney circulating nurse who wants to go home. I am sure you doing great.

Mario

Also one thing that kept me going was post-oping patients. Most of them you will remeber you and are thankful for what you did for them. I think its a good practice. I have even had a couple patients request me specifically for for second or third surgies. They were only quick urology and colorectal cases but it was nice.

 

[jennyboo]

It's normal to be totally wiped out by 5pm during your first month.

Surgeons do not realize that as a new anesthesiology resident you are on your own. Their new interns are never left alone in an OR in July, but you are. They are supervised by several layers from attending to senior resident to junior resident to intern. Not so for you -- you're the only one in the OR doing your job and you don't know how to use all the equipment! Take any surgical or medical resident and put them in your position and they would be scared $hitless.

This will get better. You will look back and think you're glad you don't ever have to be in your first month of anesthesiology residency again! Your hours will probably not get shorter and as you progress you will probably have more nights on call, but in 6-9 months you will be able to sit in a case and feel pretty relaxed.

 

[drfeelgood]

I had two residents in my program get kicked out during their CA-1 year. One guy wouldn't do a thing when the sat was reading 85% on several occasions. Another guy gave a stick of vecuronium instead of a stick of Ancef after the baby was delivered in a C-section under spinal anesthesia. 🙁What got him in trouble was that he didn't admit he screwed up and never took care of the ABCs. Luckily a senior resident walked in when the sats started to drop!!!🙁 (sux-pent-tube and gave some versed and scopolamine to scramble her brain) Always show up early!! Never be in a rush..and always read bottles twice before giving anything.

 

[jetproppilot]

I had two residents in my program get kicked out during their CA-1 year. One guy wouldn't do a thing when the sat was reading 85% on several occasions. Another guy gave a stick of vecuronium instead of a stick of Ancef after the baby was delivered in a C-section under spinal anesthesia. 🙁What got him in trouble was that he didn't admit he screwed up and never took care of the ABCs. Luckily a senior resident walked in when the sats started to drop!!!🙁 (sux-pent-tube and gave some versed and scopolamine to scramble her brain) Always show up early!! Never be in a rush..and always read bottles twice before giving anything.

Man, is that some great advice.

To this day if I pop it or stick a needle thru the rubber, I read the label.

In fact this is so important I'm gonna make a new thread on the subject.

Thanks for mentioning it.

 

[Gaseous Clay]

I had two residents in my program get kicked out during their CA-1 year. One guy wouldn't do a thing when the sat was reading 85% on several occasions. Another guy gave a stick of vecuronium instead of a stick of Ancef after the baby was delivered in a C-section under spinal anesthesia. 🙁What got him in trouble was that he didn't admit he screwed up and never took care of the ABCs. Luckily a senior resident walked in when the sats started to drop!!!🙁 (sux-pent-tube and gave some versed and scopolamine to scramble her brain) Always show up early!! Never be in a rush..and always read bottles twice before giving anything.

Just curious why sux was given if vec (I will assume a "stick" is 10 mg) was already on board. Also, do you routinely have your meds drawn up during a C-section? I have the syringes on the top of the cart but no meds besides the Ancef, Neo, and bag of pit on the top of my cart.

 

[Arch Guillotti]

What got him in trouble was that he didn't admit he screwed up and never took care of the ABCs.

ALWAYS take the blame, even if it isn't your dadgum fault sometimes. Arguing gets you NOWHERE.

 

[mille125]

So intern year has passed and like many of you i've prayed for this day to come when internal medicine was just a bad nightmare that is now over and done. Now onto the wonderful world of volatile anesthetics and epidurals. How grand life would get now...

Is it just me or does Anesthesia seem that much more stressful, overwhelming and tiring than what we remembered as med students??? I honestly have never felt as unconfortable with my patients as i do now. At the end of intern year i felt on top of the world, like i could handle almost anything that came to the ER door. Now it feels like getting kicked in the nads again....At times lost in the OR looking for tubing that seems to connect in infinite ways, looking at drugs that could literally kill pts if not given properly, trying to hang blood for the first time and missing the days when i could just order it and have the pt's Hct magically increase the next morning, getting yelled at by surgery attendings right after my anesthesia attending leaves the room - "Can we get a valsava?....(In my head-Hmmm, can the pt really bear down while unconscious?) Ummm...then moments of awkward silence...then call the attending and look like a *****. This feeling passes right??

