I'm a doctor (anesthesiologist) at home on my day off. AMA

On January 9, 2013, my big brother went into the Mississippi Valley Surgery Center for a shoulder scope, after suffering an injury at work. Being that it was a shoulder scope, he was in the "beach chair" position. He was given the drug "Labetalol" to slow down his blood pressure, making a faster, cleaner surgery. Because he was in the beach chair position, his brain was higher than his heart, resulting in a prolonged unsafe drop in blood pressure.

He never made it out of surgery. He was in a coma for 8 days before being pronounced brain-dead on January 17, 2013. He was 29 years old. Words can't possibly express how absolutely empty my life is without him.

I don't think I'll ever be able to trust another surgeon or anesthesiologist after this. I'm sorry if I've brought everyone down, but I've made it my mission to make everyone aware of how terribly wrong things can go during what should be a routine surgery. Especially when the surgeon is a stupid bastard that tries to hurry everything along to book as many patients in a day as possible.

I love you big brother, and I'll never let anyone forget you.

That is terrible and I'm really sorry :-(

I hope I wasn't making it seem like surgery and/or anesthesia is any kind of a walk in the park. There are definitely some very serious and possibly deadly risks!

I don't blame you for mistrusting any doctor at all for as long as you live. I'd probably feel the same :-/

Why do I say such horrible things while anesthetized? Could I get you on board for my talk show idea where all the guests have recently woken up from anesthesia?

OMG please!! I would love that!

I've also thought of starting a weight loss business where you come in to my clinic and I just knock you out for about a week and don't give you any food lol

When I was a kid I liked to freak my brother out before surgeries by telling him about anesthesia awareness. How common is that and how much of a concern is it for you?

It's incredibly rare, especially with more modern equipment and monitoring techniques. In the OR I can pretty much tell when your brain is becoming more and more active ("waking up"), so all I have to do is increase the amount of anesthesia you're receiving.

Back in the day the anesthesiologist basically only had a stethoscope and a finger on your pulse so it was much more common!

Screw that. I'm so glad I live in this time and not in the past.

Amen, brother (or sister)!

And going even further back, all they had for anesthesia was a swig of whiskey, an ice cube for numbing, or a hammer to the head!

during my wisdom tooth removal, I was trying to walk around the room, and babbling about what i was gonna do when I got home lol. Is it normal for people to do that under general anesthesia?

Umm... how were you walking around the room if you were under anesthesia? I'm confused!

I don't know! I was thinking it might be some type of anesthesia awareness, and the doctor told me I was walking towards the door once

Hmm.. this sounds fishy to me!

For a wisdom tooth extraction it's not likely that you were under general anesthesia. You were probably just under some light sedation. In that case I suppose it's possible that you could actually get up out of your chair and walk around... but still, it sounds kind of weird to me. Next time ask for video footage!

i think he's confusing nitrous oxide with anesthesia? but still, how do you walk around with nitrous strapped to your face? i guess slightly more plausible?

LOL I just pictured yamacrane with a nitrous oxide tank strapped to his/her face haha

You smoke weed?

Not any more. I went to music school for 5 years though, so yeah... haha

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Ugh.. it's pretty hard, man.

You have to go through...

1. 4 years of college
2. 4 years of medical school
3. 4 years of anesthesiology residency

All the while you're taking these evil exams that seem to be purposely made to make you second-guess everything you think you already know. And then there are difficult or angry patients, your parents, your friends coming and going at all hours of the day and night, and the almost complete lack of free time.

But it's also a privilege and a pretty cool career that most people don't get to see. So in the end I'm glad I'm doing it.... so far haha

theres also the 300,000 dollars a year

I currently make about $48k a year. But yes, hopefully by next year I'll finally be making enough money to start to pay back my $400k-$500k in student loans!

This makes me feel way better about my $82k loan for a degree in medical science.

Yeah, I try not to think about it too much :-)

What advice can you give to someone studying to become a doctor?

1. Always look at the big picture. It's easy to get down on yourself for one bad test score, or feel like giving up when you're tired and cranky. But as long as the general trend is upward and forward, you're doing alright!

2. If you don't have any hobbies, GET SOME! It's easy to get overwhelmed and feel like you're drowning by all of the information that gets thrown at you. You need to have something non-medical that you like to do or you'll go crazy.

3. Do NOT do anything "just for the money". Yes, money is important and you need to pay your student loans back. But what's the point of being rich and miserable?

4. Be nice to the nurses, even if they're mean to you. Everyone can have a bad day every now and then, so forgive them because they really do have the power to make your life a living hell if they don't like you!

5. It's better to err on the side of being compassionate than to be "tough". This one is one I rarely see other people doing. It's hard when a patient is whining (yes, whining) about being in pain for the 10th time today. But put yourself in their shoes. Try to determine if it's real or not. If they're just seeking pain medications, it will become obvious soon enough. But don't withhold it just because you're annoyed and tired and you want to go home. Doing good makes you feel good :-)

In my experience with people in the medical profession (and I've had far more than anyone should have to experience in their lifetime), anesthesiologist tend to be the most obnoxious, have the best sense of humor, in general like screwing with people's heads, and are overall just the most awesome people. I'm stroking your ego a lot more than I want to be here, but, any comment on those experiences? Other than anesthesiologists, what field in the medical profession do you respect the most?

