Choosing anaesthetics

August 22, 2012

Wish I’d had one of these all those years ago

Choosing careers must be difficult. At least having studied medicine you kind of don’t have to think about it for a while as you are on a pre-trodden treadmill  But you do have to choose which branch of medicine to specialise in.

After my Houseman year I opted to for Anaesthetics. It is by far the best specialty. Perhaps Emergency Medicine runs a close second. Basically it is really practical, immediate, covers every type of patient and disease, includes Intensive Care and lots of  life and death  stuff. You have shedloads of individual responsibility – no need to consult with others about what you are doing, but work in a group environment so get the banter and human contact.

And it is incredibly well taught. That last one makes it fundamentally different from so many other specialties which tend to leave one to get on with it and learn by osmosis and experience. Anaesthetics on the other hand is very much direct Consultant and other seniors teaching juniors on a one to one basis. After all, you can’t risk a patient’s life by leaving them in completely untrained hands. And anaesthetics is all about life and death. Putting people to slepp, paralysing them so they can’t breathe, making their blood pressure drop. All good fun and physiological games. For a purpose of course.

I did my training back in London. I’d had my year out and loved it, but pined for the city on two counts. One is snobbery – as a London graduate I believed I would get better training in a London teaching hospital, and the other is just London itself.

And so it was I rolled up to The London Hospital in Whitechapel, the East End of London. It’s so long ago it wasn’t even Royal at that time. And I  joined the large Anaesthetics department, along with a number of other new SHOs (Senior House Officers). They say starting Anaesthetics is 99% terror and 1% boredom. And that by the time you are a Consultant it is 99% boredom and 1% terror. I disagree with the high boredom factor, but the terror part is certainly true at the beginning. But that’s where the fantastic training comes in. Plus an entire new breed of people who I had never really noticed as a medical student – the ODAs. Operating Department Assistants. I think they are now called Practitioners or some other arse wank title, but to me they are ODAs. Bloody fantastic. They are practical help in theatre, and can assist the anaesthetist, the surgeon or in recovery. They will prepare the room, lay out the drugs, clean the equipment and all that kind of stuff. Obviously as the anaesthetist you are ultimately responsible for  what happens to the patient, but it is wonderful to have someone you can trust to physically move machinery, get the ECG leads out, do lots of the basic tasks. And even more important they have usually got years of experience and can really help when you are doing stuff on your own and things don’t go quite according to plan.

A good ODA will prepare a patient in the anaesthetic room, putting them at ease and chatting whilst you are finishing off the previous patient. Not literally finishing off (fingers crossed), but taking them to recovery or whatever. They will draw up the drugs, label them and pass them to you as you need them, and pass the correct equipment at the right time. They might even put a needle in ready for the drugs to be injected.

It was routine to put a tube in to the trachea (windpipe) when operating for a long time or on the abdomen (because you need to paralyse all the muscles so the abdomen will relax and allow the surgeon easy access, but it also means paralysing the respiratory muscles) and usually it is very straightforward once you have the knack. But very occasionally it isn’t straightforward and a good ODA will be worth their weight in gold as they get you different equipment and suggest new strategies you might not have thought of if you are relatively new.  They will also go get help when they think you need it!

Anaesthetics is not dissimilar to cookery – there are a thousand different recipes for the cocktails to put you to sleep and every anaesthetist has their favourite ways of anaesthetising for certain operations. Different operations require different cocktails and different patients require different cocktails within that so there are plenty of permutations to consider. And the human is a living organ (we hope) and things change as the operation progresses. And the anaesthetist is responsible for keeping that person alive and giving the surgeon optimal operating conditions. So the patient doesn’t move when the scalpel goes in for example. Or their blood pressure doesn’t shoot up and make them bleed excessively. And they wake up without pain when the operation is over. And ideally without feeling sick too.  It’s all a balancing act – too much anaesthetic and you might not wake up, not enough and you might feel it or remember it.

And we also got to do Intensive Care too – another critical care area full of practical procedures, challenging problems and very sick people.

One of the many pluses of doing anaesthetics is you get to wear scrubs the whole time so you don’t have to worry about work clothes. The hospital supplies you with standard cotton (usually blue or green) trousers and a top. Or a dress.  I always wore trousers, even with a dress. And lovely white clogs or wellington boots. Topped off with a hat and mask and you are good to go. On the wards you might add a white coat, but basically you wander round in jim jams all day. Then throw them in the laundry basket on your way out of work. Result.

The other big plus is that other doctors are nearly always pleased and relieved to see you because you are usually only called in when they need your immediate help – getting a line in when everyone else has tried and failed, resuscitating when the shit has hit the fan, taking charge of the very very sick and unconscious patient. Oh yes, anaesthetics is one of the coolest specialties.  And I had never been cool in my entire life. Until now. And I loved it.

Jim jams for work. What’s not to love?


2 Responses to “Choosing anaesthetics”

  1. Jess Says:

    With my two back operations, two caesareans and other hospital events I got to know a few anaesthetists (although when I lived in the US, folks looked at me askance and corrected my pronunciation to “anaesthesiologist”). I soon found out these were the key people in the mix, especially when the surgeon – though outstanding at his craft – had the bedside manner of a plank of wood. Anaesthetists had the BEST EVER DRUGS too. How much I enjoyed my self-dosing pain relief gizmo in the High Dependency Unit. And my controlled prescriptions. Top choice of speciality Sarah!

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