My first taste of surgery, the first two weeks, was on the anesthesiology service. Anesthesia was awesome. It’s a “surgical” specialty that has magical hours: my day usually ran from 6:30 to around 5 in the afternoon. Compared to trauma, where the hours can only be described as horrible (we’ll get there), this was a cakewalk. A typical day:
- 6:30 – arrive to operating room, help resident anesthesiologist set up by incorrectly drawing up drugs.
- 7:00 – Follow resident to holding room to meet patient, watch quietly as resident asks detailed questions about bodily functions.
- 7:30 – Wheel patient back to OR. This is harder than Mario Kart makes it look. People get angry if you smash their beds into the wall. Guess how I know.
- 8:00 – The drugs start to flow. Patient passes out. I am given the high honor of holding the oxygen mask on patient’s face.
- 8:05 – The question on every student’s mind: “CAN I INTUBATE?”
- 8:06 – No.
- 8:30 – Surgery starts.
- 11:45 – We have now covered:
- how propofol works, and why it killed MJ
- international relations
- my previous job as a specialized data entry technician
- why my resident thinks anesthesia is the greatest specialty ever
- Buddhism and meditiation
This cycle repeats itself through the day’s cases, or until my resident grew bored of me and sent me home.
A bit more on intubation: this task, critical in most surgeries, is the highlight of the anesthesia rotation. As with everything in medicine, every attending has their own quirks and things they are anal about, especially things other attendings do that they consider incorrect. To wit:
When I did my first intubation, the resident walked me through the steps. In essence, your job is to take a plastic tube a bit more rigid than a restaurant straw, put it into someone’s mouth, bend it around the corner, squeeze it under a piece of tissue designed specifically to prevent your tube from going where you’re going, and put it through a hole the size of a dime. That tiny hole is also bordered by your vocal cords, which you can easily damage if you’re not careful.
Right next to this dime-sized opening is the comparatively huge esophagus, where it is both easy to put the tube and wrong to put the tube.
(Air into esophagus equals air into stomach equals barfing, which ends up equaling pneumonia, which ends up equaling a lawsuit.)
Anyway. A typical setup includes an endotracheal tube with a bendy stylet inside. The stylet serves to give the tube a little more rigidity as you’re cramming it down into this tiny hole. Once you’re in, you pull out the stylet and all is well.
The second intubation I did was with a different attending than the first. (By the way, in case you are confused by my use of “attending” and “resident,” please see my chart from yesterday.)
The attending saw me reach for the stylet and started.
“What are you doing?” he said, glaring at me.
“W-what?” I confidently replied, trying to look as competent as possible while wearing a disposable paper hat.
“Stylets are for bitches,” he said, and yanked the stylet out of my now-floppy endotracheal tube.
So now I know. Stylets are for bitches.
Despite my flaccid instrument, I was able to successfully intubate. This is a weirdly awesome feeling. YEAH! I JUST JAMMED A SODA STRAW DOWN A GUY’S THROAT! WE LAYIN’ SOME PIPE TODAY! WHO’S THE MAN!? I’M THE MAN! GO ME! WHOOOO!
(THE PATIENT WOULD BE TERRIFIED AND UPSET IF HE KNEW THAT I DID THIS!)
…was what I was saying in my head. Out loud I said, “I have bilateral breath sounds.”
My resident merely said, “strong work.” The ceiling of the OR parted and a warm beam of sunlight shone down upon me, restoring my ego to post-7th grade levels. “But next time…” he continued, as the fluorescent lighting abruptly took back over.
Once the patient is prepped and ready, most of the work for the case is finished until it’s time for the patient to “emerge” when the surgery is over. Thus begins the Great Period of Waiting. If you or your resident are awkward people, this can be a pretty horrible series of uncomfortable silences as you both sit and stare at the vital signs monitor.
(I’m not awkward at all, obviously, so the silences in every case were the resident’s fault. Obviously.)
Final point of interest: how patients wake up is totally unpredictable. My last patient on the rotation woke up with a serene smile on her face, eerily resembling Dolores Umbridge from Harry Potter. We asked her how she was feeling and she just kept repeating, “oh, yes. Oh… oh, yes.”
A previous patient slept far longer than anticipated, then woke up all at once believing he was the Hulk in full-blown Smash Mode. You could tell this was coming: while still unconscious, he made a fist so strong the muscles in his forearm closed off his IV. We had to tie him down with leather restraints and Valium until he regained his senses. When he first came to, he yelled, and I quote directly, “RAAAAAAWR.”
All told I loved my anesthesia rotation. It’s a great combination of procedures, lifestyle, patient contact, and bright lights and shiny objects. One of the attendings told me a strangely apt aphorism:
“If your favorite place in the world is the operating room, become a surgeon. If your favorite place in the hospital is the operating room, become an anesthesiologist.”
Food for thought.
And then I moved on to trauma (where I am now), but that’s a story for another day.