Preface: I've never been great at making important life decisions. I turned in my letter of intent for college on the last possible day, during which I pretty much flipped a coin in my mind. I had no strong convictions for a major through 2 years and 2 trimesters through college. Because I had taken the harder science classes (in case I wanted to switch into a more demanding major), I eventually just stayed the course and picked one that made use of those classes. I do not have a passion for protein synthesis or fatty acid oxidation. I ended up applying to medical school because it made use of my major, and because the alternatives were far less attractive to me. I'm going to stop with the examples because I'm starting to bore myself.
And so here I am at another decision point. The dozens among you who actually sift through my walls of text on this blog will find this particular post to contain less exposition and more attempts at introspection. It's an excuse for me get some thoughts down in anticipation of making a career choice (and the personal statement that will accompany it).
And at the end of the tunnel, there was...another tunnel.
At this point in time, I am ~90% sure that I will be applying for an anesthesiology residency. If the other 10% ever comes to fruition, I will be scrambling horribly to get aspects of my application in place.
Why anesthesiology?
Even more so than the "why medicine?" question which has stymied pre-meds since the Middle Ages, this question does not even offer a fighting chance of being original. But let's give it a shot.
A good portion of the medical specialties can be roughly divided into two groups: those that more utilize anatomy and pathology, and those that focus on physiology and pharmacology. The first group includes all the surgical specialties, radiology, and pathology. The second would include general internal medicine, many IM subspecialties (e.g. cardiology, nephrology, endocrinology), and anesthesiology. If you hate anatomy, you're not becoming a surgeon unless you're a masochist.
Again, this division is very rough. Most specialties will encounter these topics at least occasionally. That's the reason all docs go to medical school.
Obviously, I fall into the category of enjoying the physio/pharm more than the anatomy/path. Physiology in particular is based in concepts rather than pure memorization. There's a certain logical elegance that I appreciate in this approach to managing disease. Anesthesiology at its core is applied physiology and pharmacology. The role of an anesthesiologist is to maintain a patient's normal physiologic function (e.g. oxygen saturation, carbon dioxide levels, heart rate/rhythm, blood pressure, temperature) during surgery with the use of pharmacological agents. Of course, depending on the situation, you will also provide varying levels of consciousness, pain relief, and amnesia.
So why not internal medicine then? The internist can/will prescribe the whole gamut of medications, but then he'll wait 6 weeks to see you and monitor if it's doing you any good. Then maybe he'll up the dosage on your cholesterol-lowering stain or add an ACE inhibitor to you blood pressure regimen. The anesthesiologist will see your heart rate get a little too high in the OR and will immediately inject a drug. Within seconds, the pulse oximeter will show him the results. The feedback for your medical decisions is much more immediate. Above, I already mentioned some basic physiologic variables that all have interventions of their own. Add to that list various other factors such as electrolyte levels, RBC counts, blood pH, intracranial pressure. These things can all come into play in the OR and many of them will affect each other.
I also like the math-oriented graphs and equations of applied physiology, as well as the pharmacokinetics/dynamics that are steeped in chemistry.
The other major reason I would say people go into anesthesiology is the procedures. Other than surgeons, I don't think any other group of physicians do more technical stuff with their hands, so to speak. Securing the airway involves stuff like mask ventilation, intubation, extubation, LMA insertion. Things like placing IVs and arterial lines will become second nature. Regional anesthesia involves basically poking people in very specific areas of the spine and nerves with drugs. There is an element of technical proficiency, and a learning curve that goes with it. I've played piano and guitar for many years (and mastered a few poker chip tricks), and I can appreciate the development of dexterity. (I know what you're thinking. Yes, I will probably leave my years spent practicing Starcraft mouse skills out of the personal statement.)
The last of my "major" reasons for choosing the specialty is a little gimmicky. I love sports, and I played 11 years of soccer in my childhood, mostly as a defender. That mindset of preventing "bad" things from happening is something I am quite used to. Yes, I realize that giving up a goal isn't quite the same thing as losing a patient. This will hopefully make a little more sense after I explain. A soccer defense has to coordinate itself and understand where the threats are coming from. The sweeper is the player who anchors the defense. He has a near complete field of vision and will communicate what he sees to his players. He is also the last line of defense before the keeper. He has to anticipate things that might happen and be ready to guard against it.
You can see how the analogy might work. The anesthesiologist is trying to keep the patient alive while the surgeon (i.e. the striker) is slicing and dicing. One example of "anticipation:" When the surgeon cuts, the heart rate will spike as a response to pain, so you wouldn't treat a low heart rate right before he cuts. If you do your job well, there's really not much to notice or cheer about. Really, it's just the satisfaction of knowing that the job was done well that is hopefully all the gratification an anesthesiologist needs.
