Anesthesiology-Life in the Twilight Zone

As the first post of my new blog, I do want to explain a little bit about the profession I have chosen as a career (at least for now, until I have the guts to become a struggling writer).

When I was still a naive intern who first started learning about anesthesia, our now retired chairman use to say to us: “This is the best profession on Earth. You save lives and you relieve pain.” Both are very true, but it is definitely not as glorious as it sounds. Most people think that anesthesiology is just putting people to sleep so the surgery can be performed. But the real job of the anesthesiologist is to wake patients up exactly when you want them to be awake and with no deficit neurologically or any organ of the body.  Not always as easy as it sounds.

Operating room, intensive care unit, pain clinic, and rapid response teams are the main areas where anesthesia personnel are found. Putting people to sleep so surgeons can operate is the traditional role of anesthesiologist. With the advancement of medical procedures which are getting ever so aggressive, anesthesia service is required for many radiological, endoscopic, dental diagnostic and therapeutic procedures. In the intensive care unit, anesthesiologists would coordinate care for very very sick near dying people because of their expertise in airway, monitoring, and superb knowledge of cardiopulmonary physiology. Pain clinic is actually very different from the rest of anesthesia. It involves longitudinal management of chronic problems (ie pain) where other anesthesiologist are more involved in stabilization of the acute issue. It is a very lucrative field which also offers the best lifestyle. Rapid response teams are where lives are truly being saved. Every second counts to bring medically dead people back to the living.

As glorious as all those sound, anesthesiologists are solemnly the hero of the situation. The reason is they usually work in the background. By the time everything is stabilized and better, they are long gone. I do think it takes a certain personality to go into anesthesiology. The ability to keep calm during very stressful situations, the ability to maintain focus during very boring times, the ability to keep quiet, and understand that less is more.

In most medical school curriculum, the exposure to anesthesiology is limited. Many students may think it is an easy specialty because all they do is sit around during the surgical cases and go on breaks. May be true in 90% of the cases, but things can go very wrong very quickly and hence you have to keep your cool but anticipate the things that may happen. Many students don’t like it because no disease is being cured by providing anesthesia and there is no gratification afterwards. This is true, but you also have to think about all the diagnostic or therapeutic procedure and surgeries that cannot be performed without the help of anesthesia.

Many people think this is a dying profession because of the advancement of technology and spread of mid-level providers (CRNA and AA), the role of anesthesiologist is not important. It is true that better technology allow physicians to provide safer anesthetic, but no technology is better than clinical knowledge and expertise. The issue with mid-level is wide-spread in all fields of medicine and due to some unfortunate decisions of our predecessors, our specialty is the most affected. I will discuss the mid-level providers’ role in medicine in another blog post.

All in all, I do love anesthesiology and it is my second passion other than writing. I think it is still a wonderful specialty with great potentials that medical students should consider. Like one of our attending anesthesiologist use to say, “If you want to help patients, pick medicine. If you want to help yourself, pick anesthesia.” 🙂

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