Then there's the stuff you don't see as med students, getting there at 5:45 to set up your room, getting the evil eye by surgery when your inexperience delays the pt waking up at the end of a case, trying to turn over your room and do pre-ops in 5 min or less, wondering if you should do something about a spike in pressures or just wait and watch, getting yelled at when your pt moves even after your attending tells you the amount of gas to put on board
, coming home dead tired every day and then coming back for more the next morning, being anxious everyday just doing simple procedures such as IVs, not to mention a-lines or central lines.
This is probably the steepest learning curve i've had. Sorry if it sounds like i'm complaining because honestly it beats internal medicine 100 fold. We don't get calls about a K+ of 3.8, try to play social worker every day, or have to deal with drunk pts at 4 in the morning. I see now why we get compensated so well. It's just that i've never felt so much responsibility in such a short amount of time. I'm sure it'll get better, or at least that's what i'm telling myself.....

it gets better for sure...concerning your med student comment...who did you shadow when you did the rotation...everything that you mention is pretty easy to see when shadowing...i dont know how they hid it from you

 

[Leverage]

So intern year has passed and like many of you i've prayed for this day to come when internal medicine was just a bad nightmare that is now over and done. Now onto the wonderful world of volatile anesthetics and epidurals. How grand life would get now...

Is it just me or does Anesthesia seem that much more stressful, overwhelming and tiring than what we remembered as med students??? I honestly have never felt as unconfortable with my patients as i do now. At the end of intern year i felt on top of the world, like i could handle almost anything that came to the ER door. Now it feels like getting kicked in the nads again....At times lost in the OR looking for tubing that seems to connect in infinite ways, looking at drugs that could literally kill pts if not given properly, trying to hang blood for the first time and missing the days when i could just order it and have the pt's Hct magically increase the next morning, getting yelled at by surgery attendings right after my anesthesia attending leaves the room - "Can we get a valsava?....(In my head-Hmmm, can the pt really bear down while unconscious?) Ummm...then moments of awkward silence...then call the attending and look like a *****. This feeling passes right??

Then there's the stuff you don't see as med students, getting there at 5:45 to set up your room, getting the evil eye by surgery when your inexperience delays the pt waking up at the end of a case, trying to turn over your room and do pre-ops in 5 min or less, wondering if you should do something about a spike in pressures or just wait and watch, getting yelled at when your pt moves even after your attending tells you the amount of gas to put on board
, coming home dead tired every day and then coming back for more the next morning, being anxious everyday just doing simple procedures such as IVs, not to mention a-lines or central lines.

This is probably the steepest learning curve i've had. Sorry if it sounds like i'm complaining because honestly it beats internal medicine 100 fold. We don't get calls about a K+ of 3.8, try to play social worker every day, or have to deal with drunk pts at 4 in the morning. I see now why we get compensated so well. It's just that i've never felt so much responsibility in such a short amount of time. I'm sure it'll get better, or at least that's what i'm telling myself.....

I can't wait for next year.

 

[Arch Guillotti]

So intern year has passed and like many of you i've prayed for this day to come when internal medicine was just a bad nightmare that is now over and done. Now onto the wonderful world of volatile anesthetics and epidurals. How grand life would get now...

Is it just me or does Anesthesia seem that much more stressful, overwhelming and tiring than what we remembered as med students??? I honestly have never felt as unconfortable with my patients as i do now. At the end of intern year i felt on top of the world, like i could handle almost anything that came to the ER door. Now it feels like getting kicked in the nads again....At times lost in the OR looking for tubing that seems to connect in infinite ways, looking at drugs that could literally kill pts if not given properly, trying to hang blood for the first time and missing the days when i could just order it and have the pt's Hct magically increase the next morning, getting yelled at by surgery attendings right after my anesthesia attending leaves the room - "Can we get a valsava?....(In my head-Hmmm, can the pt really bear down while unconscious?) Ummm...then moments of awkward silence...then call the attending and look like a *****. This feeling passes right??

Then there's the stuff you don't see as med students, getting there at 5:45 to set up your room, getting the evil eye by surgery when your inexperience delays the pt waking up at the end of a case, trying to turn over your room and do pre-ops in 5 min or less, wondering if you should do something about a spike in pressures or just wait and watch, getting yelled at when your pt moves even after your attending tells you the amount of gas to put on board
, coming home dead tired every day and then coming back for more the next morning, being anxious everyday just doing simple procedures such as IVs, not to mention a-lines or central lines.