This is taking longer than I anticipated. I will finish up the rest of the reasons for "why anesthesiology?" in the next post. I'll also try to honestly assess the reasons for "why not?"
I recall being taught in high school chemistry that Xenon was used as a general anesthetic for really important people because it had no lethal dose - is this true?
Related to that, for the anesthetics meant for us common people, how big is the threshold between "effective" and "overdose" for your average patient?
Of course it can't hurt that you make $300,000 a year after only 4 years of residency. Although I do hear that anesthesiology residencies are hectic with many nights on call. Good luck getting a top residency spot. Although anesth is one of the easier residencies to get, all top residency programs are really competitive. I'm happy that someone is doing anesthesiology for the right reasons (actual interest) rather than simply the high compensation and controlled lifestyle.
I can relate with the whole poor at making life decisions thing. Pretty similar case for me, except I just ended up following my gf for university, and I picked grad school over med school. But yea, anesthesiology sounds like a good fit for you so good luck.
To be honest, I don't know much about xenon other than that it is considered a good but expensive potential inhaled anesthetic of the future because of its favorable chemical properties. I haven't seen it used, nor have I heard much about it from talking to people.
I don't know exact LD50 numbers either. I've never heard or read it mentioned so I can only assume that it is not really an issue. The inhaled anesthetics (for which you are maintained through most of the surgery) are eliminated very quickly from the body almost exclusively by ventilation, meaning you can just breath 100% oxygen to get rid of it from your body rather quickly. Basically on the off chance that anything goes wrong, you are in the perfect situation with all the right equipment and people to deal with it.
In that case, what about the intravenous anesthetics?
I went under general for an operation a couple years ago intravenously, and it was kinda cool waking up cause I was chill as fuck for like 3 hours. But, a question! The anesthesiologist told me just before I went under that he was giving me 2 separate drips, one of which was supposed to make me drowsy and the other of which would knock me out - but I was completely out like 10 seconds after that. Is that normal procedure and was it normal for me to go out so fast?
This was an interesting read, as I'm starting pre-med as a freshman in the fall. Did you just decide to be an Anesthesiologist? Pretty convenient that you got all your pre-med reqs out of the way(or did you decide to become one because you had already done those classes?) I am going into your first category(surgery) because I am very interested in anatomy(or at least the one offered at my HS).
On July 26 2010 13:07 kzn wrote: In that case, what about the intravenous anesthetics?
I went under general for an operation a couple years ago intravenously, and it was kinda cool waking up cause I was chill as fuck for like 3 hours. But, a question! The anesthesiologist told me just before I went under that he was giving me 2 separate drips, one of which was supposed to make me drowsy and the other of which would knock me out - but I was completely out like 10 seconds after that. Is that normal procedure and was it normal for me to go out so fast?
You may have still had an inhalational anaesthetic agent. The preferred method of induction in the majority of cases is intravenous, with gas induction usually reserved for children, and those without intravenous access. Anaesthetic gases are still commonly used for maintenance of anaesthesia, though TIVA (total intravenous anaesthesia) is growing in popularity.
TIVA is particularly good for its rapid onset/offset, in (relative) reduction of nausea and vomiting, and where inhalational anaesthesia may be contraindicated. Particularly in the setting of day cases, it may be cost effective in reducing length of hospital stay and in greater throughput (as you can taper the dose, emergence can be predicted). It is more costly than maintenance with an anaesthetic gas, though I wouldn't say that it is significantly so, compared to the overall cost.
What you had sounds quite typical. You will usually receive an opioid, partly to attenuate hyperstimulation with the gag response, and also the induction agent. In addition, antiemetics and benzodiazepines may be administered at this time.
Sounds like you've given this a lot of thought. I'm a few years out from this decision myself, but I've got nothing as far as ideas go. I hope it all works out well for you.
(Im assuming you've seen this before, but probs not all of TL)
if you don't mind me asking, what are your step 1+2 scores? applying is one thing but getting in is another.
but if you do get in, then congrats. it's a really high paying low stress job.
from the sound of it too, seems like it was a last minute decision to go in this direction, so do you have research in the field that you have lined up? anesthesiology falls into the category where high scores by itself wont get you in, you need like publications and what not.
Congrats... the tough part is over. Making this decision is very difficult for the majority of medical students.
Residency interviews are much less stressful than medical school interviews. In most cases, there is a spot somewhere for you if you want it. Don't sweat the whole process too much.
