You’ve found The Anesthesia Consultant website, so you have some interest in anesthesia. Perhaps you’ve heard that anesthesiologists earn a comfortable living. Per wikiprofessionals.org: “According to figures from the U.S. Department of Labor, the lowest 10% of anesthesiologists earn under $135,110 per year, whereas the top 10% earn up to $408,000 per year. The median annual earnings, defined as that figure where half the experienced anesthesiologists earn less than that amount and half earn more, is $292,000. Anesthesiologists’ salaries are among the highest of all U.S. professions.”
Perhaps you’re wondering if anesthesiology is a potential vocation for you, your child, your cousin, or your niece. The truth is: a career in anesthesia involves unique demands that most people would not seek, tolerate, or ever grow accustomed to.
Nonetheless, I believe no medical specialty is more fascinating than anesthesiology. Based on thirty years as an anesthesiologist, here’s my checklist of ten qualities necessary to succeed in this profession.
You must have:
- Calmness under intense pressure. I’ve experience countless emergency moments where patients dropped their heart rate or blood pressure dangerously low, increased their heart rate or blood pressure dangerously high, hemorrhaged from an artery, lost their airway, or in some other unexpected way sustained a life-threatening event. An anesthesiologist must remain focused and decisive at these moments. An anesthesiologist must choose the correct diagnostic and therapeutic moves to save the patient’s life. An operating room emergency is not a time for screaming, temper tantrums, or freezing. An operating room emergency is a time for calm, assertive action.
- Vigilance during long periods of quasi-boredom. In between those emergency occurrences, an anesthesiologist must remain attentive without becoming bored or distracted. The motto of the American Society of Anesthesiologists is one word: Vigilance. During surgery, much of our job is to observe. One day I brought my 15-year-old son into the operating room with me to observe surgery, hoping he would respect the complex nature of my job. Instead his impression afterward was, “Dad, most of the time you don’t really do much of anything. You watch monitor screens, talk to the surgeon and the nurses, and listen to music.” One of my partners overheard this analysis and remarked, “If you see an anesthesiologist working hard, then you’ve really got a problem!”
- Superior skills with your hands. There are no tests during college pre-med classes or medical school clerkships to quantify an individual’s fine motor skills. Many doctors with superior manual dexterity migrate toward operative specialties like surgery or anesthesia. But not all anesthesiologists are equal. Some resident anesthesia doctors are less skillful than others at various anesthesia procedures such as placing breathing tubes into windpipes, inserting catheters into veins and arteries, injecting nerve blocks near peripheral nerves, or injecting spinals and epidurals into the lumbar spine. Residents have dropped out of our specialty altogether because they were not confident with the required procedural skills.
- The patience and motivation to persist through 25-27 years of training. In the song Subterranean Homesick Blues, Bob Dylan wrote, “Twenty years of schooling and they put you on the day shift.” In anesthesiology, twenty years of schooling earns you both the dayshift and the night shift. Your education will consist of thirteen years through high school, four years of college, four years of medical school, one year of internship, three years of anesthesia residency, and probably an extra one or two years of fellowship specialization. This cascade of years stretches your education past the age of thirty. You must to be accepting of delayed gratification. During the last of those twenty-five years, when you owe $250,000 in educational debt and are roaming hospital hallways at three a.m., your college classmates who chose business careers are at home sleeping in a house they’ve already purchased.
- A tolerance for sleeplessness. You must have the ability to thrive during early mornings and late nights. Scheduled surgeries start early in the morning, usually at 0730. Prior to that hour, anesthesiologists meet, evaluate, and obtain consent from their first patient, and then bring the patient to the operating room and safely render them unconscious. Not all cases start at sunrise—surgical patients get sick around the clock. Emergency surgeries may start at midnight or three o’clock in the morning. Anesthesiologists must be tolerant of fatigue and still be able to work unimpaired.
- Compulsive attention to detail. All aspects of anesthesia care, including a) the review of a patient’s medical condition prior to surgery, b) the planning and conduct of the anesthetic, and the management of medical conditions and c) complications immediately after surgery, require the anesthesiologist to avoid mistakes of any kind and to strive for near-perfection. Psychiatrists often diagnose OCD (obsessive-compulsive disorder) in patients. It’s probable that most anesthesiologists have a least a touch of OCD.
- Thick skin. You cannot be too hard on yourself, even though anesthesiologists are not allowed to have a bad day. A bad day in this career could mean a dead patient, a comatose patient, or a patient who was supposed to be discharged home instead lying in an intensive care unit on a ventilator. You’re human, and you may make a mistake. That mistake may have no consequence or it may cost a patient dearly. If a patient suffers a bad outcome secondary to a mistake you make, you’ll have to endure the emotional toll. There are stories of anesthesiologists who quit the specialty, become addicts, or commit suicide because a patient suffered a bad outcome. You can’t succumb.
- Excellent communication skills. You must be someone who can sell yourself to a patient in ten minutes. Anesthesiologists typically have ten minutes before surgery to interview a patient, examine them, obtain their consent, and gain their trust. The patient will be anxious. You need to assess and manage both their medical and their emotional needs at this demanding moment. An anesthesiologist’s patients are unconscious most of the time, but not all the time. If you want a medical career with zero awake hours of patient contact, consider pathology instead of anesthesiology. A successful anesthesiologist must also cooperate with different teams of surgeons, nurses, and medical techs every day. Surgeon personalities come in all varieties—some are demanding, some are condescending, and some are bullies. You have to work effectively with all types of surgeons, whether you admire that individual’s personality or not.