This is probably the steepest learning curve i've had. Sorry if it sounds like i'm complaining because honestly it beats internal medicine 100 fold. We don't get calls about a K+ of 3.8, try to play social worker every day, or have to deal with drunk pts at 4 in the morning. I see now why we get compensated so well. It's just that i've never felt so much responsibility in such a short amount of time. I'm sure it'll get better, or at least that's what i'm telling myself.....

It all passes in time. Residency really does fly by (as I sit here studying for the board exam wondering why I didn't read more in residency). Enjoy this initial time when everything is new and exciting (and frustrating). About a year from now when you are sitting cranis and cabg's and AAA's and sick peds and everything is new yet again you may wistfully wish you were sitting something "easy". At some point you will look around and think to yourself "damn I just CRUSHED that difficult airway" or "damn I just massively resusciated that very sick dude" and you will know that eventually you can handle anything that comes your way. Of course right after that you may be humbled by an epidural on a 500 pound beast...

 

[DreamLover]

So intern year has passed and like many of you i've prayed for this day to come when internal medicine was just a bad nightmare that is now over and done. Now onto the wonderful world of volatile anesthetics and epidurals. How grand life would get now...

Is it just me or does Anesthesia seem that much more stressful, overwhelming and tiring than what we remembered as med students??? I honestly have never felt as unconfortable with my patients as i do now. At the end of intern year i felt on top of the world, like i could handle almost anything that came to the ER door. Now it feels like getting kicked in the nads again....At times lost in the OR looking for tubing that seems to connect in infinite ways, looking at drugs that could literally kill pts if not given properly, trying to hang blood for the first time and missing the days when i could just order it and have the pt's Hct magically increase the next morning, getting yelled at by surgery attendings right after my anesthesia attending leaves the room - "Can we get a valsava?....(In my head-Hmmm, can the pt really bear down while unconscious?) Ummm...then moments of awkward silence...then call the attending and look like a *****. This feeling passes right??

Then there's the stuff you don't see as med students, getting there at 5:45 to set up your room, getting the evil eye by surgery when your inexperience delays the pt waking up at the end of a case, trying to turn over your room and do pre-ops in 5 min or less, wondering if you should do something about a spike in pressures or just wait and watch, getting yelled at when your pt moves even after your attending tells you the amount of gas to put on board
, coming home dead tired every day and then coming back for more the next morning, being anxious everyday just doing simple procedures such as IVs, not to mention a-lines or central lines.

This is probably the steepest learning curve i've had. Sorry if it sounds like i'm complaining because honestly it beats internal medicine 100 fold. We don't get calls about a K+ of 3.8, try to play social worker every day, or have to deal with drunk pts at 4 in the morning. I see now why we get compensated so well. It's just that i've never felt so much responsibility in such a short amount of time. I'm sure it'll get better, or at least that's what i'm telling myself.....

I feel like I wrote this myself!

...and let's not forget calling a different attending every night just to sound stupid and be like uhm....we can use roc... oh you want to use cis-at ....okay........and uhm, yeah, I know everything about this patient down to the last CXR, EKG, Labs, current meds and H&P but I don't know how many units of PRBCs she's required since admission....(thinking to myself-and I'm not driving back to the hospital to find out)...this was my conversation like 5 min ago with my attending in the morning...

430am will be here in a blink of an eye thus 530 am will be here before I know it and I will be mixing up my epi and phenylephrine like a champ...time to go pretend like I have a life before I fall asleep in 2 hours!!

 

[Calilove]

It DOES get better in some ways.... and WORSE in others as you progress in years and knowledge base and skill!!!

My CA-1 year: constant fears of harming the patient because of my inexperience, wondering will I/will I not get THIS ETT/IV/Central and a-line in before the attending pushes me out of the way while I'm flailing, nervous because always being left alone in the room, complete exhaustion by the time I get home, getting asked questions for 30 minutes by the attending on the phone at 7 pm for the next day's pre-op, nurses/surgeons barking at you to release their own life's frustrations

My CA-2 year: constants fears of harming patient because they are Sick As S tink!, getting 90% of my ETT/IV/Central and a-lines in only for the attending to give me a 30 minute lecture on the only RIGHT/BEST (their) way of doing that procedure, attendings in the room ALL of the time because this patient is Sick As Stink, complete exhaustion by the time I get home, getting asked pre-op questions for 30 minutes by the attending at 7pm, nurses no longer barking at you but being PASSIVE AGGRESSIVE, surgeons barking at you to release their own life's frustrations

