I had an extremely challenging day in the operating room a long time ago in a HIPAA-compliant hospital far away (as always, names/sex/surgery/dates/specific clinical situation changed so the meaning is the same, but the situation is not identifiable). Challenges with intubations, ventilation problems that came about unexpectedly and required nuanced care, under-the-drape bronchoscopies, unexpected cardiovascular crises! It reminded me of my first day as an anesthesiology resident.
Now, for anyone who doesn’t know, I graduated medical school and completed a residency in pediatrics. I had long planned to do either pediatric cardiology, or pediatric critical care. I still think those fields deal with some of the coolest, absolutely most interesting physiology and pathophysiology. But, alas, it wasn’t a great fit for me in the end. I added a chief residency year to the end of my training, largely to learn medical administration and get an intense exposure to education and teaching, but it carried the wonderful benefit of buying time to decide what to do with my life. I had very specific goals in mind and, while complaining to an anesthesia friend that I wasn’t doing enough of that stuff, I was told “Hey, I do that every day! You should just switch to anesthesia!”
So – even having literally close to zero exposure to the anesthesia world – I did. I was interviewing in pediatric critical care, so I canceled my applications, shadowed a day (yes, one day) in the OR, switched applications mid-cycle and starting interviewing two weeks later.
When my anesthesiology residency started, I had been a doctor for four years, but was greener than most medical student sub-interns in anesthesia. I had never pushed drugs, hooked up a ventilator, reversed neuromuscular blockade, connected drips or diluted concentrated drugs. And wow, my first day was like cliff jumping into ice water. Blood pressures were normal until I stepped in. Then bam – 210/105! Better treat that… oh no, now 64/30 – too far, rapidly treat, overtreat, back to 190/100! Don’t forget to reverse block – patient’s weak? Uh oh. What were the rules for extubation? How can I tell if they’re strong?
But I was hooked. I got a nervous feeling in my stomach before even routine intubations and certainly with every arterial line. Even peripheral IVs got me going – I had put in four (four!) in all of my prior training. But I loved the nervousness, the high-acuity, the quick ability for any of the anesthesiologists to walk into a room and all alone know what to do, how to do it, and be able to quickly save the day.
Days like today in the operating room are challenging. And in health care we’ve built in this long history of complaining about how hard things are, or were, or are going to be. But, isn’t that what we signed up for? Didn’t you write in a personal statement long ago that you wanted to “help sick people” (or whatever your other critical, important and – yes – challenging goals were)? Those things are hard, but it is what we couldn’t do without. Yes, I was tired. Yes, I was nervous and mentally exhausted by days end. But it was a breath of exciting fresh air. I wouldn’t want to do anything else. And after all, A Smooth Sea Never Made a Good Sailor!