For Example

Being on call at the Valley means lots of pages, a little multitasking, and no sleep. On one call night, I started with a 10 year old requiring removal of an external fixator for an old tibia-fibula fracture. It was my first pediatric patient, but at least he wasn't a child. The attending walked me through the anesthesia for adolescents, from the way we explain things to dosing of medications to preparation of equipment to induction of anesthesia and securing the airway.

Once I had placed the breathing tube, however, I was called for a series of code blues. I went with the other attending and found one person with congestive heart failure and an oxygen saturation of 85%. I quickly got my equipment together, positioned the patient for intubation (difficult due to his underlying disease and shortness of breath), induced anesthesia, intubated the patient, and put him on a ventilator. Before I had time to clean things up, I got paged with another floor patient with acute respiratory decompensation. This one was far more challenging, however, because he was 300 lbs and septic with low blood pressure, necrotizing fasciitis, and acute renal failure. I was very nervous, and due to his renal disease, we decided intubate the patient without a muscle relaxant. Despite his weight and the non-ideal conditions outside the controlled and familiar operating room, I managed to get the tube in pretty easily. It was incredibly satisfying.

By the time I got back, we were ready with another case in the operating room: a cystolithopaxy to remove a kidney stone in a gentleman with acute renal failure. After I started that case, I was paged with two epidurals on labor and delivery, and so I rushed up to place those, including one in a woman whose body mass index was 60 (normal is 20-24). The evening ended with a straightforward appendectomy, and by that time, I was exhausted.

The cases come so fast that I can't even log them all, and after a call night, I have to think pretty hard to recall each anesthetic I provided. I've learned to just paste patient stickers on my sleeve to keep track of them all. On my second call night, I had two appendectomies, an incision and drainage of an abscess, a dilation and curettage, an epidural, and two C-sections, one done under a spinal. On my third call night, I placed two epidurals, managed two C-sections, intubated someone on the floor, saw two appendectomies, and took a patient to the operating room for a perforated viscus with air under the diaphragm. Despite the busyness, I really enjoy it, especially since it's often a lot of fast cases, good procedures, and solid learning.