When he introduces the anesthesia course to his students every year, New York's Dr. Steven Shoum explains the role of an anesthesiologist by telling his students about the terrible mistake once made by two pharmacy students. You see, they were waiting to meet Shoum outside his door when one said to the other, "What do these anesthesia guys do, anyway?" The other answered, "They're the guys that put you to sleep!"
Shoum wasn't about to let that misconception slide, so he explained his work in a way they'd never forget.
"Imagine you're lying on a stretcher, you are rolled into the OR [operating room], and the surgeons surround you. The surgeon takes a scalpel, places it at your throat, presses it down to the underlying bone, then slides it down past your waist. The assistants place a saw under the sternum and split the ribcage open, inserting steel retractors to crank open the chest. After suturing tiny blood vessels together, they drill holes and wire the chest closed. The abdomen is also sutured and the skin closed. Now, I ask them, could you sleep through that?"
It's a disturbing example, but Shoum believes it's important to make the point that there is more to anesthesia than simply "putting people to sleep." Anesthesiologist Dr. Ian Zunder agrees, saying many people don't understand his job at all.
"A lot of people are unaware that anesthesiologists are doctors," says Zunder. "They also don't realize that we are responsible for maintaining their life while the surgeon operates, and that we make all the decisions regarding which drugs to give, which fluids to administer."
People in this field say it's ironic that most patients are unaware of the anesthesiologist -- the patient's most important advocate in the operating room. Not only do anesthesiologists ensure patients are comfortable during surgery, they also look after all of the patient's life-support needs.
When an anesthesiologist administers anesthesia, they are actually giving the patient a controlled amount of poison, which restricts the body's normal functions and puts the patient in a state of unconsciousness. While the patient is under anesthesia, the anesthesiologist uses sophisticated equipment to sustain the person's life.
"Basically, it's the anesthesiologist's job to be the surrogate patient," Zunder explains. "The anesthesiologist monitors and moderates the patient's blood pressure, breathing, heart rate and temperature -- doing all of the things the body would normally do itself."
The surgeon is usually viewed as the "star" in the medical industry, but often the role of the anesthesiologist is the most critical during surgery. As they say in the business, "There may be simple surgery, but there's no simple anesthesiology."
"If something goes wrong, we only have seconds to a minute to correct the problem before irreversible harm occurs," says Shoum. "You have to be cool as ice when it hits the fan, but able to remain alert during long procedures that may last all night long."
While the stress and responsibility levels in this career are high, both Shoum and Zunder agree this challenge is part of what they enjoy about their job.
"We take tremendous pride in making the 'sleeping' experience as pleasant as possible. As well, we strive to ensure that pain control is optimal. We help pregnant patients with labor and delivery, and care for the sickest patients in the intensive care unit," says Zunder.
High stress doesn't necessarily mean a lot of excitement for anesthesiologists -- which is a good thing, since excitement generally means something has gone wrong with the patient.
"It is said that anesthesia is either terribly simple or simply terrible! There are long periods of sheer boredom, punctuated by moments of terror. You can't be the person who is waiting for the excitement; the boredom is what you obviously are trying to create," says Shoum.
Zunder agrees with Shoum, saying that keeping things under control is an important part of the anesthesiologist's job. In fact, Zunder says, the most satisfying part of his work happens when he can take a difficult situation and help bring it under control.
"The most rewarding part of anesthesia is dealing with the emergency situation -- for example, the accident victim. In these situations the patients show up at your door in terrible shape and potentially on the brink of death, only to be saved, hopefully, by your skilled administration of the proper fluids and drugs, coupled with surgical correction of the internal injuries," says Zunder.
In the last few years, thanks to more sophisticated technology and advances in pharmaceuticals, the job of anesthesiologists has become both more challenging and more rewarding.
"Anesthesia...has advanced in leaps and bounds over the last few decades, and we are operating on people now that would have had little chance of survival in the past," says Zunder. "It's incredibly gratifying to take this person with multiple medical problems, and get them through an operation and out the hospital door."