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The Real Poop

Zzzzzzzzzzzzz.

This career unit is brought to you by Nyquil.

You're the type who loves humanity, but it's the people who are, well, hard to deal with. And you want to help humanity by being a doctor, but your bedside manner is the kiss of death. But there is hope for all you introverts. You can shine in anesthesiology.

As an anesthesiologist, your goal is to help your patients skip out on feeling pain. Usually, this means putting them to sleep, knocking them out—with chemicals. Since your patients will be insensate, you hope, most of the time, you won't have to spend much time at all polishing your conversational skills. And you like that just fine.

Whoa! We're talking extremes and stereotypes here. Here's the real deal.

Anesthesiologists go way beyond fulfilling a patient's request, "Just put me out, doc." Since everyone gets sick at some point, anesthesiologists, like primary care docs, work with patients of all sizes, shapes and colors and at every stage of life. So they can understand how patients will react to painkilling drugs, they must have a working knowledge of medical specialties, such as cardiology and pediatrics, and tailor the drugs accordingly. And they have to be able to talk to the patients and the other members of the medical team about what the heck they are doing.

So, introverts, the days of hiding behind a medical chart are over—if they ever existed in the first place.

This pain-obliterating specialty has been around for as long as mankind has been hurting. Long before the wonder drugs of today that seem to work in nanoseconds, there was booze, opium, speed (not the meth kind, we're talking about being quick with the scalpel) and hypnotism. And legend has it (that is, The Flintstones, a carton set in a fictional prehistoric suburbia) that prehistoric humans bopped each other on the heads with clubs to knock the person out so he wouldn't feel the pain of a horror like a tooth extraction.

Seriously, folks, there were the real problems with these pre-drug methods. Hypnotism didn't work well. Liquor and opium only dulled the senses of the surgical victim, who could still feel excruciating pain, albeit through an alcoholic or morphine fog. And speed, well, think about it. Thirty seconds of sawing off a gangrenous foot would seem like a hellish eternity of pain to a patient who usually had lapsed into a state of shock. Prolonged pain was not only excruciating, it also killed. Many a patient probably said something to the effect of: "Later for this. Let's slip this mortal coil," and died.

Everything changed in the mid-19th century with the discovery of ether's pain-busting properties. In Boston in the 1840s, a doctor (a Dr. Morton, to be precise) removed a tumor from the neck of a man unconscious and etherized upon an operating table. No pain, and no tumor. And the rest, it's said, is history. Chloroform and nitrous oxide (also called laughing gas) joined ether as painkillers, and their use spread throughout the modern world. There were naysayers who opposed this new balm, saying that almighty God intended that humans, especially women in childbirth, should suffer pain, but they were quickly silenced as the popularity of painkillers spread. Even Queen Victoria asked for chloroform during the birth of a son in 1853. Ether and its comrades were up and running.

Medicine has moved from beyond either. The modern drug arsenal includes Ethrane, halothane, Forane, Penthrane, Pentothal, Brevital Sodium, Surital, Valium, Sublimaze, Inapsine and Inovar—all of which are poisons and potentially lethal if given in excessive dosages. Modern drugs do have side effects, like nausea and vomiting, but they also can do things ether and chloroform never could do—wipe out pain and all memory of the surgery itself (popular amnesia-inducing drugs include Valium and Ativan).

It's also come a long way from the fleet-of-hand surgeon wielding a saw for quick and not-too-clean amputations. Now, if you pay attention to what the society of anesthesiologists says, as of a couple of years ago, the chance of dying from anesthesia is between 1 and 10 per 1 million (50 years ago, the chance of dying in surgery from anesthesia was 1 in 1,500). About 40 million anesthetics are given each year in the U.S., and 90 percent of these anesthetics are administered by anesthesiologists.

Anesthesiologists have a big toolbox of stuff to deep-six your pain. In general, there are three kinds of anesthesia: general, regional, and monitored. Typically used for major operations, general anesthesia puts the patient to sleep for the entire operation. The anesthesiologist usually administers it intravenously as a liquid or by inhalation as a gas. Regional anesthesia blocks sensation, and thus pain, on part of the body, and usually the patient is not asleep. Think epidural and childbirth. Many women appreciate the charms of the regional approach. Finally, there's the monitored kind, or MAC, which is local and induces moderate or deep sedation. MAC is good for things like cataract operations, where you can see the approach of the surgical instrument, but you and your body don't give a hoot. Of course, when the drugs wear off, the pain is still there. Ouch.

Remember, these drugs don't really banish the pain. They eliminate your ability to feel the pain that is still there throbbing away. Local anesthetics work by blocking nerve impulses to pain centers in the nervous system. No nerves, no pain. General anesthesia is a bit trickier, and its exact mechanism is still mysterious, even though these drugs have been kicking around for more than 150 years. Basically, nerve transmission is reduced, which makes the patient lose awareness and sensitivity to pain.

So what type of person goes into anesthesiology? Ideally, you're a person who loves science and discovering how the body works, and you truly, madly, deeply care about people and their pain, and dream of ways to help them. And you get a kick out of playing around with chemicals.

If you follow through with this dream of banishing pain from the lives of patients, brace yourself for spending the bulk of your young life in school, training to be an anesthesiologist. Undergrad, of course, is a must, followed by medical school. After that, it's at least four more years of advanced training, where you'll learn how to administer, manage and/or manipulate an arsenal of pain-killing drugs, be they gases, intravenous agents or injectables. If you go into a sub-specialty, add another year to your education, during which you'll be steeped in critical care medicine (alleviating pain for the injured and sick), hospice and palliative care (for terminal illnesses) or pain medicine (think bad backs and cancer pain).













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