Why do other people misunderstand anesthesiologists?

[dara678]

Sorry, but I have to get on my soapbox. I think anesthesiology is one of the best specialties in medicine -- hence why I am dedicating the next couple years of my life to studying it. However, when I tell the people I am going into anesthesiology, I get perplexing responses. One guy (a radiology fellow) said, "She's going into it so she can leave at 3." Huh?????? I've done nine weeks of anesthesia in my short medical school career and I RARELY, if ever, left at 3. Cases would end at 5 or 6 and there would be preops to do! Then, in another rotation, my resident was like, "What do pediatric anesthesiologists do? They just put babies to sleep in MRI. And they get to leave at 5. Can you sense our bitterness?" HUH????? If you're bitter, why did you go into your specialty of choice? Why are you ragging on anesthesia? And peds anesthesia is an intense subspecialty -- putting kids to sleep can be some of the most difficult cases you can do. I don't get it. Do they think that we sit around and twiddle our thumbs all day? If so, then how can we get them to change this perception? I don't know about the residents out there, but my perception was that, although it isn't neurosurgery or anything, you certainly put in a lot of hard hours. Much unlike the specialty of this particular resident I am speaking of (I am unsure of why she was complaining in the first place, because we spent most of the day just sitting around and chatting).

---

Members don't see this ad.

 

[GasEmDee]

It is one of the best specialties and also one of the most intense. However, I think that a lot of what we do is totally opaque to an outside observer. In the OR, you might have a very sophisticated understanding of the patient's physiologic state and the insults that it is undergoing, and you might be doing heroic things, but to the untrained eye, it just appears that you are simply standing there, or pushing syringes, or watching numbers. Also, the fact that we often relieve one another, while surgeons usually keep working till the end of the case, fosters the illusion that we are interchangeable, and thus, just commodities.

Sorry, but I have to get on my soapbox. I think anesthesiology is one of the best specialties in medicine -- hence why I am dedicating the next couple years of my life to studying it. However, when I tell the people I am going into anesthesiology, I get perplexing responses. One guy (a radiology fellow) said, "She's going into it so she can leave at 3." Huh?????? I've done nine weeks of anesthesia in my short medical school career and I RARELY, if ever, left at 3. Cases would end at 5 or 6 and there would be preops to do! Then, in another rotation, my resident was like, "What do pediatric anesthesiologists do? They just put babies to sleep in MRI. And they get to leave at 5. Can you sense our bitterness?" HUH????? If you're bitter, why did you go into your specialty of choice? Why are you ragging on anesthesia? And peds anesthesia is an intense subspecialty -- putting kids to sleep can be some of the most difficult cases you can do. I don't get it. Do they think that we sit around and twiddle our thumbs all day? If so, then how can we get them to change this perception? I don't know about the residents out there, but my perception was that, although it isn't neurosurgery or anything, you certainly put in a lot of hard hours. Much unlike the specialty of this particular resident I am speaking of (I am unsure of why she was complaining in the first place, because we spent most of the day just sitting around and chatting).

 

[coprolalia]

Our specialty is one where, the better and more "slick" you are, the less people realize that you are actually working. We are victims of our own successes. Of course, when the **** hits the fan, then people get a chance to see how we earn our money.

-copro

 

[Tenesma]

so true... nobody cares for anesthesia until the crap hits the fan - and then everybody LOVES anesthesia...

my favorite were the young gun surgical residents (usually PGY-2 or 3) who were convinced they ruled the world (as long as their seniors weren't around) - they would poo-poo anesthesia, but they would be the first to cry the loudest for anesthesia to come bail them out with a crashing patient...

 

[nociceptor]

This should be our theme song. Everybody sing it now.



[YOUTUBE]http://www.youtube.com/watch?v=z4yVN5CKwJ4[/YOUTUBE]

 

[Bertelman]

1) That's pretty good production value for a 60's video

B) I think the guy on the synth is a PGY-1 in my program

3) I f&^#'in love YouTube

 

[Jeff05]

it's true that most surgeons (the people we spend our entire careers with) have NO idea what we know. they will tell you when or when not to give blood or fluid or when the patient is "light" or "awake." medicine people will look at you funny if you offer some gentle advice during management of a crashing pt (you can put in a central line in about 60 seconds, diagnose that arrhythmia and treat it, correct the hypotension while diagnosing the causes, etc) - why is this anesthesia guy even talking, he's just here to put in the tube.


YOU WILL KNOW MORE ABOUT TAKING CARE OF REALLY ACUTELY SICK PATIENTS THAN ANYONE ELSE IN THE HOSPITAL - BUT, NO ONE WILL KNOW THAT YOU KNOW THIS.


here's what:

IF YOU NEED ANESTHESIOLOGY FOR EGO GRATIFICATION - you will be disappointed. my advice, don't worry about educating others about how great we are (they don't care), it will be our little secret. take joy in the small victories (breaking that kid's laryngospasm, doing a slick awake intubation, waking up a patient after a 12 hour prone 6 level spine case, extubating, and having him complain of 0/10 pain, doing the perfect epidural, etc), take joy in, at least for now, the fact you will be well compensated, and in the fact that at the end of the day, you get to leave the hospital behind and have a life.

