Wednesday, November 15, 2017

The Hardest Part Of Being An Anesthesiologist, Part 1

When I saw the headline in KevinMD, "For an anesthesiologist, this is the hardest part of medicine," I thought, great. Somebody is finally voicing their frustrations with the the practice of anesthesiology. I figured maybe I can learn something from this person's career difficulties and how they overcame it. What I got from the article was not what I expected.

The article is what JK Rowling might describe in the UK as treacly or here in the US as cringy. Its saccharine depiction of the author's encounters with patients in preop made me roll my eyes until my extraocular muscles felt like they might rip off my eyeballs. Dr. Sasha Shillcutt, a cardiac anesthesiologist, describes that when she shakes hands with her patients, they are so scared that frequently they won't let go. She portrays herself as the patients' and their families' medical hero because, well, the surgeon and the preop nurses are just too busy running around to really listen to their concerns. It's the anesthesiologist to the rescue since nobody else in the entire OR suite has the time or the humanity to sympathize with the abject fear the patients are silently experiencing.

I'm sorry but I don't have the same experience. Yes the author can write whatever she wants on her blog, but let me inject some reality into this situation. It's usually the anesthesiologist who is running around like crazy before surgery. Especially for cardiac cases, we arrive in the OR at an ungodly early hour to check our machines, draw up drugs, mix bags of more drugs, and do fifty other things to get ready for surgery. Then we rush to Preop Holding to do a quickie five minute evaluation with the patient and start the IV. We are the member of the OR team that has the least rapport with the patient and their family. The surgeon will presumable have already had a decent relationship with them when he saw them in his office and explained the procedure to them. The preop nurse has had about thirty minutes of undivided attention to sit there and discuss with the patient their history and other concerns. We are the ones who rush in, say a quick hello, and quickly rattle off the anesthetic plan, which for most patients means they will be sleeping during the case. That's usually as specific as patients want to know about anesthesia.

So, no. The hardest part of anesthesiology is not comforting a scared preop patient by shaking their hand. I'll tell you what are really the hardest parts of anesthesiology in the next article.


  1. Agreed! I get there at 5am-530am to set up. Meanwhile the surgeon has already met the patient previously and developed a relationship, and they have the techs set up their equipments for them, while we are rushing around doing all sort of things. But hey maybe things are different at her institution.

  2. What you missed is she is in academics, which means her residents and fellows do all the work, and she just holds the pts hand :)