I wear a lot of hats in my job.  Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table.

Many days I spend in an administrative leadership role or conducting research studies.  These functions support the best interests of my patients as well as the science and practice of anesthesiology.  On my clinical days that I spend in hands-on patient care, I provide anesthesia for patients who undergo surgery and other invasive procedures.  I also treat acute pain as a consultant.  Some of my colleagues in anesthesiology specialize in chronic pain or critical care medicine.

As a medical student, I had a hard time at first understanding what the physician anesthesiologist does.  I saw monitors, complicated equipment, and technical procedures that involved a lot of needles.  Thankfully, I worked with resident and attending anesthesiologists who inspired me to pursue this specialty.

Anesthesiology is a unique field within medicine.  It is at the same time incredibly cerebral and extremely physical.  For example, the physician anesthesiologist must be ready to diagnose heart or lung problems that may complicate the patient’s surgery, and decide which medications are appropriate.

Before administering a medication, it’s not enough just to understand the complex pharmacologic effects of the drug and determine the right dose.  The anesthesiologist also has to know how to dilute and prepare the drug, the appropriate route for the medication, which other medications are and are not compatible, and how to program the infusion device.  In addition, an anesthesiologist has to be technically skilled at finding veins—sometimes in the hand or arm, sometimes leading centrally to the heart—in order to give the medication in the first place.

I am always aware of the trust that patients and their families give me, a total stranger, and I work hard to earn that trust throughout the perioperative period.  The job of the physician anesthesiologist is deeply personal.  In the operating room, I care for the most vulnerable of patients — those who, while under anesthesia, cannot care for themselves:

• I constantly listen to the sounds of their hearts.
• I breathe for them when they are unable.
• I keep them warm in the cold operating room.
• I provide the fluids that their bodies need.
• I pad their arms and legs and other pressure points.
• I watch the operation step by step, anticipating and responding.
• I learn from their bodies’ response to anesthesia to give the right amount.
• I prevent and relieve their pain.
• I protect them from dangers of which they are unaware.

I have heard people, my colleagues included, compare physician anesthesiologists to pilots.  No one claps when the plane lands, just as no one expects any less than a perfect uncomplicated anesthetic every time.  We physician anesthesiologists draw great personal satisfaction from doing what we do, and from providing a unique type of personalized medicine.  Our patients and their families depend on us to be at our best, always.

Edward R. Mariano is an anesthesiologist.  He can be reached on his self-titled site, Edward R. Mariano, M.D. and on Twitter @EMARIANOMD.

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