Sunday, September 18, 2016

Last Words

I make little notations to myself about blogs I want to write. I jot them down on scraps of paper, saved emails, and notepad documents titled "temp." Some of them make little sense to me when I find them again (kind of like trying to write down my dreams). Some feel so big and important that I want to set aside dedicated time to write conscientiously. Unfortunately, the window of opportunity is closing. For a lot of reasons out of my control, this blog is making its last rounds.

One note I wrote to myself was, "Anesthesia is not easy; discuss risk taking and dependence on surgeons." I don't specifically remember what stimulated that idea. There's a great deal that I could say (and have said in the past). Anesthesia is one of the few specialties that depends heavily on the skill of another professional. The doctor on the other side of the drapes affects almost everything I do. For the same surgery, two different surgeons may require very different anesthetic plans. Whether the surgeon is speedy or slow, loses a lot of blood or loses nothing, requires deep anesthesia and paralysis or manages with little - it all affects my decision-making. I have written before that anesthesiology is protecting the patient from the (necessary) surgery and surgeon, and I really believe that. It's no small thing to cut into someone, and my job is to safeguard the patient while that happens.

Of course, the skill of the anesthesiologist affects the surgeon. What I do can profoundly change the surgical conditions from whether there's excessive bleeding to how much the brain swells. I can think of very few other symbiotic medical specialties; perhaps obstetrics and neonatology, but not much else.

It's easy to underestimate how difficult anesthesia is. There is a metaphor of the Stanford undergraduate being a duck; on the surface of the pond, she appears serene and relaxed, but under the water, she is paddling furiously to stay afloat. Sometimes, that's how I feel with anesthesiology. Although we show a calm demeanor above the drapes, we may be working tirelessly to mitigate risk and optimize every single aspect of the perioperative period.

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