Saturday, October 2, 2010

Seeking Personal Redemption And A Good Night's Sleep

If you're going through hell
Keep on moving, face that fire
Walk right through it.
You might get out
Before the devil even knows you're there.
Rodney Atkins, "If You're Going Through Hell"

Now I conclude my series on why I chose anesthesiology as a career.  It took years of self immolation to wake me up to the fact that I hated the surgical lifestyle. But if not surgery, what else should I do? I knew that I still didn't want to treat chronic diseases. That eliminated Medicine and other primary care fields as my next career move.  I also knew I wanted to stay in the OR. But what kind of doctor works in the operating room but is not a surgeon?  There really is only one answer--anesthesiologists.

Luckily for me during the late 90's it was relatively easy to find an open position in an anesthesiology residency. It was not the highly competitive field it is today. I was afraid I would have to hang out for a year to wait for a spot in a training program. But I was able to locate an anesthesiology residency nearby that had vacancies to fill and I could start immediately.

Anesthesiology was everything I expected residency to be and everything my old surgery program was not. The work was intellectually stimulating. The attendings actually seemed to care about the well being of the residents.  The idea of getting breakfast and lunch breaks was a revelation. The other residents felt more like my kindred spirits, not competition ready to pounce at the slightest stumble.  And of course anesthesiology residency allowed a much saner lifestyle. While the other anesthesia residents complained about taking five calls a month, I reveled in the luxury of having three of every four weekends off.  Slowly I regained the self confidence I had lost after years of humiliation and abuse. I could see that I was not a worthless piece of human excrement. Nobody is perfect and anesthesia attendings didn't make me feel like s*** if I had a difficult day. I was finally able to enjoy living in Southern California, something I didn't have a chance to do in the years holed up in the hospital before. I went to the beach without concerns about how my patients were doing in the ICU or dreading another call the next day. I lost 30 pounds by the time I finished anesthesiology training. Life was good at last.

All those years of surgical training were not in vain. I had already placed hundreds of central lines and arterial lines as a surgeon so those presented no problems for me at all in anesthesia. I once impressed an attending when I was able to use a long alyce clamp to retrieve a broken tooth during an intubation (not my intubation). The one procedure I needed the most practice on was starting an IV. Never had to start one in surgery; either the nurse did it or we put in a central line.

I found that about 70% of my experiences in surgery were applicable to anesthesiology. The main things I had to brush up on ironically were all the different chronic disease processes an anesthesiologist is likely to encounter in preop. But that's okay because we only need to take care of these maladies for the duration of the case.  Anesthesiologists don't have to follow the course of the illness for the patient's entire life, or even the duration of the hospital stay. Once the patient makes it safely out of the PACU the problems were no longer mine to deal with.

This is of course the main attraction of anesthesiology. At the end of the day, when the patients are safely out of surgery, I can turn off my pager and go home to enjoy time with my family. There is no need to worry about how my fifteen patients are doing in the hospital. I don't get awakened at 3:00 AM because somebody on the floor needs a sleeping pill, or my patient in the ICU is suddenly desaturating. I am not tethered to the hospital or the answering service. I can enjoy life without fear of getting called back to the hospital for an emergency. Freedom of mind far exceeds the so called prestige of being a surgeon.

So that is my story of why I chose anesthesiology as a career.  I entered a dark tunnel in search of surgical glory and emerged into the light as an anesthesiology professional.  Yes surgery was fun, but there is more to life than the hospital. I give kudos to doctors who can tolerate such a work environment but I belatedly realized that was not for me. I have now been in practice for nearly a decade and love my job more than ever. I make a decent salary and have a devoted family I can go home to every night.  Hopefully the medical career you choose will be more straightforward than my circuitous path but ultimately you have to be satisfied both professionally and personally with your choice. It's alright to start over if you decide you went down the wrong road; there is no shame in realizing you made the wrong career decision. In the end it doesn't matter if you trained at a "prestigious" training program or authored fifty papers or make half a million dollars a year. If you can find job satisfaction, that is all that matters.

21 comments:

  1. As someone who is currently in Anesthesia residency and thinking of leaving anesthesia, I find this particular blog interesting. I struggled to choose between surgery and anesthesia in med school and eventually settled for anesthesia. Now I realize I made a mistake with my choice. Yes, anesthesia is a great field, for all the reasons that you mentioned, except, for me, I have failed to find that "intellectual stimulation." The decision to switch out has been extremely difficult and stressufl, especially because it is a switch rarely, if ever, made. But thanks for your blog.