 

[militarymd]

it's true that most surgeons (the people we spend our entire careers with) have NO idea what we know. they will tell you when or when not to give blood or fluid or when the patient is "light" or "awake." medicine people will look at you funny if you offer some gentle advice during management of a crashing pt (you can put in a central line in about 60 seconds, diagnose that arrhythmia and treat it, correct the hypotension while diagnosing the causes, etc) - why is this anesthesia guy even talking, he's just here to put in the tube.


YOU WILL KNOW MORE ABOUT TAKING CARE OF REALLY ACUTELY SICK PATIENTS THAN ANYONE ELSE IN THE HOSPITAL - BUT, NO ONE WILL KNOW THAT YOU KNOW THIS.


here's what:

IF YOU NEED ANESTHESIOLOGY FOR EGO GRATIFICATION - you will be disappointed. my advice, don't worry about educating others about how great we are (they don't care), it will be our little secret. take joy in the small victories (breaking that kid's laryngospasm, doing a slick awake intubation, waking up a patient after a 12 hour prone 6 level spine case, extubating, and having him complain of 0/10 pain, doing the perfect epidural, etc), take joy in, at least for now, the fact you will be well compensated, and in the fact that at the end of the day, you get to leave the hospital behind and have a life.

that, my friend, is why the other doctors don't think we're doctors.

 

[militarymd]

it's true that most surgeons (the people we spend our entire careers with) have NO idea what we know. they will tell you when or when not to give blood or fluid or when the patient is "light" or "awake." medicine people will look at you funny if you offer some gentle advice during management of a crashing pt (you can put in a central line in about 60 seconds, diagnose that arrhythmia and treat it, correct the hypotension while diagnosing the causes, etc) - why is this anesthesia guy even talking, he's just here to put in the tube.


YOU WILL KNOW MORE ABOUT TAKING CARE OF REALLY ACUTELY SICK PATIENTS THAN ANYONE ELSE IN THE HOSPITAL - BUT, NO ONE WILL KNOW THAT YOU KNOW THIS.


here's what:

IF YOU NEED ANESTHESIOLOGY FOR EGO GRATIFICATION - you will be disappointed. my advice, don't worry about educating others about how great we are (they don't care), it will be our little secret. take joy in the small victories (breaking that kid's laryngospasm, doing a slick awake intubation, waking up a patient after a 12 hour prone 6 level spine case, extubating, and having him complain of 0/10 pain, doing the perfect epidural, etc), take joy in, at least for now, the fact you will be well compensated, and in the fact that at the end of the day, you get to leave the hospital behind and have a life.

that, my friend, many well trained CRNA's can do also

 

[VentdependenT]

that, my friend, many well trained CRNA's can do also

Sign me up!

I'm a ready ta g'head n' trade in mah fanciee doktor cerrr-tiff-eeee-kut fer one o' them there rock solid as Geee-suhs Seeeyarrrn'A thingies. T'a hell if I'ma gonna go down with this here sinking heap of $hit!

 

[militarymd]

Sign me up!

I'm a ready ta g'head n' trade in mah fanciee doktor cerrr-tiff-eeee-kut fer one o' them there rock solid as Geee-suhs Seeeyarrrn'A thingies. T'a hell if I'ma gonna go down with this here sinking heap of $hit!

U.S.S. Anesthesiology is not sinking....because of everything that is happening both within medicine and the economy and governmental regulations.........


I do believe that it is coming about to a new heading.

 

[VentdependenT]

Speaking of CRNA moments I got one for ya! And its an EGO booster or shatterer to boot! Just depends on whose side yer on pardner.

AIRWAY CODE overhead to MICU. Myself, a CA-1, and a NEWLY MINTED FRESH OFF THA GRADyeeeuuuuaten RUSH SRNA class head up to the code. Its about midnight mind you, on call.

I say to the CA-1, have at it. SRNA, ahem, CRNA cuts me off and says to everyone in the room as they are helping the CA-1 set up suction, bag, postioning etc. "Hey, whats the situation here! When did he eat last!"

Ok I says to myself, thats reasonable. Even though I'm gonna tube this gomer whose clearing sputtering out. I could care less when they ate last. The tubes goin in.

So she finishes her inquistion, nobody knows the answers to her questions of course.

I'm sitting in the corner watching the CA-1 and nod for him to go ahead. Spray the mouth and use brutane says I. One of the nurses says something funny/nice to me as I'm just sitting there and I say "well, I'm just having a senioritis moment here" (as in my residency is comming to a close). CRNA turns to me and says with all the seriousness and pride and zeal of an american flag burning taliban "Well technically, I have the most seniority here." She then proceeds to try and take the airway.

I felt like I just got b!tch slapped.

I just say "why don't you let CA-1-name handle it."

You want ego, thats F'n ego dude. CA-1 nailed the tube and I went to bed. I've never spoken to that person since. At least not directly or intentionally.

 

[VentdependenT]

Oh yeah, I just stole your thread. For an awful cause. Sorry.

 

[bullard]

Wow, what a b**ch. But do your CRNAs always join you for airways/codes? Ours prefer to leave the hospital at 3 pm. Have never seen them at a code.

Speaking of CRNA moments I got one for ya! And its an EGO booster or shatterer to boot! Just depends on whose side yer on pardner.

AIRWAY CODE overhead to MICU. Myself, a CA-1, and a NEWLY MINTED FRESH OFF THA GRADyeeeuuuuaten RUSH SRNA class head up to the code. Its about midnight mind you, on call.

