In a recent interview for the new York times, William Shatner was challenged to defend his acceptance of even trivial roles. He replied, "but every word has music in it"
I understand that. For me, every anesthetic is a poem and a puzzle. Sometimes it's about saving a life. More often, it's simply about leaving somebody feeling well enough to eat lunch after their carpal tunnel.
It may be a case I've done hundreds of times, with a technique I've used for decades. Those cases are like comfortable old songs that I sang with my kids over and over when they were small, and still sing for myself when I think (hope) no one is listening.
It may be a chaotic trauma, all of us struggling to bring some order to the pandemonium of grotesquely disrupted anatomy or maybe it’s a big burn patient, leaking their life's fluid away through hideously charred skin, or no skin, the underlying fat and muscle obscenely exposed, like an anatomy class corpse, jarringly wrong. Those cases leave me unsettled, sometimes for a while.
On good days, I practice anesthesia in a state of grace. My step is light. I feel the little “snick” as my
epidural needle pierces the ligamentum flavum, on to a beautiful release of air from a glass syringe which was just a millimeter ago a bouncing shock-absorber. Two minutes later, the suffering mom-to-be, who was previously involuted with pain, looks into the father’s eyes and squeezes his hand, and they both smile.
Other days, I can’t seem to thread a 20ga angiocath into a vein the size of an LA freeway. Every patient wakes up combative and disoriented. 10 hours is an eternity. Thank god some days anesthesia is difficult, lest I begin to take it all for granted. (or take my hard won skill for granted?)
For it is a gift and a privilege to be able to do something I am good at, which has meaning for me and for others around me. Something necessary. Something real. To hold a hand, make reassuring eye contact, stand vigil (well, sit mostly) and manipulate (mysterious) consciousness. Fighting pain, defending my patient from the vicissitudes of life and the necessary suffering of surgery.
I ask my junior associates how they are, and they say, "living the dream." I think "amen to that" although I know they are being facetious. That makes me sad for them, because it smacks of “quiet desperation,” and although anesthesia is a wonderful calling, it’s a really tough job, for reasons that every anesthesiologist understands... you better love it, or you're gonna hate it.
Thank you, Mr Shatner, for reminding me.