1900

Hooray! This is the 1900th post for this blog. I've had a blast writing, and it's really been a privilege and an opportunity. This blog has put me in touch with readers who were curious about medical school, and I've helped a few take that plunge and get in. I've met students whose interest in anesthesia led them to this blog. I've heard from patients who've reached out after reading some of my thoughts. I've expanded my writing and gotten involved in The American Resident Project. Thank you to all who read this and all who send me an email or leave a comment. It's been such an eye-opening, fun, and satisfying part of my life. But it's a time-consuming one as well, and I'm going to take a break for a week after this blog. I'll see you next Monday.

This blog was never meant to be a public education tool. But occasionally, I want to get up on a soapbox and share an idea. If I were to write to a reader about something I've learned from residency, I would write about what an anesthesiologist does. Few people understand anesthesiology. It seems like such a simple thing, to have someone "go to sleep," and there are perceptions that anesthesiologists simply do crosswords and update their investments in the operating room. Pharmacological and technological improvements have made anesthesiology safer, but this has given anesthesia the reputation of being easy, simple, unimportant. I argue that this is a major misunderstanding.

In the operating room, I take a patient and render him in a state suitable for surgery. I make him appropriate for a surgeon to take a scalpel and cut into him, to laser a vocal cord polyp or remove a vascular cancer or to graft a vein onto a heart or to replace a joint. I have to understand the surgery and its needs and balance it with the patient's other medical problems to come up with the appropriate pre-operative testing, drugs, monitors, and post-operative disposition. At an advanced level, I think about the system's resources, the patient's recovery, and the cost of care. I bridge the medical side with the surgical. I not only have to understand the management of congestive heart failure, adrenal insufficiency, and rheumatoid arthritis, but I also have to understand the anatomy where the surgeon is working, how a neurosurgeon monitors nerves he's working near, and where a cardiac surgeon places his bypass cannula.

But I also want to get across that anesthesiology is more than just medical knowledge and experience. In providing general anesthesia, we take full responsibility and control over someone's body and shield it from what the surgeon must do. When I push my propofol, I commit to breathing for the patient. When I roll a patient back to have his aortic aneurysm repaired, I take responsibility for the massive blood loss that will ensue. When I allow a neurosurgeon to open up the skull, I must do everything I can to preserve brain function. This weighs heavily on anesthesiologists. It's an emotional burden we take day after day. It's easy to imagine the courage a surgeon must have to cut someone's skin, but it's easy to forget the courage an anesthesiologist has to allow him to do so.

We are always in the background, never in the spotlight. Nearly all that we do happens when the patient is asleep. Surgeons struggle with this too; their patients only see the scar and sutures, not that 3-hour anastamosis or challenging laparoscopy that was saved from becoming open. Most patients can imagine what a surgeon does. This blog is written to help patients get a little insight into what an anesthesiologist does. We don't need fanfare, but we do appreciate recognition that what we do is more than pushing propfol and putting our feet up.