BWH Clinical & Research News

The Next Generation: Getting to the Core of Anesthesiology

Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month’s column is written by M. Alice Vijjeswarapu, MD, Interventional Pain Medicine Fellow in the Department of Anesthesiology, Perioperative and Pain Medicine.

M. Alice Vijjeswarapu

When I graduated from anesthesiology residency at BWH last summer, our class put together a parody of Jay Leno’s popular sketch from his late-night show called “Jay-Walking.” We went onto the streets of Boston and asked people about anesthesiologists. The results were hilarious. The answers to one question in particular stood out:

What does an anesthesiologist do after you’re asleep?

“Leaves.”

“Goes home.”

“Goes away.”

“Checks your body.”

“Cleans syringes.”

“Hands it over to whoever is doing the surgery.”

After being asked to write this post, I wanted to focus on why I chose to pursue anesthesiology as a profession. But truly, to ask “Why anesthesiology?” we need to get to the bottom of “What is anesthesiology?” and there are three main components at the core of anesthesiology that drew me to the field.

Patient Safety

Undergoing anesthesia for any procedure, large or small, carries risk. We give patients doses and types of medications that suspend natural physiological processes, keep patients safely in this state during the procedure and then bring them back in a way in which, many times, they feel like nothing has happened. I often have patients wake up from anesthesia and ask me when we are going to start.

As recently as about 50 years ago, anesthesiology was an incredibly risky field, often more risky than the surgery itself. Anesthesiology has come a long way since that time, and it was the result of physician-anesthesiologists investing time, energy and intellect into research and technology to improve the field. Anesthesiologists and engineers in Boston collaborated with the aviation industry to improve delivery and standardization of anesthesia. In fact, the now-popular term “patient safety” was coined by anesthesiologists.

Anesthesiology is now one of the safest procedural specialties in medicine. When a patient is asleep, we are very much the patient’s guardians, treating blood pressure, heart rhythms and breathing, and speaking up for the patient’s well-being. We are by the patient’s side working on behalf of him or her on an individual scale, which is why I decided to go into medicine in the first place.

Inclusion

Anesthesiology has a rich history of inclusion and diversity. It was one of the earliest specialties in medicine to open its doors to minorities and women. It was also one of the first specialties to center around a team-based approach to delivering medicine, integrating specialized nurses and assistants into the care team. This team-based approach has now permeated into most aspects of medicine. Our department is a great example of diversity, and I am so proud to be a part of a rich team of individuals who come together every day to deliver excellent care.

Leadership

If you watch Grey’s Anatomy (like I do), you would assume that when a patient codes on the operating room table, there are one or two people who take control and solve the situation. Though this makes for dramatic television, this is actually not the case.

A patient code in the operating room is a team emergency for which all hands are on deck. In fact, a Code Blue in an operating room is called an “Anesthesia STAT.” Every available anesthesiologist comes to the OR in a matter of seconds, and while the surgeons work on addressing the immediate surgical issues, the anesthesiologists take on the role of stabilizing the patient, diagnosing the pathophysiology of the inciting event, getting extra lines and monitoring, and delivering blood products. This well-oiled team of anesthesiologists gets to work and leads the team in a dynamic way.

This leadership role transcends the OR. Anesthesiologists are integral to just about every aspect of the hospital: interventional radiology, interventional cardiology, Labor and Delivery, endoscopy, the ICU, the Emergency Department and the medical and surgical floors. We are everywhere. In my personal experience as a resident, I have cared for a patient receiving a heart transplant and then taken care of women in labor on the same day. How incredible is that? Since we are mostly present when patients are in crisis or when they are asleep, we are often left out of the narrative of the hospital experience, but we are integral to our patients’ care.

I am so proud to be a part of an anesthesiology team at BWH that exemplifies what it’s like to be an excellent physician and patient guardian. It’s truly one of the greatest and most meaningful professions out there. Now, if someone asks you what anesthesiologists do once patients are asleep, you will be able to tell them we keep patients safe and cared for.