Wow, I have been a bad blogger! Its amazing how quickly these last few months have flown by. Things are going well in my CA-1 year. I'm currently doing a PACU rotation and before that I did a 1 month pre-op rotation. Both have been great experiences especially in terms of being able to follow a patient through their surgical experience. During the preop month (we call it Preoperative Evaluation "POE" clinic) I had a chance to really tune patients up for surgery; stress testing, sleep studies or simply initiating beta-blocker therapy. This month is managing a lot of postoperative nausea/vomiting, hyper/hypotension and of course pain control. Its amazing how patients can be in 10/10 pain and fall asleep while telling me about it! I have to admit, I'm really looking forward to being back in the OR next month.

Call has been a great way to keep up on the OR skills that are still so new to me. Last Friday night between 10pm and 7am I did 4 consecutive appendectomies! I swear there was a sign outside the ER offering appys at half price! For the first case, I felt a little rusty (having been out of the OR for 2 months) but by the fourth case I was feeling right back in the saddle - albeit a little sleepy.

I'm heading up to Canada to see my long lost husband for Xmas and New Years - really looking forward to that... hopefully that Greencard will come through soon! Ok, well I have a "Postop Nausea and Vomiting" presentation to work on for Friday so I'll sign off for now - promise to write again soon!

I'm starting to be left alone with my anesthesized patients. Usually for about 20-30 minutes my senior resident will step out for a little coffee break and there I am, behind the drape with ephedrine in one hand, vecuronium in the other and my eyes glued to the monitors. Those 30 minutes are exhausting as I constantly scan; are the IV fluids still running? is the ET tube still properly in place? is the patient still paralyzed? how is the end tidal CO2? what's the heart rate? blood pressure? O2 sats? temperature? are the IV fluids still running.... We are taught to scan about every 5 minutes, but once I am left alone I never stop scanning - terrified that something might go awry.

It was in the middle of one of those coffee breaks last week that I noticed the patient's blood pressure dip down to 80/60. The heart rate was about 50 and I pushed 5mg of ephedrine (something I had done many times with my senior resident). The patient was prone at the time, surgeon was just leaving and the PA was finishing suturing. The next thing I knew, patient's heart rate was 45...40...35... "He's bradying down," I announced. Heart rate went to 30...25... "I'm calling a code", I said as I reached for the code button. The rest is a blur. We flipped the patient over onto his back, and the PA starting chest compressions as his heart rate quickly went from 10 to 0. Asystole. Before I knew it, the room was filled with people, atropine was pushed and to my relief a steady heart rate and blood pressure were quickly recovered. It was determined that the patient must have had a vagal reaction which caused his heart rate to slow and stop. Troponins returned negative and he was discharged from the hospital the following day. During the experience I was terrified; going over and over in my head what had happened - afraid that I had done something wrong. In retrospect, it was a good experience, though. I'm sure that over the years I will have many similar situations; you never know how patients will react to surgery. I know that as a resident I will have support at the push of a button. Its important to know when to call for help and nice to know that help it available.

I have played those moments over and over in my head since last week. For two days I wouldn't let my senior resident leave the room for so long as a bathroom break. I'm starting to feel better about things now. I'm realizing that adverse reactions happen and part of the anesthesiology resident's job is learning to handle these situations calmly and confidently.

My husband lives in Canada... I live in Flordia. It doesn't take an MD to figure out that one of us is in the wrong place :-).  We met and dated 16 years ago while in boarding school in Connecticut. We started dating again 3 years ago and were married last November. We surprised our families at Thanksgiving dinner with the announcement that we were getting married that weekend! Ten family members were at the wedding (and a couple watched via skype) - it was a fabulous beginning to what my friends have since dubbed an "e-marriage". His Visa is being processed, but in the mean time we continue to fill our free weekends with a lot of international travel!

Today marks the beginning of my second week in my three-year anesthesiology residency - I won't count how many weeks I have left. Despite some early morning, I am really enjoying my days. During my first month I am paired with a 3rd year resident. We do about 2-3 cases/day and then the 1st year residents have lecture from 3-5pm where we learn a lot of basic anesthesiology. Its amazing how much information is being thrown at us and even more amazing how much is actually sticking! I'm learning so much! Today I did two rapid sequence intubations - without any damage to teeth or lips. Although daunting at first, the anesthesia machine has become my friend and I'm starting to feel much more comfortable with the whole process of anesthesizing a patient... There is so much to learn - back to the books!

Well, we've been married 18 years. My husband and I went out for our Anniversary "date," and spent the whole time with my CA-1 (clinical anesthesiology-year one) schedule and a calendar planning out travel softball (the teen), horse riding competitions (the preteen), school, mole call, family get-togethers, college visits (the teen, again), and a few seconds just for us.

It's much easier making plans once you're in your CA-1 year and everything becomes predictable. It was a little more complex during last year's Internship rotations.

I am looking forward to officially starting my CA-1 year tomorrow, July 1. I am no longer an Intern. I'll let you know how my first day went tomorrow. See if all my planning will fall into place.

Sometimes getting started is the hardest part. July 1st is the 'leaping off' point for the final phase in my medical training. I will approach this first year with both excitement and trepidation. Excitement in that I look forward to the journey of finally becoming an Anesthesiologist and trepidation, in that the learning curve is steep and the responsibility is incredible. I hope that this blog will provide insight into both the residency and profession and allow honest responses to questions posed by those considering the profession. Here goes. - Dr. BG