I must breathe for this patient

Mostly it is just terrifying.

I sat on the edge of the bed in my fleece pajamas and tried to describe the fear.

“I’m sure you’ll do great,” my husband tried to reassure me.

“But you don’t understand. Every time you induce general anesthesia, you’re basically almost killing someone. It’s … petrifying.”

“But everyone always said you were a great resident Felicity, you’re going to be a great attending too. I’m sure everything will be fine tomorrow.”

“But that’s the problem. I’m not sure everything will be fine tomorrow. I could easily kill someone tomorrow. Every day I could easily kill someone. I thought I loved this before – as a resident I loved the hard cases, the sick patients, but now it’s … it’s just petrifying.”

I have not killed anyone. I have not come close to killing anyone. I have not had any egregious errors or unexpected complications. I have a strong safety net of other anesthesiologists if I need it. But I am in a continuous state of pure fear.

I thought I loved this, the stress of the unknown, the pure challenge of the most complex physiology. I had no idea how different it would be once the ultimate responsibility rested with me.

There is always the one moment. I connect a patient, a live human whose family I have met and handed a box of tissues to, to the various monitors and give him oxygen to breathe. I cycle the blood pressure cuff and double-check my suction and move all of the airway equipment and all of the drugs into perfect position so that I can reach everything without more than rotating my ankle. I watch the expired oxygen concentration to make sure that the nitrogen in my patient’s lungs has been completely replaced by oxygen. And then, there comes this moment when I turn the stopcock and push the syringe. The medicine is white and it fills the IV tubing completely. When I am done I turn the stopcock again and flush it in completely with saline.

Now it is done. I have taken away the will to breathe. There is no going back now. I must breathe for this patient. It is usually quite easy but if I cannot mask ventilate him and I cannot intubate him then he can die. I have seen that only one time in three years but for now, in these days when I am just beginning that is all I can think of. Every time I turn the stopcock and say “Okay, you’ll feel a little burning in your arm but that’s just the medicine that puts you off to sleep. I’ll take good care of you and you’ll see your family soon,” I am petrified.

So I turn the stopcock. And always for a moment I pause.

Felicity Billings is an anesthesiologist who blogs at One Case at a Time.

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