Volume 77 Number 3

Snooze Button Not Included: Chronicles of an Anesthesiology Resident

For the over 7,000 anesthesiology residents across the country, a day in the life varies considerably month to month, week to week—and even day to day. This is by design. Our four years (at a minimum) of rigorous postgraduate training will equip us to become anesthesiologists with a robust fund of knowledge and experiences that span nearly every medical and surgical specialty.

Typically, anesthesiology residents wake up early with the morning rituals of any early riser.
Once at the hospital, we flock to the operating room (OR) to set up the first cases based on the needs of each patient and the planned surgical procedure. We then meet our patients and perform physical examinations, review their histories and confirm allergies and medications—while also reassuring understandably nervous patients and their loved ones before surgery. After completing our safety checks with the interdisciplinary surgical team members, we bring the patient to the OR. We proceed with the anesthetic plan for our patient, with the supervision of our anesthesiology attending. 

While the purpose of all our preparations is to provide the safest and highest-quality care, we remember that we’re humans taking care of other humans.

One of the greatest rewards of being an anesthesia resident is the significant portion of our day that is spent providing direct patient care. These many tasks include managing the airway, maintaining hemodynamic control, obtaining adequate intravenous access, placement of invasive monitoring and pharmacological treatment. We become one of their most fierce advocates. We provide a voice to those under anesthesia and ensure safety throughout the case. During the procedure, we monitor the surgical progress and plan for the end of the case. As the surgery wraps up, our job is far from over. We shepherd the patient through emergence from anesthesia, ensure pain control postoperatively and provide a comprehensive transfer of care to their next stop along the periprocedural journey.

On Any Given Day…

• Just as one of our resident peers resets their OR, another is receiving a call from the surgical intensive care unit to evaluate a patient with a rib fracture for multimodal pain management as a part of their acute pain/regional anesthesia rotation.
• After the resident places a thoracic epidural, they return to perform an adductor canal nerve block on another patient waiting for a  total knee replacement.
• The next patient may be enrolled in a randomized clinical trial for regional anesthesia, and by participating in this research the resident  becomes part of a continued effort to advance the field of anesthesiology.
• Adjacent to the preoperative holding area is our post anesthesia care unit (PACU), where a resident cares for every patient recovering from surgery throughout the day. This resident also serves as an additional set of hands to start cases, including morning cases requiring fiberoptic assistance for difficult airways.

Once the first-start cases begin, a “Code Blue” is announced over the hospital-wide public announcement system, indicating an in-hospital cardiac arrest. The resident along with their attending rushes to secure the airway and places an endotracheal tube without disrupting vital chest compressions—and then heads back down to the PACU.

By this time, in the cardiothoracic intensive care unit (CTICU), an anesthesia resident has completed morning rounds with our cardiothoracic surgical colleagues and is updating patients and their loved ones about the day’s  plan. Arterial and venous access lines are being placed or removed, vasopressors are titrated—and just as things are settling down,  the first open-heart case arrives on the unit. With a “straightforward” quadruple coronary artery bypass grafting complete, the plan for this patient would be to follow our fast-track extubation protocol.

While a breathing tube comes out in CTICU, a pregnant mother has progressed in labor and is now talking with the obstetric anesthesia resident about her pain management options on the labor and delivery unit. Following an epidural placement, she’s contracting peacefully and finally able to get some sleep for the first time in what feels like forever. Meanwhile, her next-door neighbor—who presented for her second cesarean section—has a history of difficult intravenous (IV) access and requests an ultrasound-guided peripheral IV. Following an uncomplicated  IV placement, we proceed to her baby’s birthday party in the operating room.

With the day wrapping up, it’s time for the resident in the chronic pain clinic to place a fluoroscopy-guided epidural steroid injection. Following the injection, they still have a few post-procedure patients to follow-up on from a few weeks ago. Their day ends with seeing one last patient referred for chronic lower back pain with symptomatology and neuroimaging findings consistent with lumbar radiculopathy, who is interested in exploring available pain management options. Day in and day out, thousands of anesthesiology residents across the country serve tens of thousands of patients over a variety of clinical settings. The strength of our post-graduate training comes largely from the diversity of care we provide. By the end of our residency, we will have proudly participated in thousands of cases, learned a plethora of approaches to anesthetic care and ultimately readied ourselves for a long career ahead as trusted attending anesthesiologists.