Thanks for doing this AMA. I've always loved talking to my anesthesiologists - they're always the most hilarious people.

Thanks! But wait, we're the most obnoxious?? Aww :-(

I meant it in a good way, it goes hand-in-hand with the sense of humor. (Example: I once told an anesthesiologist that he had the easiest job in the world - he just sat there and watched me sleep - and he said - right before he put me to sleep, "Yeah, except when they don't wake back up - then I get a bad rep.")

Also, you didn't answer my question about what field in the medical profession you respect the most.

Haha well in that case I'll take the compliment :-)

As far as respect goes? Hmm... I feel like I probably respect most people in the hospital to some degree or another. But I do have to say that I respect psychiatrists a LOT because there's no way in hell I could do their job!

I spent one 8 week rotation in the psych ward at my hospital when i was a med student and it was the most wretched, horrible thing I've ever done! The disrespect for the patients was appalling, being basically locked up inside with 30-40 people per wing who ALL have NO ability to hold a normal conversation.. it's just not for me!

So when I hear someone else wants to go into inpatient psychiatry, I just can't believe it! But I say thank god haha

being an anesthesiologist, have you ever "sampled the merchandise"?

No way! They take that sort of thing very very seriously. If I got caught doing that I'd probably first have to go through some kind of rehab program and be on academic probation for some period of time. But after that it's completely up to them if they want to fire me or worse, I could end up in jail for illegal use of a controlled substance.

In fact I've never even had surgery, so I've never experienced most of the drugs I give to other people on a daily basis hah

Is it possible to get away with were one maliciously inclined?

Of course! The problem as I understand it though, is that once you start you don't really want to stop so it just builds and builds until it gets out of control and you start showing up to work late all the time, or falling asleep at inappropriate times etc.. Then someone else usually will "tell" on you and you'll get in trouble.

BUT, I would imagine that one could probably get away with it for quite some time before that happened.

You seem awfully interested. Should I notify the police??

ok. thanks for your reply!

You're welcome. G'night.

What's the funniest thing you've seen a patient do?

I had surgery 2 weeks ago and I wish someone had been there to capture the horrified look on my face when I my memory kicked in and I realized I had been trying to feel up my doctor between the versed and the mask. Oh the pain of embarrassment!

Haha yeah, I've seen stuff like that happen too. Most people are understanding and cool with it (not like they're gonna sue you for rape or anything).

The funniest thing I've seen is a kid, probably around 10-12 years old pretend to be asleep and then jump up and yell "surprise" in the OR before I was able to give him the mask. Everyone cracked up and the kid was happy that we fell for his joke haha

My doctor was really cool about it. He just held my hand as I went under. I had to ask him about it after that memory surfaced I couldn't be sure if it had actually happened or if it was just the drugs talking. (Because I definitely have a crush on him.). Much to my horror he laughed at me and said it was true. Ahhh!!

Haha that's awesome!

Yes, many of us are devilishly handsome and quite debonaire :-)

I had to have my thyroid removed back in April because of a malignant biopsy. I was not really in a good mental state, but as soon as I got into preop and got to meet my nurses, anesthesiologist, and the rest of the crew, it had an immediate calming effect. My anesthesiologist gave me some Versed, which helped. When it was my turn, they pushed some more Versed. I remember going through the doors out of preop, and I know I was conscious for a while in the OR, but I don't remember it. I have one or two partial memories I think are from PACU, and then the next thing I know I'm waking up in my hospital room.

As someone who was terrified at the prospect of going through surgery, thanks for being awesome. All the staff I met had a calm, caring attitude, which helped put me at ease, and I was very well taken care of. I know you guys do this several times a day, and its just sort of routine, but for me it was a rather pivotal moment in an already life-changing event. Thanks.

Aww thanks! I try to put myself in my patient's shoes every time, but it's not always easy.

Thanks for taking the time to say something nice. Sometimes all we get to hear are the complaints! You're awesome :-)

gross annual salary?

I'm still in my residency training so I make about $48k right now. But I'm in my final year so I should be making anywhere from $200k to $350 by this time next year.

What's yours?

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Whoa, that's not bad!

What are you studying?

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Well now you've piqued my curiosity... What kind of work do you do?

You sure are the most curious AMA'er I've seen in a long time!

Oh yeah? What's that supposed to mean? Am I a clown to you? Do I amuse you?? Huh? What do you mean, curious? Am I some kind of fuckin' cat to you? What is this??

Oh. I mean, um.. thanks!

You're a resident and you have the day off?? I call bullshit. ;-)

Haha yeah, I'm just lucky that I'm on rotation at a very small community hospital this month so they had no OR cases scheduled today. But all of my other friends at the main hospital were working today!

Do you pay malpractice insurance or does the hospital take care of that?

Currently since I'm still in residency training, the hospital takes care of it. But I'll be out of here in a year and then I'll have to start paying it myself!

