I spent the last 2 weeks on a pediatric anesthesiology rotation. I scheduled this rotation about this time last year, when I couldn’t decide if I wanted to do pediatrics or anesthesiology. I knew at that time that no matter which I chose and where I ultimately ended up, I would enjoy this rotation.
That being said, I was pretty nervous to start. At the end of fourth year you experience a unique phenomenon similar to what happens at the end of undergrad: Senioritis sets in. But it’s a million times worse than any case I’ve had before. I barely read any medical journals now and I rarely look anything interesting up on up to date. Basically, all motivation to gather knowledge to impress my Attendings is gone, because I’ve been promised a job and have signed my contract. And I’m not expected to be held to those standards until July 1. Maybe that sounds rough or wrong, but I’ve been working at this for about 12 years, so I think I deserve some kind of a break. (Add on the fact that I’m 8 months pregnant and you catch my drift!)
So anyway, I was nervous to start this rotation because I haven’t studied anesthesiology since December, during interview season. And even then, I was only doing adult cases. Pediatrics is a completely different beast, with different physiology, ventilator settings, and dosages of drugs. My first week I didn’t tell anyone that I had interviewed for Anesthesia, I just told my Attending that I had matched to pediatrics so he wouldn’t have any prior expectations of me knowledge-wise. Maybe this was lazy of me, but like I said before, I had never really done anesthesia on kids anyway, and I didn’t want to be made to look dumb on one of my very last rotations.
Despite my laziness, I loved every minute of this rotation, even the difficult ones. I wasn’t able to hide my anesthesia background for long- I was quickly “found out” when my Attending had to get emergent IV access on our patient while I was in charge of maintaining the airway… which included an emergency intubation. The patient was a 2-month-old baby who was born 2 months premature… so, really, a DAY OLD baby. While on this rotation, I got to see and do so many interesting things. I got to intubate a 15-year-old, a 9-year-old, two 5-year-olds, two 4-year-olds, and a 3-year-old. I got to manage all different sizes of airways and think on my feet. And quite honestly, I miss being in the operating room.
My first couple of days all of the feelings of why I applied to anesthesiology in the first place came rushing back. I love the procedures, I love the pace, I love the operating room, I love the banter between anesthesia and surgery. I love the trust that the patients place into your hands, which is only accentuated whenever it’s their tiny children that are being operated on. I love the satisfaction when a patient wakes up effortlessly and has little to no nausea or anesthetic side effect.
But I also love the stickers that we give the kids in the pre-op area. I love getting to carry them back to the operating table, because they’re so small that wheeling them back going to bed isn’t necessary. I love their cute little gowns. I love that they get to pick a favorite toy from home to bring back to the operating room with them and hold onto it while we put them to sleep. I love that they get to pick a flavor to put inside of their gas mask, and I love that the most popular ones are bubblegum and cotton candy.
I absolutely love pediatrics. It sounds cliché, but I really think I was born to do this. Not everyone has a way with kids. And it’s beyond “oh you’ll be a great mom”. I love their physiology. I love that seeing a one-month-old is 100% different than seeing a six-year-old. I love that everything is a question. I love getting to be the one to calm down a nervous child. I made the right decision. I would’ve enjoyed a career in Anesthesia, because I love the subject matter. But I’m not sure that I would have excelled in it. I know as a pediatrician I will excel in my career, because my love of this field goes much deeper than just an academic interest. And I don’t personally want the most exciting part of my day being a baby almost losing their airway. That is an adrenaline rush I can do without.
We had a baby on the operating table last week who needed a facial reconstruction surgery. When I came into the OR, the case had started already and it was a horrifying sight. At the end of the surgery when they put her face back and fixed the bone, she was nothing less than beautiful. I turned and asked the anesthesiologist what the recovery time was for the surgery and if she would require follow-up surgeries, and what her life would be like the next few months. He laughed and said “hell if I know”. And that was when I knew. I made the right decision. I cannot not know the stories. It would drive me crazy. Seeing patients for one brief moment in time is not how I personally want to practice medicine. I want to know the patient stories, meet their families for more than just a few minutes in the pre-op area, and I want to know what makes the lives of these children individually meaningful. I wouldn’t have gotten any of that in anesthesiology.
Anesthesia is a very rewarding field and I respect everyone who goes into it. Before this rotation I’ll be honest- I had doubts if I had made the right choice picking pediatrics over anesthesiology. I saw my other classmates match into anesthesia and sometimes found myself a little jealous of them, playing the “what if “game. This rotation confirmed for me that I made the right decision. I need to be involved in patients’ lives in a more lasting way than just a few hours during surgery. I need to know the quality of life that they have, and what recovery time will be, and what their stories are. I’m so excited to start my residency in July. I can’t wait to see how the next three years mold and shape me into a different person than I am today, much as I have changed over the last 4 years. It is good to know I made the right decision.