PGY1 rethinking choosing anesthesia

[ling000]

PGY-1 really worried about going into anesthesia. I really enjoyed anesthesia as a medical student but after doing my rotations in the ICU I’m starting to think I made a terrible choice for my personality. I didn’t realize how much ICU is a part of anesthesia and I’m at a program where we do 2 months each year. The anesthesia residents practically run the unit and I just can’t imagine myself doing that. Too many emergencies happening at once and I get really overwhelmed. I’m worried I won’t know what to do and someone will die. I also have bad social anxiety- performance type, and having to present patients every morning and the long rounding has been really taxing to my mental health. I only enjoy doing procedures, that’s it. I like the OR and the physio and Pharm involved. I like approaching one patient at a time.But it just seems like I’ll be doing a lot of medicine stuff in this program and presenting. I just feel lately like I was not exposed to the emergency side of anesthesia and the fact that I get so anxious while being in the ICU, if there is an emergency in the OR I won’t know what to do. Maybe something like pathology or radiology would have been a better fit for me. But sadly I’m on visa so switching will be very difficult. Any advice would be appreciated. I already signed my contract for PGY2 but I’ve really been considering just finishing intern year and then going back to my country to do another specialty. I’ve been extremely unhappy and anxious being in the ICU. I thought it would get better but it hasn’t. Is it normal to feel this way or is this really not for me .

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[SunBakedTrash]

Finish residency and do transfusion medicine. Your unique background will be an asset and it’ll spare you from having to do another residency. Pain would also be a consideration.

 

[deleted875186]

Do anesthesia. You’ll be fine, 99% boring and routine, less than 1% emergency. For those that don’t like high acuity, just practice in a community setting, ambulatory surgery center, GI, pain clinic, etc.

if you hate the ICU, don’t worry, most anesthesiologists feel the same way

 

[deleted875186]

Spoken as someone who’s anesthesia trained now doing pain clinic

 

[dienekes88]

PGY-1 really worried about going into anesthesia. I really enjoyed anesthesia as a medical student but after doing my rotations in the ICU I’m starting to think I made a terrible choice for my personality. I didn’t realize how much ICU is a part of anesthesia and I’m at a program where we do 2 months each year. The anesthesia residents practically run the unit and I just can’t imagine myself doing that. Too many emergencies happening at once and I get really overwhelmed. I’m worried I won’t know what to do and someone will die. I also have bad social anxiety- performance type, and having to present patients every morning and the long rounding has been really taxing to my mental health. I only enjoy doing procedures, that’s it. I like the OR and the physio and Pharm involved. I like approaching one patient at a time.But it just seems like I’ll be doing a lot of medicine stuff in this program and presenting. I just feel lately like I was not exposed to the emergency side of anesthesia and the fact that I get so anxious while being in the ICU, if there is an emergency in the OR I won’t know what to do. Maybe something like pathology or radiology would have been a better fit for me. But sadly I’m on visa so switching will be very difficult. Any advice would be appreciated. I already signed my contract for PGY2 but I’ve really been considering just finishing intern year and then going back to my country to do another specialty. I’ve been extremely unhappy and anxious being in the ICU. I thought it would get better but it hasn’t. Is it normal to feel this way or is this really not for me .

If you knew how to do icu medicine right now, then you wouldn't need to do residency or fellowship for that matter.

Just try to learn as much as possible. Use this energy to work harder and be prepared. There are a finite set of typical emergencies you will have to handle. Play them out in your head and run through what you're going to do.

How things go in an emergency is more about how well you communicate, assign roles, and execute simple tasks correctly (like providing ACLS) than providing complex care. No one expects you to open the chest at bedside and fix a hole in the heart.

Like what if a patient needs to be intubated. Know what drugs you are planning to use. You know its going to happen. Sit down today and write down the dose of etomidate and rocuronium (or whatever it is people use, I don't do anesthesia) you are going to use. And then repeat it to yourself when you watch someone else run a code. Run through the steps you know you need to do. Its not just about throwing a tube in. There's more to it than that. Decide what your standard back up is if you can't see well with a certain blade. Etc.

 

[deleted875186]

If you knew how to do icu medicine right now, then you wouldn't need to do residency or fellowship for that matter.

