Anesthesia Analogies

I've heard anesthesiology described as "hours of boredom punctuated by moments of sheer terror." There are many analogies that exist to describe anesthesia. Some liken it to piloting; the take-off and landing are stressful, intense, high-risk times, but the duration in between is usually smooth sailing. Indeed, many of the innovations of the airline industry transfer well to anesthesia: multiple back-up systems, double check mechanisms, root cause analysis of errors.

But I've been convinced that the lay public, and even most doctors have no idea what anesthesia involves. We spend our time behind the blue curtain, projecting a confident smile, but behind the scenes, anesthesiologists do an amazing amount. Surgeons sometimes complain that "all the patient sees after the four hour operation is the dressing." Anesthesia is the same. The best you can do is what is expected, for the patient to wake up with her original baseline function. None of the stuff that anesthesiologists do is ever seen by patients or other doctors.

Anesthesia is the practice of vigilance. Most surgeries go as planned, without complications. But the anesthesiologist must be prepared to deal with anything. One attending compared it to driving a car. There are so many things to attend to that it's surprisingly difficult at first. I have my eye on the heart rate and blood pressure, and all of a sudden the attending points out the IV bag is empty or the patient might be moving or the surgeons are having more blood loss. As I'm putting in the IV, I have trouble listening to the beep of the heart rate or keeping an eye on the monitors. My attending reassured me that like driving a car, things are overwhelming when you start. But after a while, you can pay attention to the road, know the cars around you, gauge your speed, watch your gas, adjust the temperature, listen to the radio, navigate, and (with a hands-free device) talk on the phone. I can see how anesthesia is similar.