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    1. what did you switch to? (if you dont mind me asking). im an anesthesiology resident who wants to switch out as well. i had a intraop code, and had lots of anxiety afterwrds. im thinking about switching to psychiatry

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  2. Wow, thank you so much for posting the last several entries on why you went for surgery initially and then left for anesthesiology. While I am currently still in medical school, these are the two fields that I struggle to decide between... seemingly for the exact same reasons as you! Your honest portrayal is so appreciated, and really helps me in my decision making process. Although I am sorry you had to "waste" 4 yrs based on your initial decision, it seems you have gained invaluable experience. Despite some great experiences, I always felt this dark undercurrent in surgery that I couldn't quite put my finger on exactly, but it was enough to spook me a bit... so many thanks for sharing :)

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  3. This was such a great post, thank you so much. I feel like you have described most of my feelings: I've always found internal roundings incredibly boring and I've never really believed that I have the superpowers to change smoking, obese, alcoholic-who-cannot take-their-pills patient's lifestyle. I vividly remember in my freshman year writing everywhere that I will become an anesthesiologist, I've no idea why, I just knew I loved OR but I had no desire to be a surgeon, so obviously what's left was that almost nonexistent doctor behind the curtain, who did... only he knew what. Then years of abuse kinda killed all of my ideas and at one point I really started to believe that I actually am incredibly dumb and my complete lack of interest in "prevention" and "chronic" or "long-term" is unacceptable. But your post just described so well everything going on in my head during years. I think I will give Anesthesiology a try. If I make a mistake, I'll move on to something else but I know I'll really regret not trying. So, thank you.

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  4. how much money do you make now as an anesthesiologist?

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  5. Thank you for an incredible post! I'm currently a 4th year medical student deciding between Anesthesiology and Emergency Medicine, and soon to begin applications. This has been a dilemma 8 months in the making, and the most important one I'm making in my lifetime, racking my brains night and day. I'll look forward to venturing through your blog and hopefully finding some inspiration!

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  6. So you entered anesthesiology because you are a big VAGINA who is afraid of work. Wow. That actually explains a lot about your profession....

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    1. You're clearly a sexist idiot, so I don't think your opinion matters here.

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    2. I agree with the sexist idiot comment. I bet you're a grocery clerk who hates their life and has to insult other people to feel better. Don't be immature.

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    3. I was also in surgery and switched to anesthesia. It was overwhelmed with people who needed 'prestige' and 'power' and became surgeons to validate themselves to others. Classic Motiv, on personality tests. I am validated. I am powerful. I am an anesthesiologist.

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  7. Let's see.... Anesthesiology where you drink coffee while the CRNAs do all the cases or "Emergency" medicine where all you have to do is isolate the body system in question, order a CT scan that a radiologist in India reads and call the specialist for the body system in question and wait for them to show up and fix the patient.

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    1. If you think it is that easy then become an Anesthesiologist. No one is stoping you. Once you reached the oh so easy goal of becoming an Anesthesiologist the coffee of choice I recommend you drink while everyone is doing your work is Carmel Macchiato.

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  8. To the last two posts - you guys are complete idiots

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  9. I'm currently a third-year med student trying to decide between anesthesia vs. gen surg.

    What is your take on CRNAs + the Affordable Care Act on anesthesia job security and salary? On my current anesthesia rotation, it seems like all the docs are really pessimistic about the long term outlook...

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    1. You have to go with what feels right for you. You shouldn't join a profession based on uncontrollable external factors such as future job and income projections. If you think anesthesiologists are pessimistic about our future, have you talked to the general surgeons? They'll talk your ear off about how burned out they are and how little pay and respect they get.

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    2. I found your website (this post) after googling on what makes a good anesthesiologist.
      As weird as it sounds, I am a female patient who had a serious crush on a male anesthesiologist, the one who held my hand, smiled and reassured me all long my d&c (miscarriage) under spinal anesthesia! He was so so sweet. I was so thankful.
      There is no way I get to see him again, so I try to remember the pain of the needle and the words he used to guide me through it, then I can think of him.

      Probably a comment you did not expect!

      I've learned many interesting stuff on your series post about this medical profession.

      Cheers

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  10. I love my career as an anesthesiologist. Yes, the politics and non medical crap sucks but I love the job. I did a fellowship in acute pain/regional. I do not agree with the comment above about being afraid to work and drinking coffee all day. Though I do not work as many hours as my surgical colleagues my schedule is pretty busy working an average 60-80 hours a week and 23 weekends per year. I never sit down. I do 2-5 nerve catheters a day while running 2-4 rooms. I round on pain patients on the floor when I have any free time. while there is truth in some practices to the lazy anesthesiologists I think it is more the exception than the rule.

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    1. What are your thoughts on nurse anesthetists? I am a med student who is really interested in anesthesia, and they are the only reason I am hesitant.

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    2. nurses can never replace us, anesthesiologists, nobody can :)

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  11. I know it's old post but I will appreciate your honest opinion about future job prospect and CRNA. This is a topic we cannot ignore any more. I know two MDAs who left one facility due to politics over this issue. I think it is a matter of time before it is wide spread. What is your take?

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