How much per year will you be paying for malpractice insurance?

I'm not really sure. This seems to be a popular question, lemme look it up...

OK, so according to this website, the average yearly payment is around $21,480 for a $1 Million per claim/$3 Million per year policy. This is actually down about 40% from the 1985 average!

Wow, this thread is awesome, thanks!

No, thank YOU!

What is your favorite part of being an anesthesiologist? More specifically, when you are at work, what do you enjoy the most?

I enjoy being in the operating room and putting the patient to sleep. Anesthesiology has been compared to being an airline pilot pretty frequently. There's a lot of activity at the beginning and end (takeoff and landing), but sometimes there's some down-time in the middle. I personally don't mind that because I'm pretty ADHD and so there's always some little thing to be done here or there. But some people find it boring and are probably not good candidates for being anesthesiologists.

I read this entire thread. Thank you very much for posting this. You have no idea how much motivation this gave me. You even made me realize I'm not too old to try for medical school or CRNA and that either option is good. Thanks and much luck with everything

Oh cool, I'm glad I could help! And good luck to you as well :-)

I start medical school in less than a month. Any advice on getting through it in one piece?

Yup, here!

I'm a veterinarian who also has the day off. I get to do anesthesia and surgery and medicine.

Cool. Sounds like a pretty good gig!

Have you heard this seems you always get the day off.

Hah, no I hadn't heard that. Thanks!

did you ever fuck up really bad but nobody noticed?

LOL no, not yet!

One time I gave someone an antibiotic in the OR that you're supposed to give real slowly with an infusion pump... but I pushed it all in at once by accident. Nothing happened but I reported it to my superior anyway, like a good little boy :-)

Have you ever had to work on someone who is taking buprenorphine as a maintenance therapy for opiate addiction?

No I haven't. But it's very important that you tell your anesthesiologist that you're taking that medication if you ever go in for surgery!

Is it at all possible for someone to just not wake up from anesthesia? This might be a dumb question, but my Mom told me this before oral surgery a long time ago, and I've wondered it since then.

This is kind of a complicated question so I'll try to break it down into some more explicit possibilities....

1. Is it possible to die from anesthesia? Yes. For example, you could have an allergic reaction to one of the medications we use and die. That's possible.

2. Is it possible that a person can receive anesthesia and then be immune to the "antidote", so that they stay asleep forever? No. We don't use an antidote to wake you up. What we do is just turn off the anesthesia and let it seep out of your lungs. Then you just naturally wake up when you have no more anesthesia on board.

3. Is it possible for someone to have some kind of event while under anesthesia which means that they'll never wake up? Yes. You can have a stroke, or a heart attack and possibly never wake up again, but that's not directly due to the anesthesia.

If I missed the meaning of your question, please let me know.

So how's it being gay in Utah? No offense, but you're on Reddit this Friday evening, so I'm guessing not so great?

Haha well I actually live in Miami. I just vacation in Utah because it's so beautiful and the scenery is awesome.

But to be honest, I think I'd probably have an easier time finding a compatible partner in Utah than I could in Miami. I'm just not into the gay scene :-(

Well you're 39, so I'd be concerned if you WERE so much into the gay scene -- it's sorta fun when you're 25, but you can only listen to so much thumpa, thumpa in one life. Don't fret, you sound great -- I'm sure tons of guys would love to be with you. (though from personal experience, MDs are MUCH better after they're out of residency!)

Hah thanks.

That's the thing though, I've never been into the dance clubs and the "fabulousness" and all of that stuff. I just thought it was silly.

I'm not fretting! I've had some very nice relationships in the past and I'm sure I'll have more. No worries here :-)

• Has ever anyone woken up during a surgery?
• How are you treated among other other doctors? Do they act superior?
• Was it a great career choice?

Has ever anyone woken up during a surgery?

This is difficult to answer because there are different levels of consciousness. So just because a patient moves their arm while under anesthesia, it doesn't mean that they have any consciousness or memory of it later. But to make it simple, no I have never had a patient tell me that they had any awareness while under general anesthesia.

How are you treated among other other doctors? Do they act superior?

Many surgeons do act superior, although not all of them of course. Other types of doctors seem to look up to us though (like ER docs, or medicine docs)

Was it a great career choice?

I think so! If I had it to do all over again I would probably have chosen to become a CRNA instead. It's almost the same as being an anesthesiologist (although you're not an MD doctor), but with the added benefit of never ultimately being responsible in the OR. It's a pretty sweet position to be in!

Thanks for the elaborate answer :)

EDIT: Moved

You're welcome. Thanks for playing!

Got some new questions:

• Do you use checklist(s) when you do a surgery? I do not know what you do exactly but I can imagine that it is quite similar from operation to operation. A checklist would make things safer (or not). What do you think? The reason I ask is because I read here in Norway there was an article that x amount of lives could have been saved if doctors had followed checklists.

• Has ever an accident happened that could have been avoided using a checklist?

• Do you use checklist(s) when you do a surgery?