I say to the CA-1, have at it. SRNA, ahem, CRNA cuts me off and says to everyone in the room as they are helping the CA-1 set up suction, bag, postioning etc. "Hey, whats the situation here! When did he eat last!"

Ok I says to myself, thats reasonable. Even though I'm gonna tube this gomer whose clearing sputtering out. I could care less when they ate last. The tubes goin in.

So she finishes her inquistion, nobody knows the answers to her questions of course.

I'm sitting in the corner watching the CA-1 and nod for him to go ahead. Spray the mouth and use brutane says I. One of the nurses says something funny/nice to me as I'm just sitting there and I say "well, I'm just having a senioritis moment here" (as in my residency is comming to a close). CRNA turns to me and says with all the seriousness and pride and zeal of an american flag burning taliban "Well technically, I have the most seniority here." She then proceeds to try and take the airway.

I felt like I just got b!tch slapped.

I just say "why don't you let CA-1-name handle it."

You want ego, thats F'n ego dude. CA-1 nailed the tube and I went to bed. I've never spoken to that person since. At least not directly or intentionally.

 

[VentdependenT]

There are a few that take call with us. SRNA's also take call with us. The others I take call with are cool.

I've only met one other CRNA who thinks she's a doctor, and I've laid into her pretty good. She fights back as well. Which is fine. But we love given eachother the stank eye.

Almost every other CRNA I've worked with so (20-30?)far has been congenial and dedicated to gettin the job done safely in a team model. Crankey at times, but who isn't these days. Besides me 😳

 

[Jeff05]

that's why other doctors don't think we're doctors? why? because i don't live to practice medicine?

guess who else doesn't live to practice medicine: rads, ophtho, medicine, peds, derm, ortho, ent, etc....

i did well in medical school. killed the boards (did better than 90% of all the other doctors taking them). killed akts. killed the inservice. have read lange, barash, coexising dz, baby miller cover to cover (not done with ca2 yet). read NEJM, chest, a and a, anesthesiology, anes and pain managment cover to cover monthly (why? cause i like remembering a bunch of ****? no, because i believe i can take better care of pts if i know stuff) and i believe provide excellent integration of my knowledge at work - i think i take high quality care of patients (for my level anyway) because i really want them to do well. but...


guess what? our medical collegues still don't think i'm a real doctor....and i'm ok with that cause i'm not in this for the kudos.

so what does, militarymd, make you a "real" doctor? i assume you stay at the hospital until 8pm daily saving lives...and doing things that are more important than managing airways and relieving pain? let me know.

 

[militarymd]

that's why other doctors don't think we're doctors? why? because i don't live to practice medicine?

guess who else doesn't live to practice medicine: rads, ophtho, medicine, peds, derm, ortho, ent, etc....

i did well in medical school. killed the boards (did better than 90% of all the other doctors taking them). killed akts. killed the inservice. have read lange, barash, coexising dz, baby miller cover to cover (not done with ca2 yet). read NEJM, chest, a and a, anesthesiology, anes and pain managment cover to cover monthly (why? cause i like remembering a bunch of ****? no, because i believe i can take better care of pts if i know stuff) and i believe provide excellent integration of my knowledge at work - i think i take high quality care of patients (for my level anyway) because i really want them to do well. but...


guess what? our medical collegues still don't think i'm a real doctor....and i'm ok with that cause i'm not in this for the kudos.

so what does, militarymd, make you a "real" doctor? i assume you stay at the hospital until 8pm daily saving lives...and doing things that are more important than managing airways and relieving pain? let me know.

Why are you all upset?

I'm just telling you what I know some people think.

Many people don't think of me as a doctor....don't know what I know and can do....

It used to bother me...when I was younger....but now I don't really care....I make my $$$, and I go home...and hopefully, I'll be out of this rat race before we ALL work for Uncle Sam.

 

[jetproppilot]

Sorry, but I have to get on my soapbox. I think anesthesiology is one of the best specialties in medicine -- hence why I am dedicating the next couple years of my life to studying it. However, when I tell the people I am going into anesthesiology, I get perplexing responses. One guy (a radiology fellow) said, "She's going into it so she can leave at 3." Huh?????? I've done nine weeks of anesthesia in my short medical school career and I RARELY, if ever, left at 3. Cases would end at 5 or 6 and there would be preops to do! Then, in another rotation, my resident was like, "What do pediatric anesthesiologists do? They just put babies to sleep in MRI. And they get to leave at 5. Can you sense our bitterness?" HUH????? If you're bitter, why did you go into your specialty of choice? Why are you ragging on anesthesia? And peds anesthesia is an intense subspecialty -- putting kids to sleep can be some of the most difficult cases you can do. I don't get it. Do they think that we sit around and twiddle our thumbs all day? If so, then how can we get them to change this perception? I don't know about the residents out there, but my perception was that, although it isn't neurosurgery or anything, you certainly put in a lot of hard hours. Much unlike the specialty of this particular resident I am speaking of (I am unsure of why she was complaining in the first place, because we spent most of the day just sitting around and chatting).

You've gotten caught up in the specialty vs specialty wars.

We've all done it.

The only person you are adversely effecting with your thoughts is you.

Keep in mind this doesnt just happen to anesthesia.

If you were going into ER, dudes would say you're a "triage manager who calls specialists."

Surgeons are mechanical monkeys who don't really know medicine.

All medicine docs do is write notes, round, rule out stuff, change medicines.

Etc etc.

