A Day in the Life of a CA-2 at Texas Heart Institute
6:15 a.m. - First stop: the board outside of the anesthesiology office for room assignments. Today I have been assigned to two pump cases - an aortocoronary bypass and an aortic valve replacement. Excited about the assignment, I quickly realize that pump cases require a little more preparation. Picking up the pace, I cut through the central core, gather drugs from the pharmacy, and sterile attire for central line placement.
In addition to the machine check, I start drawing up drugs for the first case. I think back to my CA-1 year when a cardiac anesthesiology attending told me, "I chose CV because I like the order. Though it may not seem like it now, cardiac cases follow a very systematic series of events that you prepare for." I am beginning to understand what she means. With all my drugs lined up, I gather together my central line kit and arterial line set-up.
Is that everything? I check my set-up one more time and then head over to the preoperative holding area.
7 a.m. My patient, Mr. S., is a very pleasant 78 year old gentleman. I introduce myself to him and his wife and begin to explain the anesthetic process. He, of course, has heard this information before as most of the patients have met with an anesthesiologist earlier in the day. After discussing the case with my attending, I roll the patient back to the operating room.
Monitors on. Premedication given. Now's my first test of the day. Positioning Mr. S's arm on the armboard, I inject lidocaine to anesthetize his arm for the radial arterial line. Thanks to the patient's beta blockade, I am able to distinguish his pulse from my own tachycardia. Fortunately, I am successful on my first attempt and we proceed with induction of our anesthetic. Arterial line, done. Intubation, done. Central line....
The attending physicians here are really great. I hear my attending say, "Go ahead and gown and glove for the central line. Let me secure the endotracheal tube and prep the patient." By the time I am in full sterile attire, the patient is in Trendelenberg position with chlorhexidine drying on his neck.
Palpating landmarks, the central line goes in easily, and I am able to relax for just a moment. Looking up from my suture though, I realize that the chest is prepped and the surgeons are waiting. A couple of minutes later, I hear them getting ready for the sternotomy, and I deflate the lungs.
The patient is on cardiopulmonary bypass and my attending sends me out for a morning break. After a cup of coffee and restroom stop, I am back in the OR, where the surgeons are ready to come off pump.
Did I mention things move quickly here?
As I get ready for my second case, I have a sneaking suspicion that I am starting to really enjoy cardiac anesthesia. The thought of pursuing a cardiac fellowship enters my mind and I make a mental note to talk to some of the current fellows about their experiences.
During the next case, my attending and I talk about hypothermic circulatory arrest, and issues that we might encounter intraoperatively. I feel fortunate that I am in a training program where thoracic aortic aneurysm cases are not uncommon.
After transporting my second patient to the ICU, I make a detour to check on Mr. S. Extubated, talking with his wife, he gives me a quick wave and a smile - definitely brightens my day.
After completing preoperative assessments on a couple of patients for the next day, I am released to go home. Walking out, admittedly tired, I can't help but be grateful for my experience. One of my goals as an anesthesiologist is to be able to take care of the sickest patient - with this training, I know that I will be ready.
– Catherine Seipel, M.D., Class of 2011