Updated: Sep 20, 2019
Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Dr. Xi is sharing why she chose the field of anesthesiology and what makes anesthesiology a great field.
“The goals are simple: rely on skill, not luck; eliminate critical incidents; and never need to use the ‘Oh Shit Shelf’ [referring to where the epinephrine sits]”.
- Dr. Henry Jay Przybylo in Counting Backwards: A Doctor’s Notes on Anesthesia
Stumbling Across Anesthesiology
In atypical fashion, my interest in pursuing the field of anesthesiology actually piqued after stumbling across Dr. Michelle Au’s blog, “The Underwear Drawer” (of note, she’s the artist that created the popular Scutmonkey comics, an honest and humorous depiction of life in medicine). During the summer before medical school, I sat hunched over my laptop for hours reading through her thoughts as she progressed through medical school, started a pediatrics residency then decided to switch to anesthesiology. Her voice and personality was one that I wanted to emulate. I entered medical school with a mission to learn more about the specialty.
Watching anesthesiologists is similar to watching paint dry. Much of the skill in our specialty lies within the internal monologue of what to do next or how to handle a situation. Often I hear analogies to flying a plane; in many instances, take off (i.e. induction, or going to sleep) and landing (i.e. emergence, or waking up) are the most critical moments in our anesthetic plan. Maintenance of anesthesia (i.e. staying asleep) is like autopilot; most of the time it’s smooth sailing, but anesthesiologists must remain vigilant as adverse events (e.g. massive blood loss, disconnection from the ventilator, pulmonary complications, etc) can still happen.
As a medical student, I didn’t really grasp the concept that there was always something to keep an eye on. I only saw the procedural side of things like placing lines, intubating, and placing epidurals or spinals. My first anesthetic was as a 4th year medical student during an away rotation. During the week, my attending warned me that I would “fly solo” for one case at the end of the week. I felt prepared for the challenge. When Friday rolled around, I assessed my patient, went into the room, induced without any issue and made it through maintenance. During emergence, after I pulled the airway device, I started hearing little squeaks - indicating potential airway obstruction. I did an aggressive jaw thrust, applied positive pressure, and administered additional propofol. At this point, I was tachycardic, but my patient was ventilating adequately. I looked at my attending, and he nodded in approval to proceed. The patient was transferred to the post-anesthesia care unit and woke up uneventfully. That episode of laryngospasm is just one example of the many things that can go woefully wrong; anesthesiologists are trained to be vigilant and react quickly to prevent a downward spiral - all while maintaining a calm demeanor.
Physiology, Pharmacology, Procedures, and Immediate Gratification
The most commonly cited reasons medical students pursue anesthesiology is a “love of physiology, pharmacology, and hands-on procedures.” There’s a lot of that in the specialty. There’s also immediate gratification from our interventions. Oh, the blood pressure is low? A little vasopressor will take care of that. You’re feeling excruciating pain from your labor contractions? An epidural works wonders for that. The patient has been receiving CPR and an advanced airway is indicated? Hand me the laryngoscope and an endotracheal tube, I can take care of that. We are incredibly useful physicians; we can act as a physician, pharmacist and nurse all at once.
In episode 2 of Natalie Crawford’s podcast, As A Woman, she describes a hierarchical culture in her residency training that was not conducive to feeling supported or empowered. This was the kind of culture that I wanted to avoid. The culture of anesthesiology is one of teamwork, willingness to help, and general affability. I encountered this culture during all of my anesthesiology residency interviews and continue to experience it on a daily basis during my training. We are often not identified in the operating room as the “captains,” however when critical events such as massive hemorrhage or cardiac arrest occur, the operating room turns toward the head of the bed for stabilization, direction, and a sense of control. We are the lighthouse that illuminates the team toward safety when dense fog suddenly descends.
Anesthesiologists are also trained in communication. Try meeting a patient for the first time in a preoperative bay and convincing them that you’re qualified to provide medications to eliminate awareness, mitigate pain, and balance hemodynamics. And stick a (sometimes large) needle into them. It takes a balance of confidence, humility and suave to win a stranger’s trust.
Time for Living Life
Work-life balance is all the rage nowadays. I’m not a huge fan of using that jargon, as there is always going to be some level of “imbalance” in life. Life is unpredictable. What anesthesiology offers is shift work or pathways to subspecialties that can be arranged to maximize time for living life. While many anesthesiologists take pride in finishing a case that they start, sometimes it isn’t feasible and it’s a relief to know that a colleague can take over care when you need it. Even residency isn’t as grueling as most other specialties.
Nothing Can Be Perfect
Anesthesiology has been a fabulous fit for my personality and career goals, however that may not be the case for everyone. Working alongside our surgical colleagues can be unpleasant at times. Not being recognized as a physician or feeling unappreciated in the operating room environment can be degrading. There’s often little to no continuity of care in general anesthesia practice. Depending on the case types or practice, you could be on your feet the entire day with little time for nourishment, hydration or bio-breaks.
I am so glad that I stumbled across Dr. Au’s blog and had adequate exposure to the field of anesthesiology to determine that it was the right fit for me. Not everyone will enjoy our practice, but hopefully this entry will help you decide whether the specialty is a right fit.