This week a blog post about anesthesiology has been making the rounds on the Facebook. It was written in 2007 but somehow I haven’t seen it until now. In the post, which you can read here, the anesthesiologist describes her frustration with the ignorance most people have about what an anesthesiologist actually does. I think she got is just right, I even sent the post to several of my friends and family who I thought might enjoy a little more insight into my days (and nights) at work.

At the same time this week, I have been reviewing applications for our residency program in Anesthesia. We had over 100 people apply and we will interviewing 80 people for our 4 training spots. So I have been reading personal essays written by medical students who want to become anesthesiologists. I have read lots about they love to perform technical procedures, work on a team, applied pharmacology and physiology, save people’s lives, etc. etc. etc. I know that 11 years ago I wrote a very similar essay. And I was fortunate enough to be accepted to the program of my desire.

But a few years into that program, I was quite miserable. I wasn’t miserable with the clinical work OR with the hours. I was in misery over the lack of respect everyone else at work seemed to have for what we did. I was tired of trying to do a pre-op assessment on the 80-year-old lady with a hip fracture as the surgeon pushed the her bed down the hall WHILE I was talking to her so he could start her operation faster. I was tired of being yelled at by a cranky surgeon who didn’t understand that while his planned operation was quite simple, what I had to do to the patient so he could perform said operation MIGHT KILL THE PATIENT. And I was very tired of having to enter into a stressful negotiation/argument when I felt a patient was simply to sick or too fragile to undergo an operation at the scheduled time. It truly felt like I was fighting all the time. I remember very clearly saying to my husband “I will work in this job until my debt is paid off. But I cannot work in this field for my whole career. It will kill me”. Dramatic words, I know, but they felt true at the time. Fortunately, I married a psychiatrist, who knew enough to just give me a hug and wait.

Fortunately, a few months after that conversation with my husband, I began a rotation in pediatric anesthesia. It became very clear, very quickly that this was where I belonged. It was a kinder, gentler, albeit more stressful world. My attention to detail, the extra time I wanted to spend with patients and their families, and the careful planning I loved were all considered assets in the world of pediatrics. And so it was that I became a pediatric anesthesiologist.

So this week, I have been thinking a lot about what I do. Yes, I know a lot about physiology, pharmacology, technical procedures related to resuscitation and pain management. And I do work on a team and advocate for my patients and I am a “peri-operative physician”. But I don’t really feel like that describes what I actually do. After much thinking about it, here is how I would describe my job:

:: I take families most cherished possessions and walk away behind closed doors to the operating room
:: I take control of the child’s vital functions (airway, breathing, circulation) and create the best environment possible for the surgeon to accomplish the procedure
:: I cause some suffering to children, with airway masks, intravenous lines, breathing tubes and other procedures
:: I take away more suffering than I cause (hopefully) by ensuring that children are safe, comfortable, and feeling well during and AFTER the operation
:: I think about and plan for all possible events and problems that might occur during and immediately after the procedure
:: I comfort and reassure families about what is going to happen to their child, what they can expect, and what we can offer
:: I soothe babies, toddlers, and older children as they are waking up in my care. This often requires singing, cuddling, and sometimes caressing foreheads, the way their mother showed me. And yes, sometimes I sing at work. If it helps…
:: I follow patients who have had particularly painful procedures for days after their operation monitoring and managing their pain, until they are feeling well and do not need my help anymore.
:: But most importantly, I try to think of EVERY child as if they were my own. This can be heart wrenching, but mostly it assures me that I am giving the best possible care. If I always think within the context of “would I want this for my child” I know I am doing the best job that I can.

This last statement is the main lesson I try to impart on my residents. I am a mother and I know that when your baby is taken away and then returned to you after an absence, you examine EVERY inch of that baby. So that extra piece of tape that left a red mark will be noticed. The 3 holes from the unsuccessful intravenous starts WILL be noticed. These things will be noticed, they are important. Everything about that baby is important. It is my job to protect every inch of that baby. For me, that is the summary of my job as a pediatric anesthesiologist: to return the patient to its family in a condition as close as possible to how we received the child OR better!

In the adult medicine world, they say we are too soft and gentle in the pediatric world. But you know what? I think they have it wrong. WE are not “too soft”, they are too hard. One of my mentors once said to me “You should NEVER treat a child like a small adult. But you should consider an ill adult to be a large child”. Every once deserves to be cared for. I think that is the main thing want people to know about what anesthesiologists do: we care. Even though you meet us for just a short time, we care about every bit of you and we stay with you throughout your operation to make sure that you are safe, comfortable, and SAFE. Because we care.