Just try to learn as much as possible. Use this energy to work harder and be prepared. There are a finite set of typical emergencies you will have to handle. Play them out in your head and run through what you're going to do.

How things go in an emergency is more about how well you communicate, assign roles, and execute simple tasks correctly (like providing ACLS) than providing complex care. No one expects you to open the chest at bedside and fix a hole in the heart.

Like what if a patient needs to be intubated. Know what drugs you are planning to use. You know its going to happen. Sit down today and write down the dose of etomidate and rocuronium (or whatever it is people use, I don't do anesthesia) you are going to use. And then repeat it to yourself when you watch someone else run a code. Run through the steps you know you need to do. Its not just about throwing a tube in. There's more to it than that. Decide what your standard back up is if you can't see well with a certain blade. Etc.

I dont think as an intern I was ever expected to be responsible for intubations or anything else described above. The OP has an attending and likely senior residents and fellows. Just get comfortable with bread and butter ICU medicine and things will feel routine:

replete electrolytes
Vasopressors
Fluid resuscitation
Diuresis
Hypoxemia treatment
HyperK treatment
DKA treatment
Sepsis treatment

Impending intubation, just call the anesthesia team or ICU attending early. No reason stuff like this should be an emergency in the ICU, can usually see them coming.

OP, what type of emergencies are we talking?

 

[dienekes88]

I dont think as an intern I was ever expected to be responsible for intubations or anything else described above. The OP has an attending and likely senior residents and fellows. Just get comfortable with bread and butter ICU medicine and things will feel routine:

replete electrolytes
Vasopressors
Fluid resuscitation
Diuresis
Hypoxemia treatment
HyperK treatment
DKA treatment
Sepsis treatment

Impending intubation, just call the anesthesia team or ICU attending early. No reason stuff like this should be an emergency in the ICU, can usually see them coming.

OP, what type of emergencies are we talking?

I'm talking about being ready for emergencies during the 2 months of pgy 2, 3, and 4 that the OP will be primary for intubation. If that's what the OP is worried about, then just be prepared for it. Because it's going to happen. You can never be too prepared, and the last thing to try to figure out is how you like to position the retractor when 10 people are screaming at you to open the chest. Hahaha.

 

[doyouhaveaflag]

How things go in an emergency is more about how well you communicate, assign roles, and execute simple tasks correctly (like providing ACLS) than providing complex care. No one expects you to open the chest at bedside and fix a hole in the heart.

Fun story, this actually happened in our CTICU. There was a sharp bone edge after a sternal debridement that punctured the patient's heart. Not enough time to get to an OR. It didn't go well.

Also OP, two months a year is like nothing. Surely it can't be worth leaving the country just to do something else. As mentioned above, your practice definitely does not need to include an ICU.

 

[ling000]

Finish residency and do transfusion medicine. Your unique background will be an asset and it’ll spare you from having to do another residency. Pain would also be a consideration.

I’ll look into this. Just have to get through residency

 

[ling000]

Do anesthesia. You’ll be fine, 99% boring and routine, less than 1% emergency. For those that don’t like high acuity, just practice in a community setting, ambulatory surgery center, GI, pain clinic, etc.

if you hate the ICU, don’t worry, most anesthesiologists feel the same way

Ok that’s comforting. I’ll try my best to finish residency. I know I can make life better as an attending. Hopefully with more experience I’ll feel more comfortable in the ICU

 

[ling000]

If you knew how to do icu medicine right now, then you wouldn't need to do residency or fellowship for that matter.

Just try to learn as much as possible. Use this energy to work harder and be prepared. There are a finite set of typical emergencies you will have to handle. Play them out in your head and run through what you're going to do.

How things go in an emergency is more about how well you communicate, assign roles, and execute simple tasks correctly (like providing ACLS) than providing complex care. No one expects you to open the chest at bedside and fix a hole in the heart.

Like what if a patient needs to be intubated. Know what drugs you are planning to use. You know its going to happen. Sit down today and write down the dose of etomidate and rocuronium (or whatever it is people use, I don't do anesthesia) you are going to use. And then repeat it to yourself when you watch someone else run a code. Run through the steps you know you need to do. Its not just about throwing a tube in. There's more to it than that. Decide what your standard back up is if you can't see well with a certain blade. Etc.

