Last week I walked past him sitting outside of the OR. It was morning, before all of the first start cases, but he had been there all night. I already knew this. Two back-to-back transplants overnight. He, a surgical fellow, me, a critical care anesthesiologist who was a surgical resident over a decade ago. I could see the circles under his eyes that seemed to take up over half of his face. The weariness in his gaze. I jokingly looked at him and asked if he was questioning his life choices. He chuckled and said yeah, should have done anesthesia. We both laughed. I made that change. He didn’t.
Now both of us are here with our own biases, our own experiences, and our pain. Me begging to be respected and honored for my work; him being respected and honored for the work he does but holding the world on his shoulders. The classic surgeon/anesthesiologist relationship. One I study both intentionally and inherently as a former surgeon “who fell from grace” according to my surgical mentor. I write, think, and study how we circle each other, waiting for the first to strike; how we hold each other at arms’ length refusing to allow the other to see our weaknesses. We are always ready to blame. Always ready to talk about the other. Joking or not, it’s so pervasive it’s the reality.
After a few moments, he admitted he had put himself in time-out because he was yelling at everyone. I told him that seemed like an emotionally mature thing to do and left him to sit alone. At that moment, I remembered my own times as a surgical resident when I was the worst version of myself. It’s part of the reason I quit. But that doesn’t mean he, or even I, at my worst, are all together in the wrong. Nor does it justify the anger and fatigue and stress, and toxicity that was taken out on others. We can both know we need to be better, while also knowing we are doing a job that only a rare few will ever accomplish. Many will say this is about hours, training spots, and residency/fellowship structure in general. Fine. But it doesn’t change the fact that there are specialties that only a select few will do, and there will never be enough of them to offset the burden of their lives. We are lucky they do what they do. And they are also lucky that we tolerate them even at their worst.
But we both must have demands of excellence and professionalism on the other side of the curtain. So often, as anesthesiologists, we feel like we are not afforded respect, the ability to have an opinion, or even to be a valued member of the operative team. One of the leading causes of burnout for anesthesiologists is a lack of control. We don’t control much of anything, and when we do try to step in and ask questions or even push back on things, we are seen as a problem or merely a hurdle between a surgeon and their case. So we get defensive, snarky, and honestly detached and unengaged. We become apathetic and dejected. And we stop caring because when we care, we are at risk of pain, and day after day, that pain leads to quitting.
All of this leads to the dance I referenced above, and I saw it firsthand later that morning last week. The anesthesia team stated that “he was yelling” at everyone in passing. I asked the person who was talking to me if they had ever worked as many hours as that fellow was working, or if they had ever held an organ in their hands that needed to be sewn into another living body or had endured real true earth-shaking fatigue. The answer to all of those questions was no because, of course, it was no. That is not what anesthesiology is known for in training, but we all know that some surgical subspecialties are built on these facets of training, and that is something they choose to do because they must.
We could either stand here and call this an impasse. Or we could use it to learn more about each other. Talk to each other across the drape. Ask what the problem is when people are yelling. Ask how we can help. Listen to the anesthesiologists’ concerns and questions. Give and take. Respect running back and forth. Anger will still flare. Feelings will still be hurt; but maybe, just maybe, we will be exactly what is needed in the OR when things are hard. Near impossible. Burdens others in medicine never experience. Let’s look at those dark circles and make ourselves understand the lived experience of the other. While also holding up a mirror to them so they can see that we are worthy of respect as professionals and partners.
Nicole M. King is an anesthesiologist and intensivist.