I PASSED WHOO HOOO!!!

Whoo hoo, just found out I passed all my classes this term which means that . . . I . . . am . . . officially a THIRD YEAR MED STUDENT

(yea lame, I know, but seriously, its finally done with the basic science crap and onto to the really interesting stuff, taking care of patients, clinical medicine and B-school)

Now hopefully my exuberance can translate into work ethic for boards studying

Anesthesia, the best balance

I just shadowed Dr. H in Anesthesia. Saw some pedi anesthesia, got to watch pre-op, post-op prep and even some NORA (Non OR Anesthesia where for example they anesthetized a 2yo girl before her MRI).

Overall I think its a GREAT balanced specialty where you get to DO a lot of stuff (put a patient under, bring them back, control all of their vital functions for them, make them pain free, even palliate or offer them a “good” death a la Dr. Byock, the guy who started our palliative care group), the cases are open and shut, you get to go in, do your stuff, achieve an outcome and get out, GO HOME. Or go on vacation, or travel around the world and give talks. Dr. H does 0.8 which means she takes 1 day completely off per week which is easy to do 1) because its shift work 2) Anesthesia is a MONEY MAKER not money loser in the hospital so you are pretty well protected and supported within the healthcare organization. Its exciting when stuff DOES happen (a la the day I saw a neurosurgery go awry) but when stuff slows down your co-workers are usually nice enough to take over for you so you can take a break for 30 mins (AND you can even rationalize it since as a resident told me, you need to sometimes clear your head instead of stare at the monitors in order to spot red flags). For example, I went in at 8am, left at 4pm and had time for two lunches and some long fun conversations with the attending and residents while I was there. Oh another plus is VERY FEW NOTES and less paperwork than other internal med specialties.

Some downsides: no patient continuity and not much patient contact (although I don’t really care that much about it, just seeing your patients right before you put em down and right after they wake up groggy isn’t super appealing), also not being able to really interact with patients, gather information and make a differential dx kind of takes a lot of fun out of being a doc (although being in scrubs and DOing a lot makes up for quite a bit) and also you are kind of tied to a machine in a hospital without which you are kind of a glorified EMT. Dr H also cited the fact that it is true what they say 30hrs of boredom and 3 minutes of SHEER terror since a patient can crash and crash quickly on you and you can get so used to being in total control over a patient’s life that losing a patient can be really traumatic.

In the end the key will likely be personality fit and culture where I can safely say Dartmouth’s Anesthesia folks rank among the coolest people I have met so far here. They are pleasant without being superficial or ditzy (like Derm), determined and strong willed without being total control freaks. Overall Anesthesia gets an ‘A’ for lifestyle and ‘B-‘ for interesting work (by comparison Hospital medicine would be an ‘A-‘ for interesting work and B for lifestyle and C for pay). Anyway, note to self, schedule a clerkship EARLY (not necessary to do a Sub I and Dr. H recommends against it)