In general, no. There are some fundamental things that we do for pretty much every surgery (anti-anxiety medication, anesthesia medication, endotracheal intubation, listen to breath sounds, tape the tube etc...). These things are basically second nature to an anesthesiologist and a checklist would probably just get in the way. But each OR does have a checklist for some more serious and rare situations, such as if a patient has a cardiac arrest or if they have a specific (and deadly) reaction to anesthesia called Malignant Hyperthermia. We are trained to deal with these things even without a checklist, but since they are so rare (especially the MH), it can be tricky to remember every single step you're supposed to perform.

Many anesthesiologists go their entire career without seeing a single case of MH so you can imagine how stressful it would be if it suddenly developed and you had to rely on memory alone!

• Has ever an accident happened that could have been avoided using a checklist?

Oh, I'm sure there are countless cases! I saw a documentary recently where a patient was unable to breathe after the anesthesiologist gave the medications. The proper final step would have been to perform a cricothyrotomy (poke a hole in the neck so they could breathe through it), but sadly nobody in the OR seemed to think of it until it was too late.

When you are unable to ventilate a patient, the first thing you try to do (and the thing we are experts at) is to place a breathing tube down the throat. So it seems that in that case they spent a little too long trying to intubate and not enough time trying to think of alternatives.

But anyway, these ideas about using checklists for everything are dangerous because as I said, they can really be a hindrance 99% of the time. If this is the case, then most of us will tend to ignore the checklists anyway. This is just human nature.

This is very interesting because the transportation community thinks the exact opposite. For example, a pilot usually does nothing without a checklist, even during emergencies. Also for each phase of the flight (preflight, engine start, taxi...) there is a separate checklist that pilots look at even if they fly 6 times a day. Some companies even force them to check each checklist twice. I agree that it can be in the way sometimes but how about a "checklist nurse"? That might be a big help.

Sometimes I think that checklist aren't used because a patient dying isn't that unusual so it doesn't cause seem that much of a crime. If a single passengers dies during a plane crash then all hell breaks loose. Also checklist are rarely used so implementing them would just seem weird for many older surgeons who are used going without. Maybe it might even seem degrading to be second guessed by a piece of paper.

Am i thinking in a wrong way?

(gotta sleep now) Thank you again for the great answers, Looking forward for your answer

Sometimes I think that checklist aren't used because a patient dying isn't that unusual so it doesn't cause seem that much of a crime.

This part I have to disagree with! If a patient dies in the OR, they practically call the president of the United States to report it! Unless you're talking about a specific case like a trauma center.

There are some safety measures performed in the OR, most notably the "Time Out". Right before the surgeon is allowed to make incision the nurse calls a time out. Everyone has to stop what they're doing and listen to him/her say the patient's name, the type of surgery being performed, what side of the body the surgery is being performed on, and if the patient has any allergies to any medications. Everybody in the OR must agree that what he/she has said is correct or the surgery must be stopped!

The problem with using checklists (besides what we already talked about) is that each surgery is different. So how can you have a generalized checklist in the OR? It just wouldn't work for EVERYTHING. For certain things, I could see it maybe being an advantage, but I agree with you that it would either take our attention away from actually providing patient care, or it would require that another nurse be present in the OR. And that means paying another person's salary!

My hubby is in CRNA school right now. I am showing him this. He regrets not doing med school.

Oh man, well I guess it's a case of "the grass is always greener"?

What reasons does he have for desiring med school over CRNA school?

How safe is it to put a new born under? I'm currently 5 months pregnant and my little boy may need a heart sx once he is born. Is risk higher?

Hi there...

Yes, the risks are higher because a newborn is a fragile little thing. However, the chances of anything bad happening are still extremely low. My advice would be to talk to the pediatric anesthesiologist at your medical center where they're planning on performing the surgery and asking them about the procedure and the plan for anesthesia. If your medical center doesn't have a pediatric anesthesiologist, or you don't like the one they do have, then my advice would be to find a different place to have the surgery done.

University-affiliated hospitals often have the most experience with higher risk cases such as yours.

Good luck and let me know how it goes!

Do you feel its a worthwhile job considering you spend 12 of your prime year's in school and end up 400k in debt?

Ehh. well, overall yes I do like it and I do think it's a good career. But there have definitely been some nights where I've seriously considered quitting and going back to a "normal" job! But really, it's sort of like an investment I've made. If I pull out now I won't see any of the rewards for all my hard work. If I just stick with it a little while longer, things will get better... I hope!

I have heard anesthesia can be one of the most dangerous parts of a procedure. Have you ever killed a person?

Nope!

If you're young and healthy then anesthesia is really very very safe. The older and more comorbidities you have, the more dangerous it can be. But a good anesthesiologist knows when the risks are too high and decides against taking the patient to the OR ;-)

Hi, doc. Why anesthesia? I'm beginning medical school here in a few weeks, and anesthesiology is very intriguing. Just curious about what drew you to the specialty.

Hope residency is treating you alright.

Also, I forgot to ask: what instrument do you play? Did you train mostly as a player or as a composer?

Here are my 3 main reasons...

