When / how did you fall in love with Gas?

[dre]

Hi everyone. Congrats to the newly matched. I have been seriously considering Gas for the past few months, mostly based on my enjoyment of Critical Care, the friendly personalities of anesthesiologists I've met, and the good lifefstyle (I'd be lying if I didn't admit this is an important consideration).

Well, I'm currently doing an elective in Gas and find it to be . . . kinda boring. This, of course, was disappointing because I am now forced to reconsider going into Gas. Now, I don't know if this is just my perspective as a medical student who is nowhere near the skill and knowledge of the residents and attendings who are rationally carrying out an anesthetic plan. However, I've also learned that a lot of the intraoperative process is based on anesthesiologist preference (i.e., the art of Gas) which I'm obviously not knowledgeable enough to experience yet.

Thus, I was wondering how any of you who are in Gas now (or soon entering Gas) who speak so favorably of it fell in love with it? What drew you to the field (besides lifestyle)? Did anyone feel hesitant about Gas but still go for it anyway and then realize how much they enjoyed it later on?

Thanks for any input.

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[UTSouthwestern]

Like you, I took an anesthesia elective as a third year and was not bowled over by the rotation. While I was in internal medicine, I remember being on call in the ICU on a nightmarish night in which no fewer than four patients coded almost simultaneously. One 17 year old patient required immediate intubation and no one could intubate her despite her normal appearing airway. An anesthesiologist who happened to be following up on one of his patients from earlier in the day (open AAA), saw the commotion, made all of us look silly by putting a 9.0 ET tube in the girl's huge airway, and invited me to work with him and anyone else I could find in the OR.

After working with him one day and getting an opportunity to do several intubations (and finding out that my technique was really rather crude), I saw an anesthesiology resident and asked to shadow him the next day. I did not know that I was going to shadow him for an AVR and 3V CABG. Watching them do all of the procedures (minus the intubation which they suprisingly gave to me, but otherwise including double sticking the R IJ, an arterial line, PAC, and TEE) in 30 minutes, I was won over. The fact that the physiology of what I thought I knew so well (cards) was so clearly explained to me throughout the case also convinced me that at the very least, I had to see and do more.

A month later, I was applying all over the country to transfer to anesthesiology.

 

[jetproppilot]

I initially went to med school with aspirations of doing ER because I worked as a firefighter/paramedic after high school for a couple years. Because one's clinical rotations are very influential on career choices, U of Miami's lack of an ER residency (at the time) meant I wasnt exposed to the ER residency thing. I remember doing my clerkships....do I want to do...medicine? nope. Peds? nope. OB/GYN? nope. Surgery? nope. etc etc.
We had a gym at the med school where students/residents worked out whenever free time allowed. I remember an anesthesia resident telling me how much he enjoyed anesthesia and how bright the future was for him. Kinda sparked my interest. Then during my anesthesia rotation I was paired with one of the chief residents, Rob Mason. Outgoing, charismatic dude. Knew his trade well, and enjoyed it. And it showed. I began to notice there were alot of residents like Rob. Yeah, the grind of residency sucked periodically, but for the most part most of them enjoyed the specialty.
One day I hung around one of the cardiac anesthesiologists (Barron), and watched him do a CABG. Deft with all the procedures, knew physiology and pharmacology cold. I was like, WOE DUDE! There is no physiologic parameter this critically ill patient can throw at this guy that he can't fix!

Changing gears though, its important for med students, when selecting a specialty, to realize their priorities will change over the next 10-20 years. Residency will end. Will you be happy with the demands of your specialty? Many docs live for the career. I respect them. I am not one of them. Don't get me wrong- I love my job-and I'm good at what I do.. but my priorities have changed. I have a family...wife, kids...they mean more to me than my job, and had I picked a specialty that required 80 hours a week now, I'd be bumming big time. At work, I don't need to be in every CABG or AAA. Yes, I like the rush sometimes, but not all the time. Tonight I had a crash C section for absent fetal heart tones..into the room, pule ox & BP cuff on, propofol, sux, tube, HURRY HURRY! Its good to do those sometimes now, but boring is OK for me at this point too.
UTSouthwestern said it well: Anesthesia has alot to offer. Wanna be the man? Critical Care has many dominant anesthesiologists. Want your own patients? Pain. Want banker hours (OK, a little early for a banker, but you get the point)? Surgery center. Wanna be a partner in a group? Thats available too.
SO to end this post, I'm eight years out of residency now and am still happy- no I'm HAPPIER with my career choice than ever. My job gives me job satisfaction, the ability to care for healthy elective-surgery patients one day and critically ill patients the next, I make more money than I'd ever dreamed of, and I have more vacation than a school teacher. I have an enviable life, thanks to the career choice I made. I am very blessed.