Try not to take it so personally.

Just part of the "game."

Thank you for your post, as it reminded me of the frivolousness of some of the stuff we all hear.

My relationship with my general surgeon S.O. did alot to calm me on all the

ridiculousness of this kinda s hit.

Cuz believe me, she had a tougher road, and heard alot more s hit than you or I will ever hear.

When you think you've got it bad, imagine being a 5'2", 105 lb female trying to make it through a general surgery residency...a residency with probably the most egotistical, male dominated, dick swinging dudes out there.

Now she's a successful PP surgeon who loves what she does, and laughs at all the banter she hears....banter that goes away when one watches her operate.

She suggested at the big annual meeting of surgeons there should be a big sledge hammer next to one of those bell ringing contraptions so all the dudes can take a swing when they are entering

Keep it all in perspective.

You've got a great career ahead of you.

 

[jetproppilot]

that, my friend, is why the other doctors don't think we're doctors.

I have to disagree with you, my friend.

Yesterday I had a lady die on the table. 😱

Yep.

Can't remember that last time that happened.

70 y/o lady w metastatic disease for a port under MAC.

Preopped her in the early AM.

Met her family.

5 of her 7 kids were there.

Vibrant old lady.

Didnt look or act sick.

Case went great.....justanother routine MAC case on a little old lady.

CRNA calls me in at the end cuz she doesnt look right.

She went from quickly awakening from the light anesthesia, to agonal respirations and low BP likkity split.

Surgeons gone, talking to the family, telling them he's done, everything went great....

meanwhile I'm intubating her, calling for help....

now PEA, CPR....

chest tube eventually....half her blood volume pours out.

Resuscitation unsuccessful.

Obviously some big venous component was torn by the sheath upon insertion.

I'm still bummed, dudes.

That lady wasnt supposed to die yesterday. although, who the f uk am I to say that? The Man upstairs is in charge, not me.

I share this with you on this thread because during this tragic event, surgeon-dude and I worked in tandem during a heroic, albeit unsuccessful attempt to save this lady's life from an ever-present potential complication of this more-often-than-not routine case.

Mutual respect.

I think you'll find the people that matter know who you are, and respect you, as you do them.

The rest fail to have any impact on my life.

My inner peace at work is generated by me.

 

[VentdependenT]

Nobody knows what the hell we do except us.

I stopped telling people during rotations that I was going into anesthesia. I either heard something like "taking the easy way out" or "why dont you go into a real field?"

However during my subspecialty rotations I heard comments like "smart" and "good choice" and "you'll be happy." Encouraging.

So you know what I say now? Nothing. Nobody from the Neurosurgeon to the hospitalist has any reasonable clue of what we do. How do I inform them? I don't. I get the job done and get the hell out. Smoothly. Have fun dictating and rounding pals.

CRNA wants to be a doctor without going to med school? Kudos. I hope someday the malpractice will nip em in the bud as they drive down every anesthesia providers salary. If I have to run 20 rooms....fine, I'll do it. Gimme my F'n train wrecks, and re-do disasters, and all the other scary stuff nobody wants. I'll kill it and eat it (figuratively for all you people who need clarification). GImmie all the lines in the hospital, I'm an ultrasound line hunting beast. Put me in charge of sepsis protocols from the ER to the unit. I'll put in yer SVO2 whatever, fluids, abx, a-line, tube, wrap it up, put a bow on it, and drop it off in the unit all nice n' tidey. I'll come up with a fancy way to bill for it. I'll kill it and eat it. I'll hunt for new territory and defend it. I'll see that CRNA/AA/NAPS pusher/whatever's-comming-next on the HILL. Until then you know what I'm gonna say? Nothin.

At the end o' the day/post call, I've kept my yapper shut, the patient alive n' comfy, and flip A HUGE bird when I roll outta there without my pager, charts to dictate, a clinic full of patients to see the next day, AM/PM rounds on the floors, discharge crap, etc. The IPOD is in the ears and I'm off to the car/metro.

Plus getting out post call at 7am rocks the house when you know NOBODY ELSE gets that deal. Nobody. Getting out pre-call early as a resident is UNHEARD OF in other fields. I get the hard looks from other tired and pooped out residents as I leave the hospital when they're just leaving the OR's to go round for a couple of hours. BOO-HOO. I make sure to always kick em a big ol' friendly smile as I head for the door. As I see it no anesthesia resident really needs to bitch about schedules/hours (except in the unit which stinks for everyone). Its the best gig in the joint IMHO.

I'll flip two birds when I'm an attending.

 

[jetproppilot]

Nobody knows what the hell we do except us.

I stopped telling people during rotations that I was going into anesthesia. I either heard something like "taking the easy way out" or "why dont you go into a real field?"

However during my subspecialty rotations I heard comments like "smart" and "good choice" and "you'll be happy." Encouraging.

So you know what I say now? Nothing. Nobody from the Neurosurgeon to the hospitalist has any reasonable clue of what we do. How do I inform them? I don't. I get the job done and get the hell out. Smoothly. Have fun dictating and rounding pals.

CRNA wants to be a doctor without going to med school? Kudos. I hope someday the malpractice will nip em in the bud as they drive down every anesthesia providers salary. If I have to run 20 rooms....fine, I'll do it. Gimme my F'n train wrecks, and re-do disasters, and all the other scary stuff nobody wants. I'll kill it and eat it (figuratively for all you people who need clarification). I'll see that CRNA/AA/NAPS pusher/whatever's-comming-next on the HILL. Until then you know what I'm gonna say? Nothin.