1. I really like physiology and pathophysiology. So it's a good specialty to be in because you see a little bit of everything. One day your patient has diabetes and heart disease. The next day you have a patient with gout and muscular dystrophy. It's interesting!
2. I like to do lots of other things in my life, and anesthesiology is one of the few specialties where you can work in shifts. If your shift is from 7 to 7, then right on the dot at 7pm someone else comes in to the OR and relieves you so you can go home. That's nice! Most other specialties are not like that, especially surgical ones!
3. Most anesthesiologists I've met are happy and chill people. I don't like being yelled at (like surgeons), and I don't like being unhappy and frustrated because I've been at work for 29 hours straight (like medicine).

I trained mostly as a jazz composer, but I also have a degree in studio engineering. My main instruments are voice and piano. Do you play??

What courses should I take in college to become an anesthesiologist? :)

Take all the sciences you can!

Most medical schools require:

• Biology 1 & 2
• Chemistry 1 & 2
• Physics 1 & 2
• Organic chemistry 1 & 2

For me organic chemistry was the hardest, and thankfully it has very little relevance in my day to day activities in the OR.

If you can, a course or 2 on pharmacology would probably be helpful down the line too.

Why do you want to become an anesthesiologist?

Best reaction when someone wakes up?

Meh... waking up isn't usually that fun. It's like forcing a little kid to get up for school. Nobody likes it, not the kid, nor the parent.

But here's a similar question asked earlier.

Would you ever consider specialising in Pain management?

I've heard the primary background for specialists for pain is anaesthesiology.

Yes that's true, but I personally don't want to specialize in it. Pain management is one of the only anesthesia specialties where you have extensive patient contact, and you have to make rounds on your patients in the morning (if you work in a hospital setting) and where you don't spend much time in the operating room.

To me, all of those things are the reasons I went into anesthesiology!

On the other hand, many people realize that they don't want to spend the rest of their lives providing anesthesia in an OR, so they tend to gravitate towards pain management as a specialty.

Cool thanks for the answer!

Interesting to see the two sides in what people want to do with their jobs.

I saw a pain specialist a few weeks ago and he's booked me in for a Ketamine infusion this Wednesday, do you happen to know anything about them? Material is surprisingly hard to find on them.

Hmm, can you tell me a little bit more? What's the infusion for? What kind of pain are you having? Is this a pump to take home with you, or is it for a specific surgical procedure?

Sure, I apparently I have post surgical neuropathic pain in my left lower back after a kidney reconstruction (pyeloplasty). After 15 months of pain and medications that don't seem to work very well.

So I'm heading in to a Hospital to have IV Ketamine at an increasing dose for 5 days. I was just kind of curious to know what to expect with it.

I'll PM you in a bit if that's ok with you?

How old are you? You mentioned going to school for music, what made you decide to go into medicine?

I'm 39.

I was living in NY working as a programmer and musician back in the early 2000s. I was doing ok for myself, paying my bills etc... Then one day my apartment burned down and I was left without a place to live! So I decided to move back home to Miami to figure out what I was gonna do next. My dad had always wanted me to go to medical school and I just always kept saying no. But now I was in the situation where I was sort of like.. "well now what the hell am I gonna do?"

So he said to just TRY going back to take science courses at the university and and if I didn't like it I didn't have to continue... and the rest is history! haha

Oh man that's crazy...thanks for answering dude.

You're welcome! Are you thinking of doing something similar?

Well I'm 29, I worked in mortgage banking since I was 18. I've always wanted to be a doctor or even just an RN. Anyway...I just went back to school this last semester for EMT. Based on what I've seen and done in the ER I know for sure that I need to pursue medicine. The thing is I didn't think I had the maturity back then to handle dealing with graphic nature of the ER. Now that I'm a little older I want to go for it. How long did it take you to get your degree?

The ER can be a tough place. It's not just the visual gore you have to be ok with, the patient population is often drunk or on drugs, belligerent, mentally ill etc... It's not always a pleasant place to work!

Here's a reply I made earlier about how long the path takes. Thanks!

How competitive were you grades when trying to get into your med school? And were there any other medical specialties you considered before deciding on anesthesiology?

My grades were pretty good, but not straight A's. Thankfully I had my degrees in music before applying to medical school and they seemed to really enjoy talking about that.

I can imagine the acceptance committee sitting in a room day after day looking over the thousands of applications and just praying to god for something, anything to stand out and be different!

At least, I'm hoping that's how it went for me :-)

Before anesthesiology I really wanted to do orthopedics. Here's the story (about halfway down this comment).

What's the worst freak out you've seen post-anaesthesia.

OMG I've seen people thrashing and kicking and screaming and calling me an asshole and ripping out their lines and tubes and drains and threatening to kill everybody!

Usually these are the same people who are little angels less than 2 hours later haha

Do you have any recommendations for how to shadow a Doctor in a Hospital? Also do you feel as if there is a certain prejudice against DO's in the Health Care system? Thanks!

Hmm... I haven't seen much prejudice against DOs where I'm from. In fact we have a couple of DOs in my residency class, and no one seems to even notice. I think those days are mostly bygone!