 

[dre]

thanks for the responses UT and jetpro. helps put things in perspective when it comes to the profession. anyone else care to share whether or not they were certain about anesthesia prior to residency?

thanks!

 

[VentdependenT]

I had always thought I would be a general surgeon. During my third year rotation I first assisted every case because I could read the surgeons next moves and used my brain throughout the operation. He booted his hired first assist for the month and let me at em..anyways that got me excited. Fluids, acid base, blood, guts, laproscopes (good at video games so why not), acute interventional possibilites, all of that was appealing. Medicine was out...no way...I don't care to fly into pedantic tangents about the folic acid pathway during rounds when the patient wont even take his BP meds. Peds, not a big kid guy. OB, pfff yeah right. Psychiatry, I dont need anymore crazy. I enjoyed aspects of ER, its like clinic but on crack with more sarcasm. A definite possibilty.

I then did a surgery sub-I and sicu and the lifestyle of the GS residents (and attendings for that matter) was just a major turnoff. These guys are constantly getting slammed on the floors and in the ER. They are the hands of the hospital and as such get abused by every service. They get slapped around in the OR and on the floors, not to mention M&M. Sheeeeaut. I wasn't going there. Not worth it. Well, perhaps so if I was only in the OR all day. I have respect for those folks. Yes I understand that very few residencies are a cake walk but the kicker was that the actual lifestyle of a GS had become apparently disagreeable with my own ambitions.

I do not have a commanding authoritative attitude. I'm a bit too open minded to take on that persona. This is not to be misconstrued for lazieness or indifference, both of which are intolerable to me. I just don't need to be in the headlines or have pats on the back by myself or others. I'd rather lay down air support than be at the front lines bayonetting the enemy. Thats sort of a decent analogy...

Never the less I was somewhat disenchanted. So I decided to "chill out" on my next rotation in Seattle where I had some good buddies and some family. Hey, it was August, the city rocks, and anesthesiology was open. The only thing I knew going into it was that you give glycopyrolate after neostigmine for nmb reversal. No idea what I was in for. First day in the OR I was hooked. These folks were masterful clinical pharmacists and physiologists who were at the helms of their own ships. Its so much different on that side of the curtain. I went out and bought baby miller on my first day. It was amazing how much thought can go into every single intervention one makes. In addition there was adequate exposure to anatomy through lines, airways, and blocks for my needs. The staff was great at Harborview and they really made me think AND participate during cases. In addition, critical care is enticing in itself. I will be extremely satisfied cerebrally with the incorporation of that knowledge perioperatively, in the PACU, and the SICU. Plus my personality just felt right for the field.

ER as an itern was great. I truely liked the atmosphere and feeling of comradery with the other residents. That, by far, was its biggest draw for me. However the inexorable waves of BS, the outpatient primary care suff, the noncompliant 18th time pancreatitis gas guzzlers, prevented me from giving the field serious consideration.

That was a somewhat discordant walkthrough but hopefully it should suffice.

 

[HomerSimpson]

Hey man,

good question and observations. Anesthesia certainly can be boring. My last Lap Chole was about as routine as you can get. So I understand your concern. Even complex pathophysiology and emergency airway management, invasive monitoring, taking care of sick sick sick patients can get rather routine, and mundane after a while.

I have two points though.

1. Boring in the OR is a GOOD thing. Excitement in the OR usually means the patient is about to meet his maker i.e. ruptured AAA, crash PTCA, lost airway, etc. Therefore realize that in anesthesiology the main goal is a controlled safe elegant and maybe boring case. Boring means that the patient is probably gonna do well. Realize that it takes a lot of skill and foresight to make a case "boring"

2. Name a specialty to me that is exciting all the time. Ortho? ENT? IM? ER? Gen Surg? Radiology? Peds? FP? All specialties have routine and common things about them For every one pheochromocytoma, a gen surgeon will see about 1000 hot gallbladders. you talk to a gen surgeon about how exciting this lap chole is gonna be and she will probably burst out laughing. It can get exciting but why would you want it to be?? IM diabetes; Ortho knee scopes; Peds - runny noses; ER drug seekers; list goes on man.

Now if it is excrutiatingly boring then reevaluation may be in order. I suggest the next case you do ask the ATTENDING staff anesthesiologist to do it with you. Ask about the details of the case as they are doing it. There is a lot of stuff that needs to be done in a safe and timely( that means fast) manner. They also maybe able to give a better insight as to how this would be like as a career.

good luck to you