Using your dichotomy, I'm an "anatomy/path" guy. I picked radiology and I couldn't be happier (currently a 2nd year rads resident).
On July 26 2010 13:46 BDF92 wrote: This was an interesting read, as I'm starting pre-med as a freshman in the fall. Did you just decide to be an Anesthesiologist? Pretty convenient that you got all your pre-med reqs out of the way(or did you decide to become one because you had already done those classes?) I am going into your first category(surgery) because I am very interested in anatomy(or at least the one offered at my HS).
What med schools are you applying to?
He's already in medical school. I think he's applying to anesthesiology residencies.
I absolutely think you should go into anesthesiology man. I wish you the best of luck with it too.
My pa is an ob/gyn and set me up to job shadow our hospital's anesthesiologist for a morning of surgery. It was awesome to watch him work. Going back and forth between several operations at once, checking on all the nurse anesthetists, and educating me all at the same time is something he did with ease; made me really respect him and his profession. My penchant for fainting at the sight of needles/blood is what landed me in law school instead, but in what I've seen from the docs i know, I would definitely say the anesthesiologist has the most macro-intensive, even elegant, role in the OR. I say go for it!
On July 26 2010 15:19 thedirtyleg wrote: I absolutely think you should go into anesthesiology man. I wish you the best of luck with it too.
My pa is an ob/gyn and set me up to job shadow our hospital's anesthesiologist for a morning of surgery. It was awesome to watch him work. Going back and forth between several operations at once, checking on all the nurse anesthetists, and educating me all at the same time is something he did with ease; made me really respect him and his profession. My penchant for fainting at the sight of needles/blood is what landed me in law school instead, but in what I've seen from the docs i know, I would definitely say the anesthesiologist has the most macro-intensive, even elegant, role in the OR. I say go for it!
I'm a freshman starting in the fall going the bio major -> med school route. I know I want to go into med, but not even sure where. Tossed around getting my major with an emphasis in bioengineering because that sounds really interesting to me. Also tossed around the idea of just going for a pa, but not where I would go with that. Even thought about being a psychiatrist. I am no good at making decisions because I change my mind so often haha.
Yeah, I can definitely feel where you're coming from with the whole indecision deal, choosing majors because of vaguely defined interests and even the reasoning behind your going to med school (although I'm not at that stage yet). You seem to have figured out your reasons for doing this and conquered that indecision so good for you . Hopefully the same thing goes for me in two years...
I'm really glad to see I'm not the only one in this kind of situation...
No, I'm not in med school. I am, however, in a very large field where your interests dictate which focuses you want to study. It took a long time with a lot of introspection since you don't want to study something you won't enjoy. The whole time I was thinking "Is it really this hard for everyone?". Like you, I narrowed it down, chose a path, and start my PhD program in less than a month. I hope it all works out for you!
@Fen: Yeah I've seen that haha. It's a little pitchy dawg.
@luckySe7en: Anesthesiology is actually not highly competitive. It's considered middle-of-the-road. More competitive than FP, Peds, Psych, OB/Gyn, IM. About equal to Gen Surg and EM. Less competitive than Ortho, Ophtho, Rads, Derm, ENT. Of course, programs with big names and/or desirable locations are very competitive for all specialties. I wouldn't say it's low stress either. When things go south in the OR, it is the anesthesiologist who is running the show and has to make quick decisions to save the patient's life. Litigation is also a constant issue and is compounded by the fact that so many procedures and interventions occur in an average patient encounter. Research can only help of course, but every single person I've talked to has said it is not a big part of the application for anesthesiology. It tends to be very important for people going into the more competitive specialties like rad onc, rads,etc
@sutureself: Nice to hear some encouraging words. I would love to be an anatomy/path guy and do radiology. Very cool field.
@Empyrean: <3
@thedirtyleg: Thanks for well wishes. Macro = win.
@stack: Biochem. Do whatever makes you tick, just be ready to talk about it at the interview if it's non-science. You'll have to take science pre-reqs either way to apply. If you want a leg up for actual medical school material, that would be stuff like physiology, biochem, molecular bio, microbio.
EPT![[image loading]](http://img230.imageshack.us/i/lighttunnel.jpg/)
Although I do hear that anesthesiology residencies are hectic with many nights on call. Good luck getting a top residency spot. Although anesth is one of the easier residencies to get, all top residency programs are really competitive. I'm happy that someone is doing anesthesiology for the right reasons (actual interest) rather than simply the high compensation and controlled lifestyle.
I am going into your first category(surgery) because I am very interested in anatomy(or at least the one offered at my HS). 
