Author: Stephen Freiberg, MD
1. Anesthesiologists are your protector
Think about this: An anesthesiologist’s job is to protect you from the harm your surgeon is causing. Seriously. A surgeon’s job, at its very essence, is to damage your body. Now undeniably, it is with the intention of causing greater good and/or fixing something that is already broken. But in order for a surgeon to help a patient, they take a knife, saw, drill, or hammer, and use it on the human body. Outside of the medical arena, this would be assault. The human body is in no way designed for a power saw to split open its sternum. It is in no way designed for its belly to be sliced open, its bleeding blood vessels to be burned away, only to be disemboweled and then put back together We as anesthesiologists make it possible for patients to survive these benevolent attacks. And perhaps more importantly, we make sure patients do not remember or feel these things.
In addition to being your biological guardian, we are also your advocate, when you are rendered unconscious, paralyzed, and cannot advocate for yourself. While this is obviously a collaborative discussion with your surgeon, we are the ones who tell the surgeon, “No,” “Stop,” or “We need a new plan.”
2. Anesthesiologists maintain the balance
Anesthesiologists are experts in physiology and homeostasis. Homeostasis is the body’s natural tendency to keep everything, essentially, as it is. An anesthesiologist’s job is to keep everything, for lack of a better word, boring. The surgeon’s job is to cut and sew. They should, appropriately, be provided with the optimal environment to focus on exactly that. Everything else falls under the anesthesiologist’s domain: Your breathing. Your blood pressure. Your heartbeat. Your electrolytes. That’s all us.
3. Anesthesiologists are experts in pain management
I don’t think there is anything more fundamental to the practice of medicine than the alleviation of pain and suffering. We, as anesthesiologists, specialize in exactly that. Anecdotally, I can share that what patients fear most is not the surgery, not the hospital stay, not missing work, or even death- it’s pain. We use our mastery of pharmacology to ensure that pain is not experienced during surgery, but also to minimize it afterward. We use our mastery of anatomy, ultrasound technology, and neurophysiology to inject medications into and around the spine, or directly around targeted nerves, to modify or even ablate pain completely. Some anesthesiologists complete fellowship training to further develop these skills to perform super-specialized procedures in the field of acute or chronic pain management.
4. Anesthesiologists are experts in resuscitation
This is probably my favorite part of anesthesiology. When the sh*t hits the fan, anesthesiologists are the ones you want around.
We put in the breathing tube to breath when you can’t. We put in IVs and special catheters in your neck and chest to deliver medications, fluids, or blood products. We manage the ventilators, infusions, and medications, that quite literally, will keep you alive. And we do it fast.
In the blasphemous misrepresentation of both medicine and human interaction known as Grey’s Anatomy, whenever things went badly in the OR, it was always the inexplicably handsome surgeon barking orders to the anesthesiologist, who would fearfully oblige. Let me let you in on a little secret: in real life, it’s the other way around. Everyone looks to the anesthesiologist to run the show. In fact, most hospitals have some sort of protocol in place where when things go south in an operating room, an overhead call can be made for “All Available Anesthesia,” or “Anesthesia Stat!” They don’t call for the cardiologists. They don’t call for the pulmonologist. They don’t call for surgeons. They call for us.
5. Anesthesiologists are the custodians of perioperative care
In the preoperative setting, I might decide that it’s not safe for you to undergo surgery. It’s a long-running joke that anesthesiologist love to cancel cases, but it’s not something we take lightly. Believe me, we want you to have your tumor removed. But we want to make sure you don’t die in the process. The term we anesthesiologists favor, is we want to make sure you’re optimized for surgery, and we are there to help ensure you are.
And you know those stupid whiteboards that the beautiful TV surgeons are always convening in front of to argue about whose case needs to go first? Yeah, anesthesiologists run those boards too.
So where does this place anesthesiologists in the setting of the COVID-19 pandemic? Right on the front line.
Many COVID carriers are asymptomatic. So that means anyone coming for surgery, could potentially be a carrier. Patients with confirmed Coronavirus might also need surgery for any variety of reasons. Why is this especially dangerous for anesthesiologists? We are the ones putting the breathing tubes in. The procedure, called endotracheal intubation, is an aerosolizing procedure. That means it’s especially dangerous because it allows more viral particles, to spread farther. Plus, in order to perform the procedure, we are commonly right all up in the mouth of the beast, to torture a pun.
At many institutions, anesthesiologists perform every intubation in the hospital. Emergency medicine doctors, pulmonologists, and a few other specialized physicians perform intubations. While they are undoubtedly skilled at doing so, anesthesiologists are the airway experts. If these other physicians have trouble, they call us.
Some anesthesiologists pursue additional training to become intensivists or critical care doctors. Even for those of us without the additional fellowship training, anesthesiologist’s practice critical care medicine on a daily basis- every operating room, is pretty much a single bed ICU. Anesthesiologists are naturally poised to bring their skillset into the ICU, should the need arise.
So if you’re unfortunate enough to need surgery, and end up in our care, just know, we’ve got your back.
And in these unprecedented times, I ask that you have ours as well.