Supervision

Last night on call, I was carrying the airway pager and was paged to supervise a critical care fellow for some intubations in the intensive care unit. ICU fellows come from many different specialties and those who come from non-anesthesia residencies have to get experience managing the airway. Although they often do rotations in the operating rooms, they also have to get comfortable with intubating critically ill patients in the unit which is much harder than those coming in for elective surgery. While I am ultimately responsible for the airway overnight, I try to give fellows the opportunity to intubate when its appropriate.

The experience gives me some insight into what it's like to be an attending. It's tough. There's an overwhelming urge to step in and do the procedure, but I have to restrain myself as long as I know I can rescue an airway if necessary. Even though I talk the fellow through the procedure, I note details that could be improved and have to figure out which should be mentioned immediately and which should be given as feedback after the procedure is done. I have to become comfortable with seeing an intubation from the outside and troubleshooting without holding the blade in my hand. In the supervising role, I have to multitask by not only guiding the fellow through the airway, but managing medications, vital signs, and external factors as well. It was a really educational night, not just for the fellow, but for me as well.