He was a brilliant anesthesiologist at the top of his career when, one day, he could not intubate a neonate and was worried. The next day, his family thought he did not look well and took him to the emergency room. A CT scan found a brain stem tumor, revealing the cause of his difficulties – “elevated intracranial pressure.” In the course of only 48 hours, his life had changed. Instead of worrying about his patients, his family was trying to find a neurosurgeon who would agree to operate on him. He was only 48 years old.

“Stories like this are scattered around us and keep reminding us that life is fragile and can change in the blink of an eye. Personal health issues are only one of the several things that can change our life, our career, and affect our loved ones. Other factors that may be life- or career-changing for anesthesiologists include job loss, stress and burnout, bad patient outcomes, and medical malpractice lawsuits. Most of these factors are out of our control.”

Another anesthesiologist fell one day while leaving work and later found out his fall and bony fracture was due to a metastatic tumor. He underwent surgery, chemo, and radiation, and his life too had changed. A young anesthesiologist started a first job after a fellowship, but a domestic situation led to stress and loss of life by suicide.

Stories like this are scattered around us and keep reminding us that life is fragile and can change in the blink of an eye. Personal health issues are only one of the several things that can change our life, our career, and affect our loved ones. Other factors that may be life- or career-changing for anesthesiologists include job loss, stress and burnout, bad patient outcomes, and medical malpractice lawsuits. Most of these factors are out of our control.

One may think that clinical competence, passion, and empathy should be enough for an anesthesiologist to thrive as a professional. These traits are the backbone of our profession. Other factors like teamwork are of prime importance too, as anesthesiologists must collaborate closely with surgeons, nurses, and other health care professionals to ensure patient safety. Anesthesia residency training emphasizes development of communication skills and functioning within a team. At times, even when an anesthesiologist is capable of being a team player, implicit or explicit bias by other players in the team can lead to conflict and friction, which may lead to a need for change.

The health care system in the United States is increasingly influenced by economic factors, such as hospital budget cuts or restructuring. A major example from recent history is when the doors were closed at the oldest children’s hospital in Boston (the Floating Hospital for Children) in summer 2022. The department of anesthesiology at this university hospital had a strong pediatric division with an ACGME-accredited fellowship training program. The pediatric anesthesiologists were left scrambling, and a valued training program was lost.

Human life is fragile. It takes almost three decades for one to finish all necessary training before the coveted label of “anesthesiologist” is finally achieved. And this voyage is not solo, as the sacrifices of parents, siblings, spouses/significant others, friends, and children make this journey possible. When an unforeseen event interrupts, it affects everyone.

The December ASA Monitor contains several featured essays that encompass different aspects of the adversities faced by practicing anesthesiologists.

In the article “From Surviving to Thriving – A Burnout Story,” Jeffrey W. Hartwig, DO, offers a very personal story of burnout resulting from stressors in his personal and professional lives, which eventually led to his leaving the field of medicine. After leaving the profession, he adopted several strategies (self-guided as well as professional help) to get his life on track. These strategies were successful. When his old department approached him with a strategy to return to the profession he loves as half FTE, he accepted and began to thrive.

“Navigating the Aftermath of an Unexpected Intraoperative Death,” by Drs. Rima Abhyankar, Alexander Meshel, and Benjamin Hyers, delves into the emotional and psychological burden that anesthesiologists face after experiencing an intraoperative death (IOD), an event that, while rare, is a reality in the careers of most anesthesiologists. Despite their extensive training to manage life-threatening situations, anesthesiologists are often unprepared for the emotional aftermath of a patient’s unexpected death. The shock can shatter the sense of control and invincibility that is often found in anesthesiologists, who operate in a profession built on precision and safety. A lack of preparation and support for dealing with these outcomes can result in overwhelming feelings of guilt, self-doubt, isolation, and even dysfunctional behaviors like insomnia, substance abuse, early retirement, or suicidal thoughts. The article also highlights the “second victim syndrome,” where health care professionals experience emotional trauma after an adverse event, especially in high-stakes fields like ours. Studies show that inadequate support after an IOD can compromise an anesthesiologist’s ability to provide care and result in long-term psychological effects, with some considering career changes. The article advocates for systemic reforms, including the incorporation of discussions and simulations of IOD during anesthesiology training and the establishment of robust emotional and psychological support systems for both trainees and practicing anesthesiologists. By normalizing conversations around IOD and providing better resources, the field can foster a culture of resilience, where anesthesiologists are better equipped to handle not only the medical complexities but also the emotional challenges of their profession.

These two articles are followed by a very thoughtful piece titled “How to Cope When Things Go Wrong,” which explores various personal and professional strategies we can adopt to manage stress, especially after encountering poor patient outcomes. Allen N. Gustin Jr., MD, FCCP, FASA, FCCM, a critical care and palliative care anesthesiologist, shares personal experiences of how patient deaths can have a profound impact, both mentally and physically, on their caregivers. The article stresses the importance of a supportive work environment where colleagues can offer emotional check-ins, provide early relief from clinical duties to process the events, and expedite quality reviews. The author points out that these steps can ease emotional burdens, especially after unanticipated outcomes. The article also delves into the value of mindfulness meditation and self-compassion as critical tools for managing stress and emotional responses to difficult situations. Through years of practice, the author has found mindfulness meditation to be an essential part of reflection and emotional management, particularly after patient care failures. Self-compassion, though more challenging, helps counteract self-criticism and promotes emotional healing. The importance of self-care is also underscored, with the author outlining changes to improve physical health, sleep quality, and personal relationships as key to overall well-being. Additionally, the article recommends professional development in bioethics and the disclosure of adverse outcomes, which can help health care professionals better navigate difficult conversations with patients and families. Ultimately, the message is that each individual copes with stress differently, and we all must actively work on improving emotional resilience. By addressing these elements, health care professionals can better manage their emotions and prevent burnout.

“Despite their extensive training to manage life-threatening situations, anesthesiologists are often unprepared for the emotional aftermath of a patient’s unexpected death. The shock can shatter the sense of control and invincibility that is often found in anesthesiologists, who operate in a profession built on precision and safety.”

The last featured article in this special issue is very practical. In “Help, I’ve Been Sued! A Practical Guide to Dealing with a Lawsuit,” Drs. Jason Sung Chi, Aaron N. Primm, and Naileshni S. Singh provide a step-by-step overview of what happens when an anesthesiologist is faced with a malpractice lawsuit. The article summarizes the do’s and don’ts when a legal case is at hand, and the authors walk the reader through the commonly experienced steps of the legal process, including what to expect and how to do it right.