Anaesthesia: The Good and The Bad

I’ve completed 6 out of 8 Internship rotations and I’m still not set on a speciality. Paediatrics has always been an option, even before I started studying (people think I don’t like children, partly true, but I do like them more than adults) and recently anaesthetics has been high up on my list. I think ICU medicine would be interesting, and I even sometimes have an urge to dabble in some emergency medicine. Sports medicine also featured at one point. (Take note: surgical specialties do not feature). But there isn’t one that has completely stolen my heart. So in honour of finishing anaesthetics and as an attempt to un-confuse myself, I have come up with this list: The Good and The Bad of Anaesthetics. 

The Good

1. Anaethetists are not the most chatty people. Yes, this is a pro. Anaethetists do not participate in something at petty as small talk, even though they have all the time in the world for it. If you know me, you know I don’t have time for small talk. I’d rather sit in (awkward – only you think its awkward, I’m quite happy) silence than chat about things that no one really cares about. 

2. Your patients are asleep. The best kind of patients are sleeping patients. It sounds terrible but this blog is all about honesty. Sleeping patients don’t complain or demand. They can’t boss you around. They can’t ask you fifteen thousand questions. They can’t tell you how terrible they think the hospital is. The small amount of time that the patient is awake during a general anaestethic is before and after. Before, you’re usually holding a mask over their face so they can’t talk anyway and after, is usually quite entertaining so I don’t mind them talking then (see point number 5.) Ask any anaethetist and they will tell you that a regional block with no general anaestethic is much more effort than just putting the patient to sleep and ventilating them. You have to keep checking that they are alright and comfortable, and probably engage in some small talk.

3. There is minimal admin. Of course you have to fill in your anaesthetic chart and the million other checklists that the nursing staff insist on prior to any anaesthetic. But there are no such things at clinics or ward rounds. There are no injury on duty forms. No Panado/Brufen prescriptions. The pharmacy hardly ever phones you to tell you that you made a mistake on your script (again) because you don’t write scripts. There are no discharge summaries and my ultimate favourite – no sick letters! 

4. Balance. Anaethestics is basically the use of drugs or pharmacology to maintain a normal physiological state in a patient while they have very little control over their own bodies. It’s pretty cool. I love fiddling with the anaesthetics machine and watching how the smallest adjustment can produce a massive physiological response. It’s all about balance. Small adjustments, titrating drug doses, playing with physiology and pharmacology and anticipating trouble in order to prevent it. It also offers balance in terms of making a living and having a life at the same time. Don’t get me wrong, anaethetists work hard when they do work, but they have a lot more control (in private) over the hours they work. 

5. Waking patients up is fun. I know this sounds like I’m contradicting myself. I just said I prefer a sleeping patient, why would I want them to wake up? Well the obvious reason, is that you clearly haven’t done a great job as an anaethetist if your patient doesn’t wake up – not ideal. Second is because, the response people have when they wake up after anaethesia is my favourite. Some of the things I’ve heard is

– I want my mommy (said by a grown man with atleast 17 tattoos most likely acquired in a prison somewhere)

– I remember you Doctor (well done, you did stare into my face for a good three minutes before I put you to sleep)

– Can I get a sick letter (One, is that really the first thing you want to ask? And two, ask your surgeon) 

– I want to sleep (Gurrrl, you’ve BEEN sleeping)

– I’m hungry (my personal favourite). This is probably what I would say post extubation!

So those are the reason why I should choose anaesthetics, but of course, there are always two sides to a story. And this is the other side: 

The Bad

1. Suctioning. Suctioning is the most disgusting thing. Period. The stuff that comes out of a patient’s throat after being intubated makes me want to rinse my own mouth out multiple times. And the smell is also not fantastic either. I could really do without the suctioning involved in anaesthetics. 

2. It is kinda boring. Surgeons will be the first people to tell you that anaesthetics is boring. I’ve tried to defend this point a few times but in all honesty it does get a bit tedious. The only excitement is found during induction (putting the patient to sleep), and when something goes wrong. And the whole point of anaesthesia is to make sure nothing goes wrong. So really, if it’s not boring then you aren’t doing it right. Too many times I’ve found myself watching the surgeon, thinking, “I actually feel like scrubbing in and helping you now.” And considering that I spent my whole surgery rotation trying to avoid doing just that, it’s a bit concerning. I can’t risk being dragged to the dark side. 

3. Data costs. A good anaethetist is always on their phone. Facebooking, rechecking Instagram every 5 minutes, Googling random things, checking restaurant menus (okay, that’s just me) and catching up on admin. (I am writing this blog post with a patient sleeping in front of me). The reason for this is because, as mentioned above, things aren’t going wrong and therefore they are bored. I’ve had to buy extra data twice this month, thanks to anaesthetics. 

4. I hate being cold. If you aren’t scrubbed up, wearing two pairs of gloves and baking under the theatre lights then you will be cold. Theatres are usually set to about 20 degrees, which without a long sleeve top on, is pretty chilly. There is a silent war that happens in theatre over the temperature (one of many silent wars that happen in theatre). Between cases the anaethetist will surreptitiously turn the temperature up a degree or two, and when he turns his back the surgeon will turn it back down. It’s quite entertaining actually. 

5. A great deal of patience is needed. Something I am lacking. In the beginning of the day, the anaethetist will be ready to go, drugs drawn up, machine check done, drip up and running, and just when he thinks he’s on a roll the scrub sister will crush his dreams of finishing the list by saying “Just wait doctor, I need to open my packs first”. You see, the anaethetists think they are in charge in theatre but they are mistaken. The sisters are actually running the show. And when they say they are not ready, everything stops until they give the go ahead. And when the scrub sister has to take lunch, everyone has to take lunch. And you’ll also notice that at around 2pm everything happens really slowly. This is because theatre finishes at 4pm, and a new case cannot be started after 3pm. So if the nurses do everything really slowly after 2pm, making sure a new case can’t start, they can guarantee themselves an early day. You must see the look on a scrub sisters’ face when a case finishes just before 3 and a new one is started. Seriously, patience is a virtue. 

And there it is… The good and the bad. I still have no idea what I want to specialize in. I still enjoy anaesthetics. I still don’t know if I want to do it every day of my life. But it is high up on my list. I have two rotations to go and if neither of them steal my heart then I will be just as confused as ever. 

PS. Those two rotations are Obs/Gynae and Internal Medicine – I’m not sure there is a lot of hope for me. 

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