At the end o' the day/post call, I've kept my yapper shut, the patient alive n' comfy, and flip A HUGE bird when I roll outta there without my pager, charts to dictate, a clinic full of patients to see the next day, AM/PM rounds on the floors, discharge crap, etc. The IPOD is in the ears and I'm off to the car/metro.

Plus getting out post call at 7am rocks the house when you know NOBODY ELSE gets that deal. Nobody. Getting out pre-call early as a resident is UNHEARD OF in other fields. I get the hard looks from the tired other pooped out resident as I leave the hospital when they're just leaving the OR's to go round for a couple of hours. BOO-HOO. I make sure to always kick em a big ol' friendly smile as I head for the door. As I see it no anesthesia resident really needs to bitch about schedules/hours (except in the unit which stinks for everyone). Its the best gig in the joint IMHO.

I'll flip two birds when I'm an attending.

I love ya, Venty.

Great post. 👍

 

[VentdependenT]

It felt good Jet. It felt good.

Sorry you had a rough one in the OR with that lady.

Maybe it was a blessing man. Like you said, you never know.

 

[fakin' the funk]

that, my friend, is why the other doctors don't think we're doctors.

I think other doctors (e.g. surgeons) don't think anesthesiologists are real doctors because most of the time the attendings are looking across the drapes at a semi-clumsy low-level resident, nurse, or nurse trainee.

 

[johankriek]

I have to disagree with you, my friend.

Yesterday I had a lady die on the table. 😱

Yep.

Can't remember that last time that happened.

70 y/o lady w metastatic disease for a port under MAC.

Preopped her in the early AM.

Met her family.

5 of her 7 kids were there.

Vibrant old lady.

Didnt look or act sick.

Case went great.....justanother routine MAC case on a little old lady.

CRNA calls me in at the end cuz she doesnt look right.

She went from quickly awakening from the light anesthesia, to agonal respirations and low BP likkity split.

Surgeons gone, talking to the family, telling them he's done, everything went great....

meanwhile I'm intubating her, calling for help....

now PEA, CPR....

chest tube eventually....half her blood volume pours out.

Resuscitation unsuccessful.

Obviously some big venous component was torn by the sheath upon insertion.

I'm still bummed, dudes.

That lady wasnt supposed to die yesterday. although, who the f uk am I to say that? The Man upstairs is in charge, not me.

I share this with you on this thread because during this tragic event, surgeon-dude and I worked in tandem during a heroic, albeit unsuccessful attempt to save this lady's life from an ever-present potential complication of this more-often-than-not routine case.

Mutual respect.

I think you'll find the people that matter know who you are, and respect you, as you do them.

The rest fail to have any impact on my life.

My inner peace at work is generated by me.

thanks for sharing. I had a lady die on the table after vigorous resucitation after a thoracotomy a few months ago.after that has happened to you a few times


I think your views on medicine your colleagues change. If someone else doesnt think im a doctor.. who gives a ****.. you can only control what you think not everyone else..

 

[VentdependenT]

I think other doctors (e.g. surgeons) don't think anesthesiologists are real doctors because most of the time the attendings are looking across the drapes at a semi-clumsy low-level resident, nurse, or nurse trainee.

I think its lack of knowledge of the field.

When I see a PGY-1 GS resident taking forever to close I don't think of him as less of a doctor. I give the guy a break. It may be more painful than a hemorrhoid on a flight to China but what are you gonna do.

If its a PGY-3 GS resident taking forever to close then every time he looks up he's gonna see my pained face looking right back at him over the drapes. He's gonna see me look from the OR clock to the patient to his face over, and over, and over...unless he's a funny dude or has a killer personality. Then, again, what are you gonna do.

 

[militarymd]

I have to disagree with you, my friend.

Yesterday I had a lady die on the table. 😱

Yep.

Can't remember that last time that happened.

70 y/o lady w metastatic disease for a port under MAC.

Preopped her in the early AM.

Met her family.

5 of her 7 kids were there.

Vibrant old lady.

Didnt look or act sick.

Case went great.....justanother routine MAC case on a little old lady.

CRNA calls me in at the end cuz she doesnt look right.

She went from quickly awakening from the light anesthesia, to agonal respirations and low BP likkity split.

Surgeons gone, talking to the family, telling them he's done, everything went great....

meanwhile I'm intubating her, calling for help....

now PEA, CPR....

chest tube eventually....half her blood volume pours out.

Resuscitation unsuccessful.

Obviously some big venous component was torn by the sheath upon insertion.

I'm still bummed, dudes.

That lady wasnt supposed to die yesterday. although, who the f uk am I to say that? The Man upstairs is in charge, not me.

I share this with you on this thread because during this tragic event, surgeon-dude and I worked in tandem during a heroic, albeit unsuccessful attempt to save this lady's life from an ever-present potential complication of this more-often-than-not routine case.

Mutual respect.

I think you'll find the people that matter know who you are, and respect you, as you do them.

The rest fail to have any impact on my life.

My inner peace at work is generated by me.

read post 17....

 

[jetproppilot]

read post 17....

👍

I'm there with you, Hung.

 

[OB1🤙]

Vent-

Holy shnikeys, man, that might have been the best thing I've ever read in my life. Bravo.

