Anesthesia Impressions

It took just one case for me to know: anesthesiology is a pretty cool job, and there’s no way I’ll do it. Their job, when unperturbed, is a routine of vials, syringes, lines, tubes, and making sure a digital control station doesn’t freak out. It’s delicate and complex, but it’s also a relatively unstimulating exercise of parameter control. Their job, when perturbed, is supremely stressful, situations in which they must act within seconds or permanently brain damage or kill someone. Neither of these situations sounds remotely fun to me.

A classmate likened them to stage crew: absolutely indispensable in an operating room and just as absolutely disregarded. They physiologically prepare the patient with amnesia, analgesia, and paralysis, they sustain the patient while surgeons dive in and cut shit up, and they rescue the patient’s core functions in emergency situations (i.e. correct everyone’s mistakes).

And while their job seemed like passive monitoring (they did seem to be on their phones a lot when I was scrubbed in on surgery), it teeters constantly on the edge of imminent danger. I hadn’t quite registered that truth until this week when I was at the head of the bed, manually ventilating the a paralyzed patient with a bag and mask when the anesthesiologist teaching me called out “so… your patient is dying right now. Make sure your mask has a good seal and that you’re getting a good tidal volume.” And I thought to myself “you guys do this every day looking totally at ease. What!”

The power of the drugs they administer routinely is nuts! Midazolam, the benzo that induces near-absolute anterograde amnesia within seconds; fentanyl, the wildly potent opioid responsible for an epidemic of overdoses; succinylcholine, which causes whole-body paralysis. Phenylephrine and atropine, dramatic rescue drugs, the milky-white anesthetic, laughing gas and its far more potent halogenated cousins, etc. And their workstation is just littered with that stuff all the time.

Anesthesiologists get yelled at, most of the time unnecessarily, by the surgeons for taking too long. It’s therefore appropriate that anesthesiologists are a calm and relatively imperturbable bunch. Wait, what were we just talking about?

Their job teeters constantly on the edge of imminent danger, and because of medicine’s inherent unpredictability not every emergency can be averted with adequate preparation. Moreover, emergent situations seek out and find anesthesiologists. When something is going horribly wrong in the ER, they call anesthesia, the true masters of airway-breathing-circulation. Maybe they get a kick out of taking that kind of first-line responsibility for a patient’s life, but to me… yikes.

Finally, anesthesiology is practiced physiology, and I am terrible at physiology. Take alpha and beta receptors as an example. For those of you who haven’t studied medicine, they control of the most fundamental and central concepts in human biology. In many facets they’re direct opposites, kind of like the difference between high blood pressure and low blood pressure. And I constantly forget which is which. Along the same lines, someday I’d confuse phenylephrine and pseudoephedrine and kill someone for no good reason and it’d be stupid.

In conclusion: anesthesia is cool, necessary, and definitely not for me.