Sunday, February 16, 2014

Age 32: Anesthesiology Residency

Since I transferred in to USC Keck School of Medicine in my third year of medical school, I had no choice but to fill my schedule with Basic Rotations. There was no time to take a month of Electives, like "cake" rotations that would let me sleep all night and come in at 9:00 am. None of that.

I repeated the hardest Core Rotations: Ob/Gyn, General Surgery, Pediatrics, Internal Medicine, Cardiology, etc. So, as it turned out, I never had a chance to rotate as a medical student in Anesthesiology. But I did do a month of Anesthesiology Research, and I learned about the nerve stimulator, paralytic drugs, and residual neuromuscular blockade. I even presented two research papers at the Western Anesthesiology Resident's Conference (WARC) as a medical student. Unprecedented.

Dr. Nabil Rashad was my dearest mentor, and we wrote Anesthesiology Board Questions together, putting them into books. That was very helpful when it was time for me to take my own Anesthesiology Written Board Exam. I remember stepping out of the Exam and walk/running to my car to sit in the sun and eat my lunch alone. I felt like such a failure. I thought for certain that I had failed the Exam. All the hours I spent studying, and all the years I studied. All the 'No thank you's' to date inquiries, all the Friday and Saturday nights I spent in my apartment library, cramming information into my head. All the phone numbers of the guys who had asked me out; they were displayed in a bottle that I kept on top of the bookcase, to remind me that people come and go, but my education will stay with me forever. It's the only thing in life that I can count on.

There were no sugar plums dancing in my head. Half-lives of this drug, excretion by the kidneys or the liver? On that drug, side effects, how to put an anesthesia machine together, how to take it apart, how to make it a closed circuit to conserve body heat, all the stages of awakening and which was the most dangerous to the patient, and the reverse: the stages of reanimation, and which was the most apt to cause the patient to vomit into her lungs and die of aspiration pneumonia. And what is the diagnosis if the patient complains of chest pain after given naloxone to reverse morphine overdose? And which is the most appropriate steroid to give a lung transplantation patient postoperatively? And how do you prevent your PACU (post-anesthesia care unit) from sounding like a Haunted House, filled with people moaning and groaning in pain, and throwing up, causing you to gag? And just how much blood loss are you going to let your patient have on the table before you open your mouth and tell the surgeon you think she needs a blood transfusion? And which drugs cross the placenta:blood barrier from mother to baby, and which ones don't? And what is the difference between CPAP and SIMV mechanical ventilation in the Intensive Care Unit? How much PEEP should you add to the ventilator settings, and why? Which antibiotic are you going to give in the ICU for MRSA? For VRE? What are the side effects?

I finished my sandwich, drank my Ensure (chocolate), and cleared my mind. I prayed to God. I just wanted to pass. I didn't care if I got the lowest score in the country. I just wanted the test to be behind me and over with, so I could move on to the Oral Exam Boards. Really nice. I got out of my car, slammed the door shut with more confidence than I possessed, and walked into the room to finish the Exam.

And I'll never forget the day I opened the letter from the American Board of Anesthesiology. I passed! And I'm not going to tell you my score, because it doesn't matter. It doesn't matter at all. I passed and I was on my way to Baltimore for my next stop at Oral Exams, where they make you feel stupider than stupid.

I could put this behind me for the rest of my life.
All I could do was sink to the ground and cry and thank God.
It must've been a sight, but I didn't care.
I passed.

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