Friday, December 07, 2007

like a real doctor

Good day at work today. Well, good day for me, the resident, but not a good day for the patient. Strange how often that happens. Anyway, it was a day that I was scheduled for some relatively routine Gen Surg cases. Big cases, mind you, but nothing too crazy. The surgery was well underway when I hear the sound that will make any anesthesiologist look up and stand at attention--a prolonged slurping noise emanating from the field. I peeked over the drape, looked at the contents of the suction cannister, and motioned to the circulating nurse. "That blood in the fridge? Get it in here now." 

Two hours, five liters of blood loss and one slow-motion code later, we were stabilized and wheeling to the ICU. It was very...I don't know. Satisfying. It may be gruesome to think of that word in connection with one patient's bad outcome, but there it is. To be able to deal effectively with that situation was profoundly satisfying. There are the ordinary days, and there are the bad days that you screw things up and for days suffer with recrimination and self-doubt. But then there are days like today where you think, "You know what? One of my patients tried to die on me today, and I didn't let them."

I hear the sentiment a lot, mostly from medical students and bitter surgical residents, that they would never do anesthesia because it's so boring. Well, let's separate that out, here. Maybe you would never do anesthesia, the same way that I personally would never do...oh, say, Psych, or Ortho, because, you know, personal preference. But let's not let people undermine the work that we do by calling it "boring." Some of the scariest, seat-of-my-pants moments in medicine I have experienced as an anesthesia resident, and honestly, I am not an adrenaline junkie--I don't gamble and avoid roller coasters--but I can testify that this kind of medicine is thrilling. It's like, all that stuff you read about physiology, and pharmacology and hemodynamics in your textbooks? It's all happening RIGHT HERE right in front of your eyes. And it's really something to be on the front lines of that. I don't know. It's just fun

There's a lot of stuff that you do as a resident in any specialty you can barely argue you need a medical degree for. Tons of scutwork, papers to fill out, patient transport, transcription and dictation of lab values, some purely clerical, mindless stuff. But real anesthesia, the front line acute care medicine, makes me feel like, for lack of a better explanation, a real doctor.

I know that no one understands what anesthesiologists do, people don't look at what we look at and don't see the things that we're constantly, even unconsciously attuned to. And of course, people resent us for this that and the other thing, and while sometimes that annoys me, most of the time I'm OK with it. Because I know what I do. And my patient in the ICU will wake up later tonight because of what I do. And that, friends, makes me feel pretty damn good.

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