Anesthesia: Behind the Curtain

There are a lot of reasons to like anesthesia. You are the only doctor in the whole hospital whose sole job it is to take away pain. If you think about it that is a really big deal. Almost everyone who comes into the hospital or goes to a doctor does so with the primary complaint of pain and as an anesthetist you take that pain away.  Maybe not forever, maybe not even for a whole day but you give the patients a reprieve from suffering. You get to touch every specialty on top of it: having a baby and in too much pain call the anesthetist, going into surgery and don't want to feel it, call the anesthetist,  having chronic back pain with no one else to turn to, call the anesthestist, having a bone put back in place and can't take the pain, call the anesthestist.  I am surprised so many overlook this specialty because they are the doctors whose patients are happiest to see them and saddest to see them leave.  And despite their bad rep of sitting in the corner and reading a magazine on the job, they are responsible for most people's whole hospital experience-- the lack of pain.  And they are the people who put in the most numbers of IVs, central lines, lumbar punctures, and other procedures. (I do love procedures).

Most of anesthesiology has revolved around giving the perfect anesthetic, which is not just pain relief but also amnestic so you don't remember any of it and sedation so you don't unconsciously hit the surgeon as he/she operates. The term we discuss for this is called MAC (minimal alveolar concentration). This is used to compare the potencies of the various gases.  The MAC is the concentration of that gas that it takes to quell 50% of people's motor response to pain (aka smacking the surgeon). This gives you a 'starting point' concentration of gas to see if the person requires more or less. There are many other numbers and calculations that have to be done to figure out the exact right amount.

Of course, despite pain medications and maxing out on gas, there is only so much that we can do. There is nothing that anyone can do to take ALL the pain of surgery away.  This is something that many patients don't seem to understand.  The limits of pain management can only be stretched so far, if patients require more we give them something to sleep because there is nothing else we can do.

An anesthetists world is an amazing amount of flashing numbers, math formulas, and pharmacology. When things are going good, they go very well and can afford to read in the corner, because only rarely does something go wrong.   There is an art to it that many were sharing with me.  For example, its long been known that redheads have fiery personalities and medically the pigment they produce is a totally different chemical than the pigment from the rest of the population. This normally doesn't apply to medical practice except in anesthesiology where apparently the amount of gas given or pain medicine injected must be altered. They are more sensitive to certain medicines and wake up faster and even fight harder against the tube. (who knew?).  Also people on Lisinopril having more liable blood pressures under anesthesia for some unknown reason- so you have to fight their pressure the whole time. There are all sorts of little weird secrets that I have learned, but none of these facts have been from the doctor..... most of my time is spent in the OR and most of that with the nurse rather than the doctor. 

Despite giving anesthesia my best effort, and despite learning as much as I can.... I must say I am still uninterested in it-- that's an understatement. It is the most lackluster, boring rotation I've been on yet. Probably because  anesthesiologists are only present to put the patient asleep and then wander off, leaving the highly trained nurse anesthetist to monitor the patient (and me to stare at the floor because i'm not allowed to help).  And most of the time, if things go well, they simply record the vitals and sit there until the surgeons are done.  And from what I have discussed with the nurses during the long long hours of sitting and staring at numbers, they love their jobs because they get to make lots of their own decisions (after all they have a masters) plus they make tons of money without any liability or malpractice (covered by the doc they work under). In some states they can work independently, working under a surgeon instead of an anesthesiologist. But all this doesn't matter because I'm sitting on stool for literally HOURS just staring at stuff. The floor. The puddle of blood and the way it splatters. The grout in the tiles and wondering how much forensic scientists could study off the residual DNA still probably embedded in the floor..... 

So besides monitoring the nurses and being there for questions.... what do the anesthesiologists do??  I am still unsure. It seems the nurses have moved in on this job. And this makes it a boring rotation, at the very least they should let me bring my study materials or my phone to do questions or SOMETHING. But they don't. Its not sterile. I go home everyday at like 2.  Most of the time I feel like its a waste of my time because I am so uninterested in this stuff its not even funny, despite being allowed to do intubations. Its not worth it in the end. I should have taken these two weeks off. To study or do something useful.  *SIGH*