Overwhelming

Beginnings are hard, and anesthesia is no different. As I move from the cerebral explore-all-possibilities in drawn-out-rounds of medicine to the fast-paced hurry of the operating room, I can feel myself become more and more stressed. There is always time pressure in the operating room. I've found that optimizing efficiency is all about preparation of details. Before the start of the case, I rip small pieces of tape with little tabs for easy access, lined up neatly along the edge of a workspace like elementary school. I pre-label syringes, arrange my monitors, and line up medications in the order they are needed.

Despite preparation, I still find anesthesia chaotic. I'll write more in depth later about the process of inducing anesthesia and placing a breathing tube into a patient, but it can get overwhelming very fast. It requires substantial multitasking and yet significant concentration on one job. There's so much sensory input to filter - seeing the vocal cords, the patient's breathing, the misting on the mask, the arrangement of my tools; hearing the monitor's beeps (both routine and alarm), the cycling of the blood pressure cuff, the sound of the bellows on the ventilator; feeling the squeeze of the bag as a proxy for lung compliance, the fit of the mask to exclude an air leak, the position of the head, the pressure on the teeth. At first, I can only process these things sequentially and I rely on my attending to interpret things faster and anticipate problems.

I think the two central lessons I learned in my first week of anesthesia is to prepare for everything, and then to learn what I didn't prepare for and anticipate it next time. It's a stressful and overwhelming environment, but I'm sure I will adapt to it soon.