In our anesthesiology residency program, we rotate across six hospitals in the Texas Medical Center. Our county hospital, a level 1 trauma center, is also our primary teaching hospital and where senior residents do many… many… in-house call shifts. I often get asked on social media “what does a senior do on call”, so here it goes!
I get to work around 2:00 PM and “run the board” with the operating room (OR) front desk. We discuss the nurse/staffing availability, how many rooms we can run at certain times throughout the shift and the current operative cases plus add-on case list. Certain days of the week, SRNAs or junior residents need to attend afternoon lectures, so I’ll shift personnel accordingly. This is usually when people are expecting to hear from the senior resident regarding their fate (ie, when they can go home). It’s important to be as fair as possible… but still have enough coverage to staff the ORs and a potential floor emergency or stat operative case.
For the rest of the shift, the senior anesthesiology resident basically guides inflow and outflow from the operating rooms in conjunction with the various surgical specialities. If we can only run two operating rooms for elective cases and a third for potential stat cases, we have to be fair to everyone – orthopedics, neurosurgery, general surgery, etc. They all have countless cases they want to finish during off-hours, but sometimes it’s just not feasible. Rarely I’ll even postpone a purely elective case if the patient strikes me as someone who requires much more workup or optimization prior to proceeding to the operating room… especially at 3 AM with an exhausted skeleton crew.
After the entire day team has gone home (usually around 8 PM), the call team remains consisting of an attending anesthesiology, senior anesthesia resident, and 3-4 junior trainees (usually PGY-2s and/or SRNAs). I’ll be responsible for helping them consent and complete a pre-op assessment for each of their patients, discuss an anesthetic plan, perform said plan, safely maintain the anesthetic, emerge from anesthesia, and transport post-operatively.
I encourage the junior residents to try new things when they’re on call with me like using advanced airway equipment or performing their own peripheral nerve blocks for their cases. Depending on the case load, I’ll create teaching sessions, arrange for breaks (especially dinner), and hopefully give them enough time to catch a few hours of rest.
The senior also runs the post-anesthesia care unit (PACU) ensuring that patients are comfortable, stable, and ready for transfer to the floor, step-down unit, or ready to be discharged home. Occasionally there are post-op complications (like an expanding neck hematoma) which need to be explored further.
We respond to call “code 1 traumas” in the EC and provide airway/line assistance to our colleagues in the emergency department. This gives us a quick preview of the patient in the event that they come to the operating room for a stat laparotomy, thoracotomy, etc. Similarly, we provide similar aid in code blues around the entire hospital.
Being the senior anesthesiology resident requires a lot of organization and communication between physicians, nurses, techs, and other staff to provide safe, coordinated care for our patients each shift. 🙂
I just read a google review about a spine surgeon at a relatively rural hospital near Albany, NY, and the hospital had put up billboards advertising him and his practice. I am 63, and my primary is a long-time close personal friend in same municipality. Primary told me that 50% of their patients with this surgeon end up worse than before. The gravamen of the most concerning one star review and the reviews were also 50% fives and 50% ones, and that the reviewer’s BF “woke up” during surgery and it was not completed. In all fairness, my 32 yoa daughter completed anes residency at Ivy League school, has been an attending for a year, and just passed last step of her boards and we had dinner last night, Christmas Eve. On my 49th birthday, Oct 1 2004 I had an anterior cervical discectomy with instrumentation and fusion at levels C4/5 and 5/6 using cadaver bone. This oldest daughter was 17 and was my ride; the neurosurgeon came out after surgery and she said then, he looked upset and asked “does he drink or smoke,” bearing in mind that I was fully honest that I did not smoke, did abuse alcohol and had been on hydrocodone 5/500 for say 3 months before surgery. I was sick to my stomach the next day, when I looked at the fluoroscopy and during a year long odyssey I saw at least 3 orthopedic and 3 neurosurgeons and learned two screws penetrated C6 into C6/7 disc; a 2d CT myelogram showed continued severe nerve compression; and that an osteophyte that was supposed to be removed was left 1mm from my dura, and I did a complete revision in NYC just over a year later, one professor at NYU remarked, Mr D this is very, very bad, but this is so interesting I want to conference it with my 5 6th year spinal fellows. A neurosurgeon said, “I can’t believe he left the screws like that, and the osteophyte was a no-brainer.” NYU guy, having warned me I would get 6 different opinions felt I should just live with pain, and screws–the other surgeons were willing to do the revision, which was done with hip bone, and lost the disc with screws in it. I now live with left mandible numb and feel like a have a ligature around my throat. I am fairly entertaining and pulmonologist/ critical care doc I met on match remarked “spine surgery in the United States is a scandal, and it would appear that Jerome Groopman, MD, in How Drs Think, might agree.
Like this google review I have always wondered if I had awakened during surgery, and the very tired neurosurgeon (surgery done on Fri but on Tues I was advised his OR privileges had been suspended for failure to submit hospital paperwork, but I was called by his office on Wed “OK birthday boy go in for pre-op tests on Thurs” and I now that he had a second surgery in afternoon after my morning surgery.
Why would a spine surgery ask a 17 year old girl, does he drink or smoke, bearing in mind that the operation just was not finished–one surgeon said, he had put screws in like that himself and that it takes 5 minutes to back them out and put them in the right way. It would give me peace of mind to know. If you want to contact me, my e=mail is below. Best Regards.
Happy holidays, Robert! I have a strict policy online where I don’t go into the specifics of peoples’ medical encounters. I’m so sorry you had to go through all of that! 🙁 I obviously wasn’t there, so I’m not sure what prompted the question regarding smoking/alcohol. All I’ll say is that these practices have implications regarding perioperative pulmonary complications, drug metabolism, and anesthetic requirements.
I should definitely work a shif alongside you pal…. For now I’ll settle on having your opinion on my cases…. Keep it up and long live Anesthesiology
Haha, it’d be fun! 🙂