It’s 5.30 a.m. I’m tempted to snooze my alarm just one more time. My mind’s telling me no, but my body… my body is telling me yes. I lay still and contemplate how those extra nine minutes of glorious rest would affect my day. Sure, nine minutes can turn to eighteen and I may be rushing to work but…nah not worth it. It’s always better to be early. I sit up, swing my legs out of bed and I’m on autopilot as I get ready. I.D., scrub cap, and I’m out of my house within 25 minutes. By now, Morgan and Mikhail, Miller, PubMed, and UpToDate are ingrained into my nightly routine. I cycle through these resources focusing on anesthetic considerations specific to my case to prepare for the difficult task of treating patients undergoing high risk cardiothoracic surgery. This morning’s orator is Jermaine Cole, and “Ville mentality” permeates my car’s speakers. The nine-minute drive is peaceful as I mindlessly navigate traffic lights and stop signs while mentally preparing for the day.
I relish the day’s first challenge: a robotic mitral valve replacement with cardiopulmonary bypass and erector spinae nerve block. This patient has severe mitral regurgitation, poorly controlled diabetes, coronary artery disease and end stage renal function. I’m even more excited because of the opportunity to learn from the phenomenal skills, vast knowledge, and unique capabilities of the cardiac anesthesiologists at the renowned Texas Heart Institute. These attendings are clinically adaptable and comfortable treating our extremely sick patients because of their excellent CV/CVICU training. There’s also a private-practice atmosphere and pace and this improves our efficiency as residents.
I stroll into my assigned OR at 6:20 a.m. The set-up is fairly routine with the MS-MAIDS mnemonic. I’m locked in at this point with my Spotify playlist cycling through the legendary poetry of Sean Carter, Kanye West and Nasir Jones. I greet the perfusionist and engage in light banter with the familiar nursing staff while simultaneously setting up an arterial line and central line kit. Our overnight anesthesia technician barges in and performs his final check, ensuring that I have the essential equipment to proceed with the case.
It’s 7:10 a.m. and by now, I’ve texted my attending to discuss the case and our anesthetic plan, greeted the patient and completed my pre-op note with the appropriate consent signed. The pre-op nurse has taken the initiative to place the IV and our OR nurse informs me to roll back at 7:25 a.m. Perfect! 10 minutes to spare. I proceed to the physician’s lounge to grab some free coffee. Free always tastes so good.
I perform a pre-induction ESP nerve block and insert an arterial line, intubate the patient with a double lumen tube, cannulate the internal jugular vein with its respective catheter, and position the patient appropriately with the aid of the staff. As the surgeons scrub in, the two CV anesthesia fellows meander in and assess the physiology of this patient with a trans-esophageal echo over the next 20 minutes. My attending seizes on the opportunity to guide and teach about the nuances of managing mitral regurgitation and techniques to evaluate other valvular abnormalities and ventricular function.
“You want to take your break?” my attending offers.
“Nah, I’m good,” I responded. Just kidding. The cardinal rule of anesthesiology: never decline a break.
The case proceeds uneventfully and we are on cardiopulmonary bypass. The physician lounge and I have an understanding and it demands at least a once-daily visit. It’s 12:15 p.m. and I’ve neglected my duty. The cavalry arrives as my attending, sensing my obligation, offers a lunch break. Say it with me. Free food always tastes so good.
As surgery wraps up, the OR board runner informs me to head home after I finish the case. “What?! It’s only 1:30 p.m. Just let me do one more case,” I exclaim. Just kidding again. Another cardinal rule of anesthesiology: when you’re relieved, give a proper sign-out to the next team and never look back. The good news is there is a release order and the board runner typically does an excellent job of ensuring that residents who are first call (aka overnight) or second call leave the hospital at a reasonable time.
The on-call resident sends out tomorrow’s assignments in the evening, allowing sufficient time to read up on the patients and the anesthetic approaches to each case. I thoroughly enjoy this rotation and the diversity of cases assigned to residents (thoracotomies, VATS, TAVR, CABG or ACB, liver/kidney/lung/heart transplants, etc.). This month solidified my decision to pursue an adult cardiothoracic anesthesiology fellowship.
