Anesthesiology

The Surgical Care clerkship includes a one-week exposure to anesthesiology. Admittedly, I entered this week with considerable bias against anesthesiology. It's boring... All anesthesiologists do is put patients to sleep before surgery and wake them up after it's over... There's not much patient interaction... It turns out, though, that my prejudices against anesthesiology were wrong.


The primary job of anesthesiologists, medically speaking, is to keep the patient alive and stable, numb, asleep, and motionless, so the surgeons can do their job.

Anesthesiology is mostly applied physiology and pharmacology. It's the application that interests me. Anesthesiologists use drugs and the ventilator machine to micromanage a patient's vital signs for the duration of the surgery and immediately afterward. Physiologic changes take place right before your eyes. Push propofol and watch the patient fall asleep, completely unarousable. Push rocuronium and watch them stop breathing. Push phenylephrine and watch their blood pressure rise and their heart rate drop. Instant gratification.

Minor procedures are another component of the anesthesiologist's job description: placement of arterial lines and central lines, epidurals, spinals, and of course endotracheal intubations.

I couldn't get enough of the procedures. Over the past week, I placed my first arterial line (after one failed attempt), and my entrotracheal intubation record was 6 successful placements for 13 attempts. Pretty good for a third-year medical student, I was told by my anesthesiology mentor, but he was probably just trying to encourage me. An actual anesthesiologist needs to have a perfect record.

I was also struck by how happy and well adjusted everyone seemed to me. One anesthesiologist just got back from a trip to the Galopagos Islands, and another partners with a team of surgeons on regular missions to Africa. At lunch one day, we determined that all six anesthesiologists at the table were runners. My anesthesiology mentor actually runs 5 miles to and from the hospital a few times per week! I felt like I fit in.


Now, I'm left feeling more confused about my future than ever. I had to write out a list of pros and cons for anesthesiology:

Pros:

• Optimal lifestyle
• Lots of procedures
• Taking away pain makes people happy
• Instant gratification
• No rounds
• Work in the OR, get to wear scrubs to work
• Happy, interesting, and active colleagues
• Good compensation

Cons:

• Does not fit the archetype of a physician that I have carried in my mind since childhood
• No longitudinal patient contact and minimal face-time with patients
• Not the star of the show