#pgy-2

Currently finishing up month 2 of being a PGY-2 (!!!)

I started the year off basically with a week of nights at our busy university hospital with brand new interns. Being an upper level is mostly terrifying so far but also exciting. 

- Syringes and needles. So many syringes and needles.

- When all of the labels are neatly lined up and facing the same direction. Or just generally when everything is neatly lined up and facing the same direction.

- Getting that perfectly crisp loss of resistance on epidural placement.

- When patients say, "Wow, getting that IV [or other awake procedure] didn't hurt at all!" (Thank you, intradermal/subcutaneous 1% lidocaine.)

- Smooth wakeups, especially after propofol TIVA with adjunctive dexmedetomidine, lidocaine, or remifentanil/sufentanil infusions. The best usually involve some variation of the arms-crossed-behind-the-head position.

- Insta-bonding with patients over commonalities or shared opinions. There's no better way to set a patient (and yourself) at ease.

- Insta-bonding with other staff over commonalities or shared opinions. I recently discovered that one of our 64-year-old orthopedic surgeons and I have freakishly identical tastes in music (both rock and classical). Not sure if that says more about him or about me.

- Feeling like an airway ninja. So far, this has most commonly occurred after (1) awake fiberoptic intubation, (2) feeling tracheal rings with the bougie, or (3) just plain getting that coveted Cormack-Lehane grade 1 view.

- Visualizing local anesthetic spread on ultrasound in exactly the place you intended.

- An effective regional anesthetic. There are few things more satisfying than a (mostly) awake patient remaining completely comfortable while a surgeon is literally drilling, sawing, and hammering away at their bones.

- Planning for cases and preparing the OR. It feels like a sacrosanct ritual, a meticulous preparation for any contingency that might arise.

- Being a go-to guy for all matters relating to cardiopulmonary physiology, pharmacology, and difficult access.

- Learning all of the tiny details that can make or break a smooth (and safe) anesthetic plan. They're a pain and a half to learn, but the process is endlessly rewarding.

- Being, for all intents and purposes, the medical equivalent of a potions master.

Today I was booking it across the ward to try to make it to my journal club presentation on time and a little boy was standing outside his sister’s room. He looked up at me with the biggest, most imploring eyes I have ever seen, so I stopped in my tracks and crouched down to get on his level. 

He immediately grabbed my elbow, then traced my forearm to hold my hand in both of his.

“I asked for a truck,” he said very seriously, with that incredibly earnest look on his face. “I’m still waiting.”

He was so cute I just about melted. Another little girl, one of his sisters, popped out right behind him with the same puppy dog eyes.

“Where are all the toys?”

In that moment, I felt like there would be no greater achievement than somehow finding these kids something to play with.

Sometimes I get so caught up in myself and what I have to do that I don’t stop to consider what the people around me might need. I’m so absorbed in my to-do list that I fail to notice when my friends and family might be having a hard time. When I saw this little boy and his wibbly little pouty face, I think it was a bit of a wake-up call; this little boy had something he really wanted, and in order for me to help him, I had to stop and listen.

This definitely applies to my relationships with other people, but also to the way I treat myself. I feel a little guilty slipping away to eat when we have a patient list a mile long and a hundred thousand things to attend to, but I do need to stop and listen to what my body needs. Sometimes I find myself doing things a certain way because my senior residents or my staff are telling me I have to, but I think there’s a better way; I need to stop and listen to my gut, and make sure I at least voice my thoughts. And most importantly, I need to stop and listen when the red flags are rising--when I am dragging myself out of bed already waiting for the moment I can lie back down, or when I am going through all the motions of regular life but feeling numb and empty.

Me: 

Around 3:45 AM, I was awakened by a page about an emergent exploratory laparotomy coming up from the ED. I hauled myself out of my call room cot, trundled down to the OR, and started hastily setting up the room. Within seconds, the patient crashed through the OR doors in extremis, left lower extremity mangled, multiple blood products already transfusing, barely responsive, purpuric abdomen exposed and grossly distended. Heart pounding and palms slightly damp, I geared up for rapid-sequence induction and intubation.

...Only to be suddenly jerked from sleep at around 3:45 AM by a page that an emergent case was heading into the OR. 

Patient interactions are so pleasant and endearing in this specialty. I feel like I can connect more with most of my patients in a few minutes and learn more about them (as humans) than I could at any point during my year of internal medicine. (And people honestly say the most peculiarly uninhibited things when they’re zonked on midazolam or emerging from a propofol TIVA.)

Production pressures are real. Virtually no time is budgeted for us to turn over a room, evaluate and consent our patients, place IVs, and roll back. Perioperatively, efficiency is the name of the game. And if delays occur, it’s always anesthesia’s fault. (Though I’ve gradually learned to be okay with this.)

I’m lucky to be (or have become) a morning person. My alarm sounds at 4:30 AM, whereafter I roll into the hospital in sweats before changing into scrubs and moseying over to my OR—where I can listen to string quartets while meticulously preparing for the day’s cases to my liking. Those hours are some of my favorites: an introvert’s paradise.

No other specialty has such a steep learning curve. After ~1 month of frantic one-on-one tutoring, we’re expected to have developed sufficient breadth and depth of knowledge/technical skill to conduct a simple anesthetic for a reasonably healthy patient with minimal supervision. It’s a trip.

No regrets so far. None whatsoever. As far as I’m concerned, anesthesiology is a consummately high-tech, high-touch, high-intensity specialty with just the right quality and quantity of patient interaction. 5/5 stars: would recommend highly to others.