As a fellow, I’m often privileged to work with medical students and anesthesiology residents in the cardiothoracic operating rooms. Many of these individuals I’ve come to know through the ICU, but some of them are very junior and haven’t spent much time doing cardiac anesthesia (let alone, in any operating room). Before I introduce them to the OR staff and get our duties underway, I ask them to tell me how many people they see around the room:

“Rishi, I think those two over there are nurses, that’s one of the surgical residents, that’s the perfusion team with a student, here’s a research coordinator, the surgical attending is outside scrubbing, the surgical scrub tech is counting instruments with one of the nurses, and then of course there’s you and me. I see ten people. Maybe there will be more?”

I smile – it’s time to impart some clinical wisdom. Not the pathophysiologic, pharmacologic, or surgical considerations inherent to the operating room, but instead, I proceed to step towards the head of our anesthetized patient.

“You forgot the most important person – the patient.”

If you walk into an ongoing surgery, it’s easy to forget about the patient. They’re often covered from head-to-toe with sterile surgical drapes. They’re motionless. They don’t respond to commands. They’re the silent figure who is the most important individual in the operating room.

Often times very junior trainees are taken back by how profound the responsibilities as an anesthesiologist are. Just around the patient’s face, one can find an endotracheal tube, bite blocks, temperature probe, transesophageal echo ultrasound probe, BIS monitor, pulse oximeter, cerebral oximeter, and a myriad of lines and cables that allow me to continuously monitor the patient to keep him/her safe.

During cardiac surgery, there’s a careful interplay between the surgeons, anesthesiologists, nurses, perfusionists, respiratory therapists, pharmacists, blood bank, etc. We are all there working for the patient rather than on them. Patient safety is our priority as a perioperative team, and something that I will always defend.

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