 

[Ferdie]

Nobody knows what the hell we do except us.

I stopped telling people during rotations that I was going into anesthesia. I either heard something like "taking the easy way out" or "why dont you go into a real field?"

However during my subspecialty rotations I heard comments like "smart" and "good choice" and "you'll be happy." Encouraging.

So you know what I say now? Nothing. Nobody from the Neurosurgeon to the hospitalist has any reasonable clue of what we do. How do I inform them? I don't. I get the job done and get the hell out. Smoothly. Have fun dictating and rounding pals.

CRNA wants to be a doctor without going to med school? Kudos. I hope someday the malpractice will nip em in the bud as they drive down every anesthesia providers salary. If I have to run 20 rooms....fine, I'll do it. Gimme my F'n train wrecks, and re-do disasters, and all the other scary stuff nobody wants. I'll kill it and eat it (figuratively for all you people who need clarification). GImmie all the lines in the hospital, I'm an ultrasound line hunting beast. Put me in charge of sepsis protocols from the ER to the unit. I'll put in yer SVO2 whatever, fluids, abx, a-line, tube, wrap it up, put a bow on it, and drop it off in the unit all nice n' tidey. I'll come up with a fancy way to bill for it. I'll kill it and eat it. I'll hunt for new territory and defend it. I'll see that CRNA/AA/NAPS pusher/whatever's-comming-next on the HILL. Until then you know what I'm gonna say? Nothin.

At the end o' the day/post call, I've kept my yapper shut, the patient alive n' comfy, and flip A HUGE bird when I roll outta there without my pager, charts to dictate, a clinic full of patients to see the next day, AM/PM rounds on the floors, discharge crap, etc. The IPOD is in the ears and I'm off to the car/metro.

Plus getting out post call at 7am rocks the house when you know NOBODY ELSE gets that deal. Nobody. Getting out pre-call early as a resident is UNHEARD OF in other fields. I get the hard looks from other tired and pooped out residents as I leave the hospital when they're just leaving the OR's to go round for a couple of hours. BOO-HOO. I make sure to always kick em a big ol' friendly smile as I head for the door. As I see it no anesthesia resident really needs to bitch about schedules/hours (except in the unit which stinks for everyone). Its the best gig in the joint IMHO.

I'll flip two birds when I'm an attending.

And the Oscar goes to...

I literally just stood up and applauded you.

And me, for being as smart as you.

 

[core0]

I think its lack of knowledge of the field.

When I see a PGY-1 GS resident taking forever to close I don't think of him as less of a doctor. I give the guy a break. It may be more painful than a hemorrhoid on a flight to China but what are you gonna do.

If its a PGY-3 GS resident taking forever to close then every time he looks up he's gonna see my pained face looking right back at him over the drapes. He's gonna see me look from the OR clock to the patient to his face over, and over, and over...unless he's a funny dude or has a killer personality. Then, again, what are you gonna do.

I think that you guys are victims of your own success. What are the death rates from GA now? Less than 1:250k from what I hear. At that level any problem becomes anectdotal. Lets say your running 10 cases a day for 30 rooms for year. At that rate your talking about one death every 2 1/2 years. It makes what you do look easy. People (and your fellow physicians) think its easy and forget the history of what it took to get there. If you look back even 30 years there is a huge difference in complications. On the other hand if you guys were knocking off 1 in 50 then it would be easy to tell who the superstars were.

The guys I work with definitely understand what anesthesia does. If we have a pretty straight forward case then they'll take what they get but the vibe in the room isn't as good. If its a tough case then they don't care what the schedule says, its going to be one of 4-5 anesthesiologists. They're not going to be explaining things when you're down ten liters of blood and you have three suckers making that "bad" sound. They won't mind if an AA or resident is there for parts of the case, but they expect an anesthesiologist to be in the chair for the important parts of the case. When things are going "not good" is when you see the difference (in my opinion).

Personally I think that you guys should go back to cyclopropane to separate the men from the boys (figuratively speaking). You would definitely get more respect from surgery.

David Carpenter, PA-C

 

[oudoc08]

When I was on ENT in 3rd yr., I spent a couple days in a off-site clinic w/ one of the university chief ORL attendings. I specifically remember several cases in those days where he would be explaining some procedure to a patient, and it seems like they had more questions about the upcoming anesthetic experience than the surgery.

I was a little surprised that the answer he gave people went something like this:

"When I do my surgeries at hospital X, I insist on and only use MD anesthesiologists. They're some of the brightest people in this business and they make my job a whole lot more tolerable knowing that my patients are in the best hands possible. You've got absolutely NOTHING to worry about with these guys."

He could've reassured the patient with a whole lot less, but went out of his way to commend the professionalism of the anesthesiologists.

Funny though, I never heard him really say anything in the OR or to anyone else about that, except maybe a "thanks" over the drape at the end of the case.

I'm a true believer in keeping up the professionalism. You never know who's watching, and silently being awesome at what you do, eventually isn't lost on most people, no matter how much they dig at you for getting out at 7am post call 🙂

 

[dara678]

Thanks for the great comments, jet. It's great to keep in perspective. It's really too easy to get caught up defending my choice, when I shouldn't really care what other people think and concentrate on doing what I want to do. 🙂

You've gotten caught up in the specialty vs specialty wars.

We've all done it.

The only person you are adversely effecting with your thoughts is you.

