t is 2005, a Saturday morning, a call day, one of the seven I take a month. It is 5 a.m., and I am arising for a morning of cases. Since when are gallbladders emergency cases? Arriving early I check the patient’s name on our computerized system and begin to fill out my anesthesia record. I cannot wait until the hospital approves our request for new machines with automated record keeping, transferring the data from Medetech onto my record. I call obstetrics (O.B.) to see how busy they are. I then restock my room, getting supplies from a computerized dispensing system (Pyxis^®). I complete the FDA machine check and then sign all my drugs, fentanyl, succinylcholine (yes, it is still around), propofol, mivacurium and Zofran^®, from another computerized dispensing system (AcuDose).

The patient arrives. Interview, examination and signed informed consent. To the operating room, again relying on amazing technology. Monitors are applied: BIS^®, pulse ox, BP, ECG temperature. Even though I have the latest vaporizers, I choose TIVA. Infusing propofol with a computerized pump (on a mg/kg basis) along with relaxant and narcotic, to theoretically reduce the incidence of PONV. OTI UDV x1 BSBE (at least I still examine patients). Positive ETCO₂. Emergence smooth. To PACU (not recovery room).

Between cases (a two-hour wait), I go to the poorly appointed, small anesthesia office to organize papers and read the ASA NEWSLETTER and Anesthesiology. I work on some of my professional volunteer committee jobs as president-elect of the medical staff and Wood Library-Museum of Anesthesiology Trustee. I like to do these activities during down time at work so I can spend time with my lovely wife and marvelous 13-year-old twins. There are some things as important as our careers.

An O.B. doctor interrupts me, asking about a patient who had a spinal for cerclage. The patient has severe pain radiating down her legs. I think the history sounds like transient neurologic symptoms (TNS). “Come to the emergency room for evaluation,” I say. I get on the Internet (Google) and find the latest review article on TNS and run the copy to the emergency room. I curse the computer to dispense supplies and drugs, praise it to dispense information. The ASA Web site <www.ASAhq.org> is great, providing information on what is new in Society news, clinical information regarding practice parameters and guidelines, a calendar of meetings and my favorite site, the Wood Library-Museum <www.ASAhq.org/wlm>.
I finish my second case and head upstairs to complete pain rounds, checking on our postop lumbar and thoracic epidural patients. It is great seeing the improvements anesthesiology has brought about in pain medicine. The last case is canceled pending “cardiology clearance.” I examine and reassure the patient with TNS and dictate a note. At least I will be home by 5 p.m.

The pager goes off. It is 11 p.m. I head back to the hospital for an abdominal delivery (cesarean). Mother and child are well. The intensive care unit (ICU) calls up to the O.B. suite (how they know I am here is beyond me); they have a patient with a tube leak and want the endotracheal tube changed. Nervously I head down to the ICU; even after 28 years, that procedure still scares me. After evaluation I figure out the cuff is above the cords, I readjust and plan to go home when the supervisor tells me the cardiologists have cleared the last case, and it is on for 8:30 a.m.

With the news of an 8:30 case on my mind, I drive home and reflect on my choice of profession (medicine) and specialty (anesthesiology). The profession is stronger than ever.

Our foundations, the Anesthesia Patient Safety Foundation, the Foundation for Anesthesia Education and Research, the Wood Library-Museum of Anesthesiology and the Anesthesia Foundation, lead the way in safety, education and research and professionalism. Our subspecialty societies and journals have added to the expertise and improvements for all anesthesiologists. Academic anesthesiology continues to train future leaders and practitioners. In fact I am thankful: thankful for my colleagues who work on ASA committees; for the friends I have made within the profession, not only physicians but the fine people at ASA headquarters; for a good living and for being able to follow in my father’s footsteps (may I practice for 40 years and have the same impact).

It is a great job (profession)! Gee, I wish I did not have that 8:30 case.

Jonathan C. Berman, M.D., is a staff anesthesiologist at North Suburban Medical Center and the University of Colorado Health Sciences Center, Thornton, Colorado.

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