What’s Your Perspective?

The past year, and furthermore, the past several years, have been quite interesting and eventful to be sure. A torrent of troubling news pertinent to every demographic, social class, community, and profession has become part of the daily reality. The economy is teetering on the brink of recession. Supply chain challenges have made the safe care of patients challenging, as we have collectively faced shortages of intravenous fluids, emergency medications, reversal agents, and even anesthetics. Violence carried out based on ethnicity, political position (whether conservative or liberal), or even different age groups has permeated society. Portions of our society appear to be as fractured as nearly at any time during our nation’s history. Even the role of the physician in the care of the sick has been called into question with misguided policies and government agency positions purported to be enacted to increase access to care while, in fact, degrading care for all Americans. Indeed, frustration can be anticipated when we as physician anesthesiologists must be responsible for and know so much, yet to be appreciated by what seems to be so few. Furthermore, an individual reading this missive has a more personal concern regarding their health or home life, their finances, or even their future. Everyone has problems!

For the first several years after finishing our fellowships (E. Williams in pediatric anesthesiology and G. Williams in critical care), George’s practice was split between the neuroscience ICU, trauma ICU, and ORs (this was before the pandemic). There is a tremendous volume of pathology at his institution, including aneurysmal subarachnoid hemorrhage, spinal cord injuries, assaults, industrial accidents, and explosions, to name just a few. From young to old, ASA Physical Status I to V, we have never encountered a patient who had been planning to have an admission to the ICU or having an emergent hemicraniectomy that day; they were all going about their daily lives at work or home when something suddenly happened to them. This was even more magnified for all of us during the pandemic. We’ve all seen 20-year-old patients requiring a tracheostomy and/or a PEG tube insertion. Similarly, we have all witnessed a patient who has an unresectable mass or a patient with young children who needs to have a goals-of-care discussion due to futility of care. We think everyone can agree that our friends and neighbors who find themselves in such circumstances have significant problems. At the end of the day, nearly 100% of the physicians caring for the souls in these dire circumstances have the opportunity to go home at the end of the day. The vast majority of the physicians reading this article likely are not connected to a life support device or unable attend to daily matters. In like manner, it is much more likely that the reader of this article has had the unenviable and serious responsibility of deciding to keep a patient intubated, place an emergent central line, or send a patient to the ICU and thought to themselves, “What if this were me or my loved one?” or “I wish this patient didn’t have to go through this.”

For us, the blessing and burden of leading and witnessing the clinical care commensurate to being a pediatric anesthesiologist or physician anesthesiologist and intensivist has reinforced the importance of recognizing and celebrating when our “problems” aren’t really all that bad. It is important to take the time to relish functionality and health whenever possible. We had never gone for a neighborhood walk as husband, wife, and three children until the pandemic. We had never had a picnic in the backyard or gone bike riding until the pandemic. Even though George thought that he had been taking time with his family and being a “good father,” all these facts made us realize the opportunity and responsibility that we had to prioritize our renewed perspective on the time that we had been gifted. Don’t get us wrong, we have personally endured several difficult and sad events, including the loss of dear loved ones over the intervening time aforementioned. But beyond our valley moments, we – no, all of us – have a tremendous amount to be grateful for. We are grateful that, as a result of many of the experiences that were mentioned above, we both now regularly go on day dates, intentionally using our post-call time. We have reinforced dinnertime together as a family nearly every night of the week, whereas in prior times we would be at home together for dinner twice a week due to our combined activities. We play “Uno” and “Throw Throw Burrito” and chess as a family. In all honesty, our children are getting so good at chess that George is thinking about buying a book to improve his skills. We’re more intentional about celebrating each other – not just birthdays or performances, but the little things like having a great week at school, being a good friend, or maybe a positive recognition at school or at church. To quote Oprah Winfrey, “The more you praise and celebrate your life, the more there is in life to celebrate.”

Overall, we can and should take into account that if we are able to read this article and understand it, if the content of this article can be discussed with family, friends, or acquaintances, if we can walk or eat or even breathe on our own, if we have the opportunity to leave the hospital when we want to… then we have it better than a lot of people. We must collectively protect our hearts from the gall of the “daily grind” commensurate to the modern practice of medicine or else it can affect not only our countenance, but also our capacity to care. The physician anesthesiologist community is uniquely suited to have an understanding of this perspective given the care that we render every day and the challenges we have collectively weathered as a specialty since the first recorded anesthetic in 1842. If we take stock from a 30,000-foot view, our problems in many instances can serve as obstacles or opportunities.

In the final analysis, even when we are travelling uphill with the wind blowing against us, a lot of people would love to be in our shoes. It can come down to the outlook we have, as we collectively have a lot to be grateful for. In our daily attempt to be our best, it all comes down to, “What’s your perspective?”