Keep in mind this doesnt just happen to anesthesia.

If you were going into ER, dudes would say you're a "triage manager who calls specialists."

Surgeons are mechanical monkeys who don't really know medicine.

All medicine docs do is write notes, round, rule out stuff, change medicines.

Etc etc.

Try not to take it so personally.

Just part of the "game."

Thank you for your post, as it reminded me of the frivolousness of some of the stuff we all hear.

My relationship with my general surgeon S.O. did alot to calm me on all the

ridiculousness of this kinda s hit.

Cuz believe me, she had a tougher road, and heard alot more s hit than you or I will ever hear.

When you think you've got it bad, imagine being a 5'2", 105 lb female trying to make it through a general surgery residency...a residency with probably the most egotistical, male dominated, dick swinging dudes out there.

Now she's a successful PP surgeon who loves what she does, and laughs at all the banter she hears....banter that goes away when one watches her operate.

She suggested at the big annual meeting of surgeons there should be a big sledge hammer next to one of those bell ringing contraptions so all the dudes can take a swing when they are entering

Keep it all in perspective.

You've got a great career ahead of you.

 

[coprolalia]

Thanks for the great comments, jet. It's great to keep in perspective. It's really too easy to get caught up defending my choice, when I shouldn't really care what other people think and concentrate on doing what I want to do. 🙂

If clinicians from different disciplines would spend less time denigrating and fighting with each other, maybe then we would realize that we are all in this together and focus our energies on fighting the ridiculous demands of insurance companies and the self-interest of plaintiff's attorneys who prey on that lack of cohesiveness.

-copro

 

[ecCA1]

Vent,

I don't know how you managed to let the CRNA claim seniority over you. So she finished two years of advanced nursing school--even numerically you've been at it longer than she by the end of your CA-3 year. Furthermore, she's on a NURSE track, so it's the proverbial "apples and oranges" comparison anyway.

What consequences, if any, would you have faced for elucidating the inaccuracies of her statement while the CA-1 deftly dropped said ETT into the guy's throat?

 

[coprolalia]

I don't know how you managed to let the CRNA claim seniority over you.

Bravado. Nothing more.

-copro

 

[Mista Suprane]

medicine people will look at you funny if you offer some gentle advice during management of a crashing pt (you can put in a central line in about 60 seconds, diagnose that arrhythmia and treat it, correct the hypotension while diagnosing the causes, etc) - why is this anesthesia guy even talking, he's just here to put in the tube.

YOU WILL KNOW MORE ABOUT TAKING CARE OF REALLY ACUTELY SICK PATIENTS THAN ANYONE ELSE IN THE HOSPITAL - BUT, NO ONE WILL KNOW THAT YOU KNOW THIS.

IF YOU NEED ANESTHESIOLOGY FOR EGO GRATIFICATION - you will be disappointed.

i think a CCM fellowship might at least help a little with the above issues, for those of us that do have an ego, and would like to walk around at least some of the time with big b**ls. during that code, when they give you the "shut the eff up!" look, you could say "f**k u, i'm CCM b**tch." in my limited career, it seems that everyone looks to the intensivist (if they are there) while a patient is crashing/coding.

probably wouldn't help much in the OR, though; like everyone else said, we gotta just deal with that and recognize the multitude of other perks of our (future) professions. and of course, you gotta really like CCM to do it, the ego factor is certainly not enough of a reason.

 

[me454555]

b/c we do our best work while our patients are asleep or unconscious

 

[VentdependenT]

Vent,

I don't know how you managed to let the CRNA claim seniority over you. So she finished two years of advanced nursing school--even numerically you've been at it longer than she by the end of your CA-3 year. Furthermore, she's on a NURSE track, so it's the proverbial "apples and oranges" comparison anyway.

What consequences, if any, would you have faced for elucidating the inaccuracies of her statement while the CA-1 deftly dropped said ETT into the guy's throat?

I'm not going to get any medals for telling her off in front of everyone. I'm almost done there and she's not going anywhere. She'll eventually piss off someone enough to cause a dramatic scene, but it just wasn't going to be me.

I'm where I want to be. She, it seems, isn't. And she's at the end of her line.

As for correcting her in front of everyone...If I took additional time during that code to explain that her one year of eyeballs, knees, hips, sinus surgeries (ASA I-III's) wasn't equivalent to 4yrs of medical school and 3.5 years of additional clinical post-graduate training then I WOULD LOOK LIKE THE JACKASS.

All I wanted was to get the patient stabilized and then go to bed. She wanted to make a statement. It fell on deaf ears. CA-1 did the job perfectly. Done deal.

Too bad I have a decent memory because her b.s. late night pride statement is obviously occupying some misfortunate neuron in my head. Oh well, I'll just drink that poor neuron of mine into an early death. Maybe my next Jager-Bomb will land squarely on it.

God speed little Venty neuron. God speed.

 

[Coastie]

see my new thread...thought about THIS POST today during the situation, vent. Too bad I didnt have some strong backup...anyway, its on the main page

Speaking of CRNA moments I got one for ya! And its an EGO booster or shatterer to boot! Just depends on whose side yer on pardner.

AIRWAY CODE overhead to MICU. Myself, a CA-1, and a NEWLY MINTED FRESH OFF THA GRADyeeeuuuuaten RUSH SRNA class head up to the code. Its about midnight mind you, on call.