My CA-3 year: All patient Sick as S tink but it'll be o.k. because you're always prepared, getting 99.9% of my ETT/IV/Central and a-lines in before the attending argues with MY technique (which allowed me to get 99.9% in!), attendings coming by the room once every 3-4 hours commenting that I should get used to not getting any bathroom/lunch breaks because that's how it is in private practice prior to leaving me alone again for another couple of hours (NOTE: always failing to mention that in private practice, we won't have the too-stupid-to-know-how-much-he-doesn't-know 3rd year general surgery resident teaching the surgical intern how to perform a "proper" skin closure and further prolonging the case another hour!, complete exhaustion because I'm getting home later than ever!, nurses still PASSIVE AGGRESSIVE at times but we "understand" each other now, surgeons still bark but now I'm barking back because we're all in this together!

Some things get better during residency, however alot of other things come along and SUCK it just the same!
Any attending that comes to you saying that BS "I wish I could go back into residency" is a freakin' liar! Noone enjoys the above parts of resident education.
However, there are some cool things that will disappear after you've finished that you can't get back as an attending i.e. camaraderie amongst other residents..... ok..... I can only think of that ONE THING!

Just BOW YOUR HEAD and keep a low profile (STAY LO-PRO) during your residency! ITS ALWAYS DARKEST BEFORE DAWN...

 

[drfeelgood]

Just curious why sux was given if vec (I will assume a "stick" is 10 mg) was already on board. Also, do you routinely have your meds drawn up during a C-section? I have the syringes on the top of the cart but no meds besides the Ancef, Neo, and bag of pit on the top of my cart.

The senior resident didn't know that a stick of vec was given. He just happened to walk into a room with an apnic patient in respiratory distress....,

 

[Gas]

Goals for residency:

CA-1: How to recognize trouble
CA-2: How to deal with trouble
CA-3: How to prevent trouble from happening in the first place

 

[Jeff05]

some things will get better. others will get worse.
overall, it will get "easier" to make it through an average day at work.
hang in there.
learn what you can.
help who you can.
try to stay out of $hit.
make a couple of well placed stands, if you must (preferably after acquiring a good reputation).
live your life in the meantime and when it's over, leave 'em in your dust.

 

[Mman]

I'll just echo what was said above.

By the end of each academic year since med school thus far, I've felt pretty darn good about what I was doing. Then the next step came and I was over my head for a while until I got the hang of it.

When I first started as a CA1, I was amazed at how physically and mentally drained I was at the end of each day. Then as the year went on it got easier and easier. Then as a CA2 I did peds and cards and thoracic and other subspecialty rotations where I once again felt clueless at the start before figuring it out. Now I'm a CA3 and I feel I can do any case that pops up before me, but I'm learning how to supervise CRNAs and junior residents and it is taking some getting used to. By the end of the year, I'm sure I'll have it figured out.

 

[GassiusClay]

There is a lot of talk about how hard residency is or gets. But, how is it once out? That's the most important thing. X years can be not so good, but it should be good after that.

Any of you guys able to compare to private practice life to residency? My main issue will be hours. I just don't care to work forever 70-80 hours a week. Some may want to for big bucks, but I think people still can afford a good lifestyle even working 50-60.

 

[Dryacku]

There is a lot of talk about how hard residency is or gets. But, how is it once out? That's the most important thing. X years can be not so good, but it should be good after that.

Any of you guys able to compare to private practice life to residency? My main issue will be hours. I just don't care to work forever 70-80 hours a week. Some may want to for big bucks, but I think people still can afford a good lifestyle even working 50-60.

Questions should like this should not even be allowed on this forum. If you already dont know that answer to this question you should have never went into this field.

Dude we work way more then surgeons. Think about it every time theres a surgery you have to be there 1 hour before and then at least an hour after. You should def switch to gen surgery.

Also theres a huge pay cut once your in private practice. Go to nursing school

 

[dfk]

that's funny.
a med student telling a resident to leave and go to nursing school.
did i say that was funny sh it already?

 

[cfdavid]

Questions should like this should not even be allowed on this forum. If you already dont know that answer to this question you should have never went into this field.

Dude we work way more then surgeons. Think about it every time theres a surgery you have to be there 1 hour before and then at least an hour after. You should def switch to gen surgery.

Also theres a huge pay cut once your in private practice. Go to nursing school

Sure dude. He should go to nursing school because he doesn't want to work 80 hours/week for the rest of his life. What a sissy.....🙄

Posts like YOURS should be considered more taboo than a resident inquiring about his future in PP. Wow.