Decisions III

Those who know me well (or read this blog - it's pretty much the same thing) can predict the few specialties that are really appealing to me right now. I have always been somewhat interested in anesthesia, a result of serendipity really. An an undergraduate, I took a seminar on physiology taught by an anesthesiologist and loved it. A few anesthesiologists down at Stanford really took me under their care, shuttling me towards the practice of medicine. I got exposure to the operating room and intensive care units, I thought through cardiovascular physiology, I was grilled on the treatment of shock. It was fun, and it came to me relatively easily. I had the luxury of time to pore over each figure in Guyton and Hall (Textbook of Medical Physiology) and reread chapters. I haven't done that with any other textbooks since. The anesthesiologists I worked with were fantastic. They represented the kind of person I wanted to be; they were nurturing, supportive, brilliant, and humble. They loved teaching. They did interesting research. Indeed, I got involved in several projects as an undergrad. In a basic science lab, I studied beta adrenergic receptor polymorphisms and in a clinical study, I looked at gene expression profiles in sepsis. I had fun, and simply because I didn't know what medicine outside the OR and ICU looked like, I came into medical school set on anesthesia.

At UCSF, I worked with an extraordinarily accomplished anesthesiologist on Pseudomonas infections. Her training was pretty crazy; she went into medicine, followed by a pulmonology and critical care fellowship, then went back and did anesthesia. Her experiences have convinced her that anesthesia was the route to take. In my first two years, I poked in and out of different anesthesia related events, meeting different faculty and residents, doing some shadowing in the operating room. I liked it; I liked the procedures, the back-seat role (as opposed to the surgeon), the focus on vigilance. When I did other rotations, I had more than one resident tell me to do anesthesia, mostly because of the lifestyle. When I did my anesthesia rotation, it was as I expected. Many of the cases were a little boring after induction, but the cardiac cases were super exciting. I enjoyed doing the hands-on stuff, but I wasn't great at it. I felt there was a little less patient interaction than I would have wanted but more than I expected. Working with surgeons is a plus-minus. But the anesthesiologists themselves were great.

My personality fits anesthesia. I like things that are scheduled and structured. I like having control. When I worked in a basic science lab, my bench was always neat and organized. Things had their place. They were labeled with concentration, expiration date, initials. I thought through my experiments and what I'd do when they failed. Anesthesia is like that; it's a specialty for planners, and a lot of the cognitive weight is built into that aspect. I like finishing one thing before starting another.

The material is interesting to me. I think I will like critical care medicine, its complexities, and its gravity. I like managing multiple drips, large volumes of data, and an evolving process whether surgical or in the ICU. Physiology and pathophysiology are great, and pharmacology, insofar as anesthesia is concerned, seems doable.

The training is reasonable. It offers further specialization into critical care, pediatric, and cardiac. Pain is available if I decide I want more longitudinal continuity with patients. The lack of patient continuity bothers some people. It might bother me, but I'm not sure yet. And I cannot downplay the lifestyle; the pay is good, the hours are somewhat flexible, and it's on that enviable "ROAD to success" (made up of radiology, ophthalmology, anesthesiology, dermatology).