I say to the CA-1, have at it. SRNA, ahem, CRNA cuts me off and says to everyone in the room as they are helping the CA-1 set up suction, bag, postioning etc. "Hey, whats the situation here! When did he eat last!"

Ok I says to myself, thats reasonable. Even though I'm gonna tube this gomer whose clearing sputtering out. I could care less when they ate last. The tubes goin in.

So she finishes her inquistion, nobody knows the answers to her questions of course.

I'm sitting in the corner watching the CA-1 and nod for him to go ahead. Spray the mouth and use brutane says I. One of the nurses says something funny/nice to me as I'm just sitting there and I say "well, I'm just having a senioritis moment here" (as in my residency is comming to a close). CRNA turns to me and says with all the seriousness and pride and zeal of an american flag burning taliban "Well technically, I have the most seniority here." She then proceeds to try and take the airway.

I felt like I just got b!tch slapped.

I just say "why don't you let CA-1-name handle it."

You want ego, thats F'n ego dude. CA-1 nailed the tube and I went to bed. I've never spoken to that person since. At least not directly or intentionally.

 

[Dfrost]

Nobody knows what the hell we do except us.

I stopped telling people during rotations that I was going into anesthesia. I either heard something like "taking the easy way out" or "why dont you go into a real field?"

However during my subspecialty rotations I heard comments like "smart" and "good choice" and "you'll be happy." Encouraging.

So you know what I say now? Nothing. Nobody from the Neurosurgeon to the hospitalist has any reasonable clue of what we do. How do I inform them? I don't. I get the job done and get the hell out. Smoothly. Have fun dictating and rounding pals.

CRNA wants to be a doctor without going to med school? Kudos. I hope someday the malpractice will nip em in the bud as they drive down every anesthesia providers salary. If I have to run 20 rooms....fine, I'll do it. Gimme my F'n train wrecks, and re-do disasters, and all the other scary stuff nobody wants. I'll kill it and eat it (figuratively for all you people who need clarification). GImmie all the lines in the hospital, I'm an ultrasound line hunting beast. Put me in charge of sepsis protocols from the ER to the unit. I'll put in yer SVO2 whatever, fluids, abx, a-line, tube, wrap it up, put a bow on it, and drop it off in the unit all nice n' tidey. I'll come up with a fancy way to bill for it. I'll kill it and eat it. I'll hunt for new territory and defend it. I'll see that CRNA/AA/NAPS pusher/whatever's-comming-next on the HILL. Until then you know what I'm gonna say? Nothin.

At the end o' the day/post call, I've kept my yapper shut, the patient alive n' comfy, and flip A HUGE bird when I roll outta there without my pager, charts to dictate, a clinic full of patients to see the next day, AM/PM rounds on the floors, discharge crap, etc. The IPOD is in the ears and I'm off to the car/metro.

Plus getting out post call at 7am rocks the house when you know NOBODY ELSE gets that deal. Nobody. Getting out pre-call early as a resident is UNHEARD OF in other fields. I get the hard looks from other tired and pooped out residents as I leave the hospital when they're just leaving the OR's to go round for a couple of hours. BOO-HOO. I make sure to always kick em a big ol' friendly smile as I head for the door. As I see it no anesthesia resident really needs to bitch about schedules/hours (except in the unit which stinks for everyone). Its the best gig in the joint IMHO.

I'll flip two birds when I'm an attending.

Hear, Hear.

Well said!! My sentiments exactly.

 

[sevo85288]

I practice in large community hospital in N. CAL. 20 MD practice, eveything but transplants.

We are treated with respect and admiration (and envy) by nurses, surgeons, hospialists, administrators etc. But only after they realize that we are good doctors and take excellent care of patients and are good natured people. We do the toughest, sickest patients and make it look easy. We are compensated well and treat everyone else with respect.

I disagree that just b/c we leave early sometimes people don't think we are doctors. We don't practice critical care here but are constantly consulted to ICU to help Surgeons with sick pt's post op. Last week the CT surgeon called me (I was not on call) at home asking very nicely if I could come to the ICU to help him with mgmt of a redo AVR.MVR.CABG now in DIC after going to the OR twice earlier. I stayed in the unit for 2 hrs giving products,checkig labs, and playing with the drips. I cancelled his order for factor VII, warmed his patient, gave Vit K, and stabilized the bleeding. He did not have to go to the OR for a 3rd time that day.

The next the CT dude calls me thanks for "saving his patient." No big deal.

Be good at what you do and care for your patients and everything else will work itself out.
Peace

 

[coprolalia]

I cancelled his order for factor VII, warmed his patient, gave Vit K, and stabilized the bleeding.

Vitamin K takes 24-48 hours to show a meaningful clinical effect. What about FFP? Are you sure the heparin was fully reversed? What was the final ACT?

Just curious. (Nice job being a good advocate for our profession, by the way. 🙂 )

-copro

 

[sevo85288]

Did all that. Lots of products. yes Vit K takes time. Factor VII too much pharmacy paper-work, lack of objective data. Saw pt today. Walking around with nurse in ICU.

 

[case42]

This should be our theme song. Everybody sing it now.



[YOUTUBE]http://www.youtube.com/watch?v=z4yVN5CKwJ4[/YOUTUBE]

wait wait wait, I thought this had been covered already...isn't this the official theme song here? 😛 [YOUTUBE]http://www.youtube.com/watch?v=xuZl9tRqjoQ[/YOUTUBE]