What makes you LOVE anesthesia?

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wundabread

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OK, so just a quick question for the RESIDENTS or ATTENDINGS (not students please), only people who get up every morning to be an anesthesiologist:

If in medicine, it's the art and the chess game of diagnosis that keeps things interesting, what keeps you going in anesthesia? What's still cool when all the procedures are routine?

Please note that I'm not that enamored with medicine. I am excited about anesthesiology, but I have reservations about what happens when you have done all of the procedures a thousand times, and you are sitting in an OR charting vitals for the 10, 000th time.

Now, medicine has plenty of BS to burn you out, but the people who love it have those great diagnoses as the light at the end of the tunnel, the mental challenge that makes all the BS worthwhile. For the family practice doc it's caring for a whole family and watching them grow up. For the surgeon it's the technically difficult procedure. You get the idea, each specialty has its own ideal rewarding situation.

What is the equivalent in anesthesiology? The procedures are great, but become more routine (as is the nature of procedures). The patient interaction is short but sweet, and I can see that being a plus, but is that what keeps the greatest anesthesiologists going?

I'm not trying to be inflamatory, I've just been wondering about burnout.

Unfortunately, when I ask a lot of people what they like about anesthesiology, they cite money, lifestyle, lack of paperwork/BS and that kind of stuff. All significant, but none of it is about the actual work IS and all of it about what IS NOT.

The best people in their fields love what they do. What makes you LOVE it? What makes you want to do it every day for the rest of your life?

Please do NOT respond about what's bad about other specialties. That's a smoke screen. Do not tell me how anesthesiology has minimal scut and good hours, etc. I know that is true, but that's not the issue. Also, please do not respond if you are not an anesthesiologist.

I just want to know what makes an anesthesiologist wake up in the morning and say, "Damn I love my job!"

What makes the great anesthesiologist LOVE anesthesia?

Thanks,
wundabread

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>If in medicine, it's the art and the chess game of diagnosis that >keeps things interesting, what keeps you going in anesthesia? >What's still cool when all the procedures are routine?

My job as an anesthesiologist is to make everything look routine and boring, even if it isn't. If everyone THINKS I am just sitting back there charting and falling asleep, then I am doing a great job. One of the things that make procedures cool even after you've done them a hundred times is that each patient may present a serious challenge. Trust me, routine procedures and cases are only routine half the time. The other half may be a struggle or a flail. Usually, we make the unexpected look routine and all observers are completely unaware of it. Plus, the routine procedures require plenty of practice and improvisation.

Last week I had a routine iv placement turn into a 2 hour iv flail with 4 anesthesiologists and a surgeon trying to put an iv in a 1 year old for a 30 minute I&D case. I took care of a 28 week premie where the transport from the NICCU was the most dangerous part of the surgery. Not all intubations are straight forward, and patients can react drastically different from the anesthetics. Today, a routine intubation ended up being an emergency trach. A month ago, a routine T&A on a child ended up being anaphalactic shock to latex. It is not uncommon for an experienced anesthesiologist to go several weeks with difficult placing an art-line, regional anesthetic and even an epidural. I had to place a routine epidural in a 340 lb pregnant woman, and 1 hour later, 3 anesthesiologists and a wet tap we finally got it in. I recently placed a Central Line in a patient who was prone and had to intubate another patient who was prone and loss their ETT in the MICU.

I look forward to improving my technique, management, and preparation for disaster. Whatever I can do, someone else can do better and I want to be that good.
 
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FASCINATING INSIGHT , RESIDENTPHYS! I'M REALLY INTERESTED IN ANES, & AT TIMES YOU JUST READ THE SAME THREADS ABOUT MONEY, RESPECT,ETC... YOU SUBSPECIALIZING, BY CHANCE?
 
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Nope, I don't plan to specialize. There is so much to learn that if I specialize in one thing (cardiac, pain, or peds) it guarantees that I will lose my skills in something else. It's amazing to see a pediatric cardiac anesthesiologist struggle when it comes to doing a neuro case or even an ECT. You lose it if you don't use it. I would rather be good enough in all cases than compromise what I already know.
 
i am going to tell you why I LOVE anesthesia.... the funny thing is that five days out of six, on my walk home i think to myself: "gee, i love my job and i couldn't imagine doing anything else...."

the reason revolves around critical issues and stress... I love it when it gets hard, when patients are trying to die, I love the faces on the nurses and on the surgeons when the **** hits the fan and everybody is staring at you, hoping that you can fix it or manage it.... here is a funny side note: on a pedi vascular case, the vascular surgery fellow told me (close to the end of the case) that he needed to step out and was wondering if i would be ok (he is a nice considerate guy)... my answer was: "sure if this kid arrests, you will be the first person i call :)" he laughed, realizing that we are the go-to-men(women) for when **** hits the fan...

but i also love the straight forward stuff... the mundane business of anesthesia... the art of making everything look easy at all times... sure if you want to be a cowboy you can choose NOT to plan ahead and then make a big scene, or you can just quietly pre-emptively nix out problems as they pop up.... I love the fact that I can walk home knowing that i participitated in the care of patients who are at some of the most stressful points of their lives.... I love the fact that i have to think fast on my feet (i am part of the Code team - for airway management) and the medical/surgical team trusts us on all critical care issues... we even run the surgical ICU (at MGH), so your exposure is broad...


the best choice of my life, couldn't be happier (oh, and did i mention that i have a social life)
 
Thanks for the insightful answers. This is exactly what I was looking for. I hear a lot from people who are happy to rehash many fourth-hand generalizations about anesthesiology, and it has been great to hear it straight from the horse's mouth so to speak.

Please keep the great input coming.
 
Tenesma, I love the fact that at Southwestern, we are the ones that are present most consistently from code situation to code situation. I find that we end up running the codes more than our medicine or surgical colleagues simply because we are there for every medicine or surgical code. Best thing is that after we have resuscitated the patient and written our notes, we're done.

On a recent code at Parkland, the anesthesiology team comprised of myself and a PGY-1 on an anesthesiology month were the first docs there, secured a cric (pt had L neck hematoma s/p MVA), resuscitated the pt with 2 rounds of atropine & 3 rounds of epi, and were placing a R subclavian cordis by the time the surgical residents and MICU team arrived. Granted it is early in the new year and they got a little lost on the way down, but it was exceptionally gratifying to be able to hand over a now stable patient to the surgical attending and her team, without having to call our own attending, and within a span of 10 - 15 minutes.
 
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