It’s easy to take for granted the precision with which modern medicine can manage and alleviate pain, whether you’re put under for surgery or in recovery. Anesthesiologists have a joke about that: anyone can put you to sleep, but it takes an anesthesiologist to wake you back up. To learn about the work an career of an anesthesiologist we spoke with Dr. David Maduram in New York. David’s studied at Harvard, Columbia, and the University of Illinois, and is now an attending anesthesiologist. Tell us about your current position, and how long you’ve been at it. My name is David Maduram, and I’m an anesthesiologist at White Plains Hospital in New York. This is my first year as a full-fledged attending anesthesiologist. At my job, I primarily administer anesthesia for patients undergoing general surgery and orthopedic surgery, but I also provide anesthesia for patients undergoing neurosurgery, pediatric surgery, plastic surgery, thoracic surgery and trauma surgery. In my role as an anesthesiologist, I also take care of patients in the post-operative care unit, emergency room, in the intensive care unit, and in the OB/GYN suites. Although most anesthesiologists enter practice immediately after residency, roughly a third of anesthesiologists complete additional fellowship training in specialty areas such as pain management, cardiac anesthesia, neuro-anesthesia, pediatric anesthesia, obstetric anesthesia, or critical care medicine. What drove you to choose your career path? Why anesthesiology? Growing up, I was inspired to go into anesthesiology by my aunt, who is an anesthesiologist as well. My aunt often serves as a medical missionary in rural India, and I was inspired at how she was able to relieve pain and bring comfort to individuals who had limited access to medicine. Later on during medical school, I felt at home in the operating room and loved the hands-on nature of the job, the intellectual challenges, the camaraderie with fellow team members, and most of all the ability to take care of patients before, during, and after their surgical procedures. How did you go about getting your job? What kind of education and experience did you need? It takes many years to become an anesthesiologist. At present, most anesthesiologists complete four years of undergraduate pre-medical studies, followed by four years of medical school, a year of general medical/surgical internship, three years of anesthesiology residency training, and possibly an additional year of subspecialty fellowship training. There are several high-stakes exams throughout these years of training, including the MCAT medical school admission test, the USMLE licensing exams, and the anesthesiology board exam. The training process to becoming a full-fledged anesthesiologist is rigorous. During my residency training at Harvard / Massachusetts General Hospital and pediatric anesthesia fellowship training at Columbia / New York Presbyterian Hospital, I typically worked between 60-80 hours per week. Most residents will spend at least one day a week working overnight at the hospital. Although there is not much time for sleep during residency and fellowship, one will definitely take care of many wonderful patients, study a great deal, and make great friends with colleagues. With regards to my current job, I actually first found about the position from one of my good friends from my residency. During the interview, I clicked well with the junior and senior members of the group, and soon after was offered a job! Every anesthesiology job is very different in terms of patient demographics, surgical case variety, and hospital responsibilities, and I feel lucky that I found a position where I fit in nicely! What kinds of things do you do beyond what most people see? What do you actually spend the majority of your time doing? Most patients see an anesthesiologist for a very brief time–right before they go to sleep, and right after they wake up. However, most of my time is spent taking care of patients in the interim, and making sure that they are safe and sound during the entire operative procedure. What misconceptions do people often have about your job? Anesthesiologists have a reputation in the medical field of being calm and composed, but underneath the surface, we work very hard to make sure that patients are well taken care of. Although medicine has become much safer in the last fifty years, people often underestimate just how fragile the human body is. If an anesthesiologist is unable to place a breathing tube properly, a patient can develop ischemic brain injury within minutes. If an anesthesiologist incorrectly doses a local anesthetic for an epidural, they can cause cardiac collapse within seconds. And if an anesthesiologist fails to be vigilant during an aortic aneurysm case, a patient can bleed out in the time it takes to cross an operating room floor. Residency training for physician anesthesiologists is rigorous because it gives trainees the didactic knowledge to identify warning signs of danger, the procedural knowledge of how to address these signs, and the judgment to know when to intervene. When things go south in surgery, there is rarely time to look things up in a textbook—you need to know exactly how the body works, how the body will respond to a certain therapeutic maneuver, and be ready to take the proper action instantly. What are your average work hours? My typical morning starts at 6AM and ends at around 5PM. I do a 24-hour shift in the hospital 2-3 times a month. What personal tips and shortcuts have made your job easier? The most important thing in anesthesiology is to stay organized! In his book Kitchen Confidential, Anthony Bourdain describes a concept of ‘mise en place’, where he organizes his kitchen workplace exactly the way he likes it before starting his shift. At Harvard, I had a senior instructor who would dump my entire anesthesia workspace to the ground if it wasn’t impeccable, and I soon took that lesson to heart. When time is of the essence, it’s important to know where your life-saving tools and drugs are. What do you do differently from your coworkers or peers in the same profession? What do they do instead? I think that the best anesthesiologists are those that are always thinking three steps ahead. Being aware of exactly what the surgeon is doing and deliberately averting adverse events before they happen is a skill that takes years to develop but has a huge impact on patient care. What’s the worst part of the job and how do you deal with it? As with most medical professions, one spends quite a lot of time at the hospital. My wife and I have a daughter on the way, and it is hard to know that on some holidays I’ll be in the hospital instead of home with my family. Tools such as Skype and Facetime have made things a little easier, but it’s definitely rough to miss seeing family and friends while working long hours. What’s the most enjoyable part of the job? The best part of being an anesthesiologist is definitely the amazing patients! It is easy to forget what a privilege it is to take care of a patient through a stressful time in their life. It’s amazing to see how something as simple as an epidural can help a pregnant patient get through labor a little bit easier. It’s nice to walk home and know that people depend on you and that you are helping them! Do you have any advice for people who need to enlist your services? Anesthesiologists perform a wide variety of services, so it’s hard to pigeonhole the people who are seeking our services. Since most patients interact with anesthesiologists prior to a surgical operation, I’ll start there. The more an anesthesiologist knows about you, the better—having a list of your medications, allergies, prior surgical procedures, and prior anesthetic records will help your anesthesiologist design a plan that is perfect for you. Many hospitals allow patients to meet their anesthesia team in a preoperative clinic prior to their operations; this can help your anesthesiologist make sure that everything is optimized before the operation. During this meeting, your anesthesiologist can draw preoperative labs, order further tests if necessary, answer questions, and hopefully calm your nerves before the day of the procedure. What kind of money can one expect to make at your job? Our pay scale is publicly available, and can be found through an internet search. It’s worth noting that pay varies significantly based on fellowship training, private/academic practice setting, geographical location, and years in practice. It’s also important to note that most physicians have substantial malpractice premiums, medical school loans, and continuing education fees that affect the bottom line. How do you “move up” in your field? After several years in practice, many anesthesiologists take more responsibilities in their respective hospital to make sure that patient care runs smoothly. Anesthesiologists who are skilled in administration typically coordinate the ‘flow’ of patients in the operating room. Other anesthesiologists can assume leadership positions in the intensive care unit and pain management clinics. What do people under/over value about what you do? People often take anesthesia for granted. A popular saying notes that anyone can put someone to sleep—it takes an anesthesiologist to wake them back up! What advice would you give to those aspiring to join your profession? There are a variety of resources to help those that are interested in anesthesiology, including the American Board of Anesthesiology Career Center. However, the most important thing you can do is to volunteer or work at a hospital to receive first-hand experience working with patients and anesthesiologists. Empathy is also a prerequisite. Although one can be taught the scientific principles behind anesthesiology and learn how to do the many procedures required, it’s important to always keep in mind that it is a privilege to serve patients and help those who are in need.