As far as shadowing goes, you'd have to contact the hospital directly because each institution has their own set of (often ridiculous) rules that they use to cover their asses in case something bad happens while you're there. So while one hospital may just be like "OK, sure come on down this Tuesday!" the next one might be like "Well, you need to bring 19 forms of ID, your own scrubs, your own private malpractice insurance, you can't eat while on campus, and you must provide your own handcuffs in case we need to arrest you."

lol I was hoping you knew some secret code! Most hospital pull the Hipaa card. Outside of that would kind of EC's did you have? I appreciate the response!

Maybe you could find a local doctor that also admits patients to the hospital? That way you could shadow him/her in their clinic and then just tag along when they go into the hospital?

And ECs? What's that? Extra-curriculars?

What do you think of Dr. Conrad Murray? Did you follow that trial at all? Any opinion on the credibility of Dr. Shafer vs. Dr. White?

No, sadly I do not follow the trial. When I'm at home and I have some free time I'm either trying to finish up some project or another, or I'm Redditing!

But as much as I hate to say it, I think Dr. Murray is completely responsible. Anybody who has ever used Propofol knows that it will make you stop breathing. So the fact that he administered it and then walked away is as ridiculous as leaving a baby alone in a pit with 10 hungry boa constrictors and then being surprised when you come back and find the baby's been strangled and one of the boas is swallowing it whole. What did you expect?

I recently had an ACL replacement along with some other shit. The Anesthesiologist told me that the Femoral Block didn't work but he tried twice. WHy didn't the femoral block take? Are there different reasons?

Usually it just means that they injected medication into the area where the Femoral nerve usually lies in most people, but that in your case maybe it just lies in a slightly different location. That's the most common cause of a failed block. However, there is a small percentage of the population that just doesn't seem to respond to local anesthetics and no one knows why (yet). But that's really rare and probably not the case with you. If you see that doctor again, ask them!

Edit: Spelling

Ok will do, I just figured I saw your AMA and would give it a shot. Thanks a ton man, good luck with the rest of your residency

Thanks!

How has pursuing medicine affected your relationships (or lack thereof), especially as a gay man?

Just my personal observation, but when I went for medical school interviews a few months ago, I swear my gaydar was going off very often when meeting the current med students. (I am gay myself and will be studying medicine!)

How has pursuing medicine affected your relationships (or lack thereof), especially as a gay man?

TBH, I don't think this is the thing that has affected my relationships. I just think I'm looking for an unconventional SO so that makes it hard, regardless of what my career choice may be.

..my gaydar was going off very often when meeting the current med students.

Yeah, I don't know if there are more gay people applying now, or what. But I have had the same experience. Maybe it's just that more people are comfortable with being openly gay? I dunno, but either way I'm glad when people feel comfortable with themselves :-)

I am gay myself and will be studying medicine!

Welcome, my brother! haha

High school senior here. What advice could you give to an aspiring doctor? Is med school as hard as my parents say it is?

Is med school as hard as my parents say it is?

Yes, but so what!? Are you smart? Do you want it? If so, then you can do it!

I'll help you :-)

Here's my advice for you.

What's the funniest anesthesiology joke you've heard?

I can tell you the one I know in case you haven't heard it:

A man and a woman who didn't know each other just had sex.

Her: "You must be a professional"
Him: "Yes, how did you know?"
Her: "Because you're polite, well mannered and soft spoken."
Her: "You must also be a doctor"
Him: "I am!, how did you know?"
Her: "Because of the way you touch, precise and gentle."
Her: "You must also be an anesthesiologist" Him: "Yes, I am!, how did you know?"
Her: "Because I didn't feel anything!"

Hah! I hadn't heard that one.

The only thing I keep hearing over and over and over again when I tell someone I'm an anesthesiologist is... "Oh, so you pass gas for a living?"

Ha. Ha. Ha. -_-

ಠ_ಠ

That is the exact face I make.

God, i really love anesthesia. I think people think I'm really weird but I sincerely love being put under...one second you're awake, the next second you feel funny, then you're waking up!

Ahhh, it's one of my favorite things.

Wow, that's awesome. You should become a spokesperson for the Propofol industry!

Where do anesthesiologists rank in terms of liability insurance cost compared to other hospital employees? Pretty high I bet?

I don't know exactly, but in general, yes! It's very high.

I plan to go to PA school in the future. What is your opinion on PA's in the medical field?

I have crazy respect for PAs. I had enough trouble just struggling to stay afloat in medical school, so I have NO IDEA how these people can absorb so much knowledge in such little time!

Hey! I hope you're still awake!

I have been thinking of becoming a doctor a lot lately. In the past 4 years I have had my aunt die of cancer, my grandfather struggle through prostate cancer, and my dad was just diagnosed with non-hodgkin's lymphoma. Not to mention that my family just has a bevy of medical issues (ALS, Alzheimer's, etc...) and it just hit me one day that I really want to (cue cliche) help people and their families who are going through rough medical issues. Because they suck such balls. I would really like to become an oncologist.

