Solo in the Operating Room

All through residency, we are never by ourselves during the induction or start of anesthesia. An attending has to be in the case at all its critical points. Even though I may manage an entire anesthetic independently, I always had a shadow in the back of the room, ensuring that my decision making was sound, that I didn't miss anything. Now as an attending myself, I end up being solo in the room. In some ways, it's not that different; during the latter part of residency and during fellowship, I became comfortable anesthetizing someone and securing the airway. But there's still a psychological strangeness to it. I have to be sure, really sure, about each of my decision points. In residency, if something went wrong and I didn't know how to fix it, I always had someone to turn to, a crutch to lean on. Now, the buck stops here. That takes getting used to.

The truth is, I'm not really on my own. The wonderful thing about my anesthesia group is that all my colleagues and I are a team. We collaborate, help each other, call on each other. For difficult cases, I don't hesitate to see if someone can lend me a hand. In an emergency, I can always call for help, even in the middle of the night. The anesthesia group is structured this way for patient safety. I'm not truly alone; I just need to recognize when I need someone else.

Nevertheless, that moment before induction of anesthesia, I always hesitate. I go through my mental check-list. I take a deep breath. What we do isn't trivial. I am glad I've been well-trained.