My Introduction to the World of Anesthesiology

Timothy D. Quinn

y introduction to anesthesiology came the summer after my first year at medical school during an internship with Nader D. Nader, M.D., Ph.D., at the Veterans Affairs (VA) Hospital in Buffalo, New York. I had no idea what to expect as a novice in the hospital and had no previous exposure to anesthesia. I found anesthesia to be a dynamic field with meaningful patient contact in a variety of settings. If it were not for this experience early in my medical education, however, I may not have considered it as a specialty. Time constraints in many third year clerkship schedules make it impossible to fully explore all career options. Students may go through their entire medical education without a rotation in anesthesia, where pharmacology and physiology truly come to life in a practical way.

First Observations
At the VA, I was introduced to the concept of perioperative anesthesia care. I witnessed anesthesiologists performing the initial patient interview, managing the patient during the surgical procedure and following up on their patients postoperatively. During the preoperative interview, the anesthesiologists took a full and detailed history to assess any risk factors above and beyond the focus of the surgery. They reviewed patients’ medical history, including recent tests; interviewed and performed the physical examination; extracted information from the history, physical examination and other physicians’ notes to determine the best plan of anesthesia for their patient; and, finally, assessed the need for postoperative pain management. Medications, allergies, personal and family history of anesthesia complications, and social history of tobacco or drug use also were incorporated and were important to developing the anesthetic plan. It became clear to me that the anesthesiologist must have a broad understanding of human physiology and pathology to effectively screen a patient for surgery.

Preoperative Interview
The preoperative interview provides the anesthesiologist with the opportunity to not only learn about the patient’s medical history but also to gain the patient’s trust before the procedure. I realized that in order to be effective, the anesthesiologist must quell any anxiety while conveying a confident and relaxed demeanor. During my internship, several residents remarked that preoperative interviews at the VA were the best clinical experience they had ever had. More often than not, important information about the patient’s medical history was elucidated during the interview — information that had not been addressed in other examinations. It is also a chance for anesthesiologists to demonstrate their dedication to provide patients with the best care. For example, I witnessed one resident track down a paper copy of an anesthesia report from medical records to learn how a patient with a difficult airway was intubated in a previous procedure.

Story of Mr. B
Perioperative anesthesia care has expanded the role of the anesthesiologist, resulting in more patient interactions over a longer period of time. A perfect example of this was Mr. B. Another resident and I did a full preoperative interview with Mr. B for a left inguinal hernia repair. On the day of surgery, we followed Mr. B from the preoperative room, through hernia surgery, and safely to the postanesthesia care unit. We visited him the next day on the floor and discharged him home with pain medication. Less than a week later, Mr. B returned to the E.R. with left scrotal edema, and exploratory surgery was scheduled for that day. The same anesthesia team saw him in the E.R. and safely guided him through another procedure. I believe Mr. B is a great example of anesthesia’s role in excellent perioperative care. Through his first interview and surgery, we developed a rapport with him that carried over into another procedure. We understood how anesthesia affected him and how to best control his pain after surgery. It was very gratifying to successfully manage Mr. B during the procedures.

There From Start to Finish
Patients present with diverse conditions and reactions to anesthesia; therefore, a thorough preoperative interview and a well-orchestrated anesthetic plan can greatly increase the likelihood of a safe and successful surgery. After surgery it is time to ensure a smooth transition to consciousness and the recovery room. I remember one instance where a code was called in the recovery room for an obese man with a long history of cardiac problems and other co-morbidities. The anesthesiologist stood at the head of the bed, managing the airway and directing the resuscitation effort. What impressed me the most was how calm and composed the anesthesia team was while taking control of a chaotic situation. After the patient was stable, it was back to the O.R. for another case.

Applying What I’ve Learned
Now a fourth-year medical student, I will be applying for an anesthesia residency this fall. The most important lesson I learned during my summer internship was the expanding and multifaceted role that anesthesiologists play in patient care.

They can be primary care physicians during the initial patient interview while performing a detailed history and physical and assessing overall health.

They can be intensivists during the procedure, overseeing and maintaining physiological function.

They can be pain specialists, providing appropriate and timely relief.

They can run a code and manage the operating rooms. Most importantly they are advocates and guardians throughout the entire surgical process, safeguarding the patient from harm and always reassessing whether the risks outweigh the benefits for any action.

Timothy D. Quinn is a fourth-year medical student, Georgetown University School of Medicine Class of 2008.