BUT

The thing is I am already 25. I have a B.A. in Theatre, and just finished two years of college for videography. I currently work as a producer for a local TV company and I don't love it.

I would need to go as far back as getting my HIGH SCHOOL sciences. Is this logical? I really want it, but I am already about $20,000 in debt from my previous student loans, and there is part of me that just thinks I would just be digging myself deeper.

I guess I am just looking for encouragement.

Oh man, here's some crazy encouragement! DO IT, DO IT, DO IT!!

I had to basically do the exact same thing! I had to go back to college to get a post-baccalaureate which is a fancy way of saying "catch up on your sciences, dumbass". Then I applied to med school, then residency etc.. It's a long road, but if you want to you should definitely do it!

I didn't even START my post-bac until I was 26 (or 27?)!

Also, read the top part of this comment reply from earlier.

Having been under anesthesia numerous times in my life (long near death experience story involved, many surgeries that I won't bore you with haha) I have always wondered, at what point and what signs do you look for to make sure that the patient is "completely out of it"? I have (very) vague memories of just moments before "blacking out" and seeing the anesthesiologist push the "plunger" (syringe) but does the patient's heart rate change or any other kind of obvious clues? Is it just a change in how they look or are there other signs? Also, how much do you communicate with the other doctors in the OR and how important is it really? Is it like you do your job and then you are free to go or do you stick around to make sure everything goes OK on your end and help to monitor the patient? I remember always joking with the anesthesiologist and saying that he was my favorite person in the room because he gave me the best drugs haha. One last thing, I remember the doctors giving me "laughing gas" before they put the syringe in my arm, is that common or should I feel like wake sauce for not being able to take the pain of a syringe going into my arm (it was in my arm at first until those vains decided to not show up anymore at which time they moved to my feet which as I recall hurt much worse) like a man?

Thanks for doing this AMA too, I've always thought that you had one of the more interesting (interesting to me at least) jobs out there. :)

PM sent

How do you determine how much anesthesia to give a patient? I've been put under twice, and they've commented both times about how hard I was to "knock out". As in, I think they had to give me more anesthesia than they thought. Does it have to do with a person's age? Size? I'm 27, female, and 120 lbs at 5'3".

Just wondering why I've been compared to "trying to take down a rhino." Lol.

Just wondering why I've been compared to "trying to take down a rhino." Lol.

Hah well, the easy answer is that there are about a trillion factors that go into how much anesthesia a person requires, so we'll probably never really know why in your case.

However, the general situation is this: The more "sleepy" a person already is, then the less anesthesia you need to give. And the more "awake" a person is, then the more you need to give.

For example, if someone came through the ER with a broken jaw after a bar fight and needed emergency surgery, but you just found out that they snorted a shit-ton of cocaine about a half-hour ago... you're gonna need a LOT of anesthesia to knock down that crazy person.

On the other hand, if a patient is 99 years old, is frail, hasn't eaten in 2 weeks and just took a Klonopin and 4 shots of whiskey to help her sleep and now suddenly needs to go to surgery... you're probably going to need very little anesthesia to put her under.

So in your specific case, I can't say for sure. Maybe it's some medication you take? Maybe it's just the way you are!

Are you a natural readhead by any chance?

Is it true that a lot of anesthesiologists steal drugs from the hospital?

Eh, well I'm sure some do but I haven't seen it happen yet!

I know male doctors have to have a nurse present when examining unclothed female patients, but there isn't anything like that requiring someone else to be present when a male doctor is examining a guy, right?

No, but good question!

Most patients are naked in the operating room, but there are always 5 or 6 other people in there at any given time. That rule you're talking about only applies when a doctor is examining a patient of the opposite gender in a room alone. They have to find a nurse of the same gender as the patient to be present with them so that the patient can't say that the doctor touched them inappropriately or anything.

In my case since I'm gay, I could totally rape a male patient any time I wanted to. (This is the just kidding part!)

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Yes please!

What's the most scary situation you've been in and had to pull a patient out?

I've had a couple of patients suddenly have their heart rates go from being steady at 70 or 80 to 50 then 30 then 15 and then zero. HOLY SHIT! Get the Epinephrine and Atropine!! Hah

They both came back, don't worry :-)

what was the situation when they were ok and then flatlined?

Well that's basically it, really. Sometimes the surgeon is pulling on something or putting pressure on something that stimulates the vagus nerve and the patient can have bradycardia. On rare occasions it can go all the way down to zero. So you tell the surgeon to stop what they're doing and you give some Atropine (first) and then if that doesn't work you can give some Epinephrine (Adrenaline) and if that doesn't work you have to start chest compressions!

I'm going to have surgery soon and going to be put under. What should I expect and should I be worried?

If you're young and healthy, then not at all!

What kind of surgery are you having (if you don't mind telling the world)? Do you know if it's under general anesthesia or just some mild sedation?

Do you feel overpaid? In other words, do you think society can get similar results without paying anesthesiologists a ton of money?

Well at the moment I'm underpaid since I'm still in my residency.

