This is a guest post by Dr. Lotus Argabioso, a practicing anesthesiologist in the Province of Palawan. She completed her anesthesiology training at Tondo Medical Centre. Interested to find out what she has in-store for your curious mind? Read on!
The field of anesthesiology is among the subspecialties in medicine that are not among the immediate choice for residency training by newly licensed physicians often owning to little clinical exposure that they have during their time in medical school and even during internship.
The short duration of rotation I had in anesthesiology was not adequate to give me a wider idea of experiences during residency training. There are many things I would have liked to share, but here are a few of the things I wish I knew before I underwent my anesthesiology residency:
1) You will not have a regular schedule
Compared to other specialties, it may seem like anesthesiology is among those who have less time handling a patient’s management. You administer anesthesia, the patient undergoes the procedure and the job is done.
Often, you’d only need to do rounds on an uncomplicated patient for 48 hours or less! But it is not as simple as that.
The saying that an anesthesiologist is the one who is the “first to arrive and last to leave” is often true. Preparing your station before the patient's arrival, managing them intraoperatively, monitoring them post-operatively and ensuring they are transferred to their appropriate room.
Often it would entail arriving earlier than your actual clock in time. There have been countless times that I was running late to a personal appointment due to sudden changes inside the operating room.
Whether encountering an unexpected complication with an ongoing procedure or an emergency direct case coming in, you would expect to be leaving the hospital later than you initially planned to.
Flexibility is the key when it comes to your schedule as an anesthesiologist.
2) It is more than just putting the patient to “sleep”
One might think, especially when one sees a more experienced anesthesiologist, that anesthesiology is one of the “easier” fields since we often spend our majority of our time sitting on our chairs.
“Turning something normal into abnormal then turning it back to normal” is what one of my consultants would tell us about the management of a patient who would undergo anesthesia. Administering any anesthetic medication would have effects on the patient’s body for a given time in order to provide the expected anesthetic effect.
Knowing how much can be safely given is vital.
The effects of the procedure and the medications to the patient would show up as changes in their overall condition. Frequent monitoring of their status is important in order to know if it is within expected outcomes or would need intraoperative management.
Considering every single pharmacologic and physiologic effects that can and will occur while coming up with management to address these effects in an instant requires vigilance and attention from an anesthesiologist.
3) The anesthesiologist is the internist while the patient is undergoing a procedure
You will see different kinds of patients throughout your training, from pregnant patients needing emergency cesarean sections to emergency craniotomy of an elderly patient who was involved in a vehicular accident to an anxious child needing to have an MRI scan.
You would need to be familiar with the normal physiology of patients of all ages and their body’s reaction to any procedural or anesthetic management given to them as well as their coexisting diseases or conditions.
The anesthetic management of a pediatric patient with pneumonia is different from what our pediatric counterpart does. The patient’s condition will change in real time and it would be the anesthesiologist’s job to provide proper treatment to bring them back to their stable condition as much as it is physiologically possible.
Pharmacology and Physiology would need to be your best friends, as well as Anatomy in certain occasions, in order to be an efficient anesthesiologist in managing your patients.
4) You would need to improve your multitasking skills
A few features of the famous cartoon of an ideal anesthesiologist is a physician with multiple arms, multiple ears and eyes all doing different functions all at once all the while anticipating the possible outcomes in the patient as well as what the proceduralist would need or do.
We don’t look like that in real life, but must be trained to be able to perform as much work in a small amount of time.
Imagine listening to the beeping of the cardiac monitor while intubating your patient and keeping an eye on the ongoing blood loss from a trauma patient. Then immediately needing to stabilize their condition with medications and administration of blood and other IV fluids.
An enhanced presence of mind would be needed and be developed throughout your training. You would soon be able to recognize which beep indicates the pulse oximeter without looking while you are focused on inserting an epidural to the patient. Everything can change in the blink of an eye and vigilance is important.
5) You would need to be a people person
Many had the misconception that an anesthesiologist never leaves the operating room and just stays behind their blue drapes separating and concealing them away from the surgical field. While it might be the main service (such as the surgery service who is mainly in charge of the management of the patient), it is the anesthesiologist’s job to ensure that the operating room team would be ready for the procedure.
It would mean communicating with the staff of different departments to ensure that the proper transfer, management and care would be provided to the patient. Running around the hospital is also common as we would need to answer some calls and referrals for non-operating room managements such as intubations, sedations and pain management.
Meetings with the patient and their family would require patience and empathy as you develop the anesthetic plan for the patient, whether pre- or post-operatively.
Anesthesiology is one of the fields that the layperson would not be very familiar with and can often sound terrifying if explanations are rushed and they are not given enough time to process or ask questions about it.
Providing comfort and kindness for them establishes a good rapport and would allow better compliance from the patient’s side as they undergo the planned procedure.
6) Anesthesiology is an ever developing field
Many of the new medical technologies developed throughout the history of medicine are often breakthroughs from the field of anesthesiology. From the use of ventilators to critical care being its own specialty to creating safer anesthetic medications, one can say that anesthesiology is continually developing since it has started.
Among them from recent memory would be the different airway management practices developed during the recent COVID-19 pandemic. An example would be the widespread use of the videolaryngoscope and the standard of good practice when securing a patient’s airway for ventilation purposes.
As modern medicine continually progresses into the future, one can say that anesthesiology would be in the forefront of these developments.
7) At the end of the day, it is still among the personally rewarding fields in medicine
Surgery is one of the life events in a patient’s life that they will remember as long as they live. It is the anesthesiologist’s job to make it as comfortable and less traumatic as possible.
Experiencing pain of the procedure is among the main reasons why a patient would back out from a procedure. But ensuring them that they will experience little to no pain before, during, and after the procedure would make them more at ease.
The comfort of knowing that a physician would be there by their side throughout their procedure has some positive and beneficial effect on the patient, in turn contributing to a smoother surgery.
There is a saying that a good anesthesiologist is often not remembered by their patient.
With the shorter time we spend with them, and most of that time they are asleep, it is not surprising. I'd be happy my patients forget about me if it would mean they safely made it through their procedure.
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