If you knew how to do icu medicine right now, then you wouldn't need to do residency or fellowship for that matter.

Just try to learn as much as possible. Use this energy to work harder and be prepared. There are a finite set of typical emergencies you will have to handle. Play them out in your head and run through what you're going to do.

How things go in an emergency is more about how well you communicate, assign roles, and execute simple tasks correctly (like providing ACLS) than providing complex care. No one expects you to open the chest at bedside and fix a hole in the heart.

Like what if a patient needs to be intubated. Know what drugs you are planning to use. You know its going to happen. Sit down today and write down the dose of etomidate and rocuronium (or whatever it is people use, I don't do anesthesia) you are going to use. And then repeat it to yourself when you watch someone else run a code. Run through the steps you know you need to do. Its not just about throwing a tube in. There's more to it than that. Decide what your standard back up is if you can't see well with a certain blade. Etc.

Yeah that’s something I’ve started doing and it’s been helping. Hoping with time I’ll get better at ICU. It’s a lot you have to know.

 

[ling000]

I dont think as an intern I was ever expected to be responsible for intubations or anything else described above. The OP has an attending and likely senior residents and fellows. Just get comfortable with bread and butter ICU medicine and things will feel routine:

replete electrolytes
Vasopressors
Fluid resuscitation
Diuresis
Hypoxemia treatment
HyperK treatment
DKA treatment
Sepsis treatment

Impending intubation, just call the anesthesia team or ICU attending early. No reason stuff like this should be an emergency in the ICU, can usually see them coming.

OP, what type of emergencies are we talking?

I haven’t been asked to do anything yet as an intern but I’ve observed from my co residents the level I’ll have to be at next year. I mostly worry about a patient crashing in the middle of the night and I’m there alone not knowing what to do. We care for a lot of sick pts post cardiac surgery and things always go wrong. I’ve been learning though hopefully I get better

 

[Dr.LeoSpaceman]

I mostly worry about a patient crashing in the middle of the night and I’m there alone not knowing what to do.

You should never be truly "alone", especially as a PGY2. And if you are, that's a structural problem with the hospital/residency. Sometimes knowing what to do means calling for help. The key piece of information in any situation is understanding what additional support is available.

Few rational people will ding you for calling for help.But they can (and should) be critical of being in over your head and not asking for guidance. (Though that changes if you're repeatedly calling for help in the same situation.)

 

[ecogfive]

You should never be truly "alone", especially as a PGY2. And if you are, that's a structural problem with the hospital/residency. Sometimes knowing what to do means calling for help. The key piece of information in any situation is understanding what additional support is available.

Few rational people will ding you for calling for help.But they can (and should) be critical of being in over your head and not asking for guidance. (Though that changes if you're repeatedly calling for help in the same situation.)

Yes, this. OP - I can empathize; I'm an IM resident and I remember feeling nauseated with worry at the start of my MICU rotations. The patients all seemed so sick and I felt like the village idiot every time I listened to the attendings and fellows debate the utility of various pressors, etc. But truthfully: #1 - you will learn so much during your intern year that some of the 'big scaries' will get less bowel-quakingly terrifying and #2 - there should always, always, ALWAYS be an attending or fellow within reach to support you during emergencies. Have a low threshold to ask for help.

 

[deleted875186]

Perhaps OP is thinking about things in terms of hypoxia, SOB, chest pain, etc, when you get called to evaluate patients.

I remember being nervous about this type of thing. Remember my first night on call I had a page for chest pain overnight from this terrible CAD patient, full of stents, tells me it felt just like his last heart attack, and pooping my pants as to what to do. The more you do it the more comfortable you get, also helps knowing the endpoint for many things, for instance I know the plan A, B, C .... etc for when I get called for hypoxia, helps in making you less nervous

 

[j4pac]

Yeah that’s something I’ve started doing and it’s been helping. Hoping with time I’ll get better at ICU. It’s a lot you have to know.

Everyone is scared about something when they enter residency. You aren’t alone. Know your deficits. Anticipate what you would do in stressful situations...practice. And understand your support.