But to answer your question, I don't think society can expect the same results in any situation without paying for it. We go through many many many years of training and we sacrifice many aspects of our personal lives to get to the position where we feel comfortable being responsible for other people's lives on a daily basis.

If I were making $400 and my salary went down to $350 I personally don't know if I would complain about that too much. However, if my salary were cut to $350 and the government just pissed it away on some bullshit program or used it to bail out some other industry, then yes I would be pissed because like I said, I've been working my ass off for 12 years to get to where I am!!

Doctors are one of the few professions that I think are justified in their pay scale. They keep us alive, they better get paid well to do it.

There's probably nothing I could say that wouldn't make me look like a jerk, so I'll just say thanks :-)

How hard is the actual work you do? Not the training, I know that's super hard, but your actual daily work. Because, of all the doctors, you're the one who can least afford to make a mistake, so I'd guess that your work has to be somewhat routine?

Somebody asked a similar question about the use of checklists in the OR and how routine the work is. Here you go, thanks!

How much schooling must you go through?

Is your job always really stressful and are you afraid to make mistakes?

How much schooling must you go through?

Here is the answer I gave earlier to a similar question.

Is your job always really stressful and are you afraid to make mistakes?

It's not always stressful. Each case is different, and many cases are basically "routine" and not very stressful at all. But sometimes there are cases with fragile and very sick patients where yes it can be very stressful and scary!

As far as making mistakes, thankfully there are always lots of other anesthesiologists around to help you so no, not too much :-)

Are there any drug types that you cannot mix with the ones used in GA?

In general, no. But most anesthetics or anxiolytics (anti-anxiety medications) have an additive effect when used together.

In other words, if I give you some valium and you also just arrived off the street after having done a bunch of heroin, I don't need to give you very much anesthesia because you're pretty much already there.

Why do you ask? DO you have a specific drug you're thinking of?

A quick google has told me that it's fine, and also the surgeon knows! But the specific one I was think of was an SSRI.

Ahh I see. No, as far as I know those are safe to use with anesthesia. But just make sure to mention it to the anesthesiologist on the morning of your surgery. Good luck!

Well thank you, Mr Dr Sir.

You're very welcome ^_^

And uhh, you may want to get that rusty hernia looked at ASAP!

Do you truly enjoy the job, and understand the power/danger each time you give the patient anesthesia

Overall, yes I do enjoy it. Of course, there are some days where I just want to throw in the towel and move to the backwoods of Utah and just go hiking every day! But in general, yeah I really do like it.

You know, sometimes it's easy to take for granted that what you're doing is potentially deadly. Sometimes 3, 4, 5 times a day! But every single patient is different and it's sort of like driving a different car every day. One day you'll get a big huge Cadillac with the soft suspension and you can just sort of sit back and enjoy the ride. But sometimes you'll get an old beat up jalopy with the broken leaf springs and no power steering and you feel every single bump and jolt in the road! In those cases you learn to become very vigilant so that you don't crash that baby into a tree :-)

I've never had any surgery, but I feel like I would have a lot of anxiety about not being in 'control' of my actions or remembering them in the time I would be conscious, but medicated. How do those with higher-than-normal anxiety about the whole surgery process generally react? does it take more anesthesia/anxiety meds to sedate them than it usually would for a person the same size?

How do those with higher-than-normal anxiety about the whole surgery process generally react?

Well, before going in to surgery we generally give an anti-anxiety medication (usually Versed), which is in the same family as valium or xanax. This seems to work miracles for everybody, regardless of their level of anxiety!

Does it take more anesthesia/anxiety meds to sedate them than it usually would for a person the same size?

In theory, yes. But in practice it doesn't really matter very much because we usually titrate the amount of anesthesia we need to each individual patent anyway. So it's not like you're in any increased danger of waking up under the knife just because you have some anxiety. We have many clues in the OR that let us know if you need more or less anesthesia while you're asleep.

I feel like I would have a lot of anxiety about not being in 'control' of my actions

This is probably the most common complaint I hear from patients prior to surgery, so don't worry. It's perfectly normal to feel this way. I'm sure I would feel the same exact way. It's a scary situation to be in! But in reality it's very very safe and the pre-medication we give you before going into the OR makes everything seem like a piece of cake, and it takes effect within a minute or two. It's good stuff!

Do you enjoy the work, or are you in "counting the days to early retirement" mode?

Well I haven't even finished my residency training so I'm definitely not counting the days to retirement yet!

Most days I do enjoy the work. Some days however, are just overwhelming and go on for way too long. On those days I like to come home and plop on my couch and Reddit the night away :-)

How would you describe the personality differences between anesthesiologists and others doctors(er doc or so be it)?

Well, not to throw too much dirt, but there's basically one big split between surgeons and non-surgeons. Most surgeons tend to have a bit of an ego and can be very demanding. Otherwise, the rest of 'em are fine ;-)

!!! I've noticed that about surgeons too. You really understated it - most surgeons have a total god complex to them. I can't really blame them, though... If my job was hands-on reworking of the human body, I'd have a god complex too.

There seems to be some debate as to which comes first, the ego or the choice of specialty hehe