- Intelligence. Admission to anesthesia residency positions is very competitive. In 2014 there were only 1,049 anesthesia PG-1 (Post-Graduate Year 1) residency positions in the United States and 1,836 individuals who applied for these positions. Nearly 50% of applicants—all of them medical school seniors or medical school graduates—failed to land a position in anesthesia. (Ref: Results and Data, National Resident Matching Program 2014 http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf)
- A love for helping people. Every physician must have this. We spend years memorizing facts about physiology, disease, and pharmacology, but a successful doctor must care about each patient as an individual. Empathy for patients before, during, and after the day of their surgery and anesthesia is essential.
These are ten qualities I look for in an outstanding anesthesiologist. The next time you need surgery, I’d advise you to look for and expect the same qualities in the man or woman who will anesthetize you.
Introducing …, THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a legal mystery. Publication date September 9, 2014 by Pegasus Books.
On October 2, 2014 THE DOCTOR AND MR. DYLAN became the world’s #1 bestselling anesthesia Kindle book on Amazon.com.
The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book image below:
In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.
Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.
Nuanced characterization and crafty details help this debut soar.
Bang-Up Debut Novel, November 16, 2014
By Norm Goldman “Publisher & Editor of Bookpleasures”
This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.
This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.
TwinCities.com PIONEER PRESS Entertainment
by Mary Ann Grossman, Entertainment Editor, St. Paul Pioneer Press firstname.lastname@example.org, January 4, 2015
“The Doctor & Mr. Dylan” by Rick Novak (Pegasus Books, $17.50)
Dr. Nico Antone doesn’t hide the fact he hates his wife, but he says he didn’t kill her during an operation. The authorities think otherwise and his trial is the riveting suspense in this novel that is part medical thriller, part legal thriller, part exploration of family relationships.
Nico is an anesthesiologist (as is the author) who leaves his wife, their plush life in California and his job at Stanford to move to his hometown of Hibbing so their son, Johnny, has a better chance of getting into a prestigious college. Johnny hates the idea of moving to a small, cold town, but he’s popular from the first day in school. Nico doesn’t do so well. He’s envied by Bobby, an anesthetist who’s jealous of the better-educated Nico. But it’s hard to take Bobby seriously, since he thinks he’s the young Bob Dylan and lives in the house where Bobby Zimmerman grew up. To complicate matters, Nico is attracted to the mother of the young woman his son is dating. When the two teens get in trouble, Nico’s furious, rich wife comes to Minnesota and needs an emergency operation that puts her on Nico’s operating table.
Novak grew up in Hibbing, where he worked in the iron ore mines and played on the U.S. Junior Men’s Curling championship teams of 1974 and ’75. After graduating from Carleton College, he earned a medical degree at the University of Chicago and spent 30-plus years at Stanford Hospital, where he was an associate professor of anesthesia and Deputy Chief of the Anesthesia Department. His courtroom scenes are based on his experiences as an expert witness.
The Physician’s Late-Night Reading List
Two Pritzker alums pen captivating tales
By Brooke E. O’Neill, University of Chicago Pritzker School of Medicine, editir, Medicine on the Midway Magazine
For most physicians, writing — patient notes, case histories, perhaps journal articles — is part of the job. But for anesthesiologist-novelist Rick Novak, MD’80, and neurosurgeon-memoirist Moris Senegor, MD’82, it’s a second career that consumes early morning hours long before they step into the OR.
Fans of John Grisham will find a kindred spirit in Novak, whose fast-paced medical thriller, The Doctor & Mr. Dylan (Pegasus Books, 2014), transports readers to rural Northern Minnesota, where an accomplished physician and a deranged anesthetist who thinks he’s rock legend Bob Dylan see their worlds collide in the most unexpected ways.
Delivering real-life twists and turns — and a love letter to the Bay Area — is Senegor’s Dogmeat: A Memoir of Love and Neurosurgery in San Francisco (Xlibris, 2014), a coming-of-age tale chronicling the author’s away rotation with renowned neurosurgeon Charles Wilson, MD, at the University of California, San Francisco. Brutally honest, it spares no details of a time Senegor, who also served as a resident under the University of Chicago’s famed neurosurgery chair Sean Mullan, MD, describes as “one of the biggest failures of my life.”
One a vividly imagined nail-biter, the other an intimate peek into the surgical suite, both books deliver an ample dose of intensity and drama.
The Doctor and Mr. Dylan (Pegasus Books, 2014) by Rick Novak, MD’80
“I thought it was a novel way of killing someone,” said Rick Novak, deputy chief of anesthesiology at Stanford University, describing the imagined hospital death that was the genesis of his dark thriller The Doctor & Mr. Dylan. A huge Bob Dylan fan — the rock icon was born in Novak’s hometown of Hibbing, Minnesota, where the story takes place — he then dreamed up a possible culprit: a psychotic anesthetist who thinks he’s Dylan.
From there, the words flowed. “I would write whenever I was with my laptop and had a free moment: in mornings, in evenings, in gaps between cases,” said Novak, who also blogs about anesthesia topics. “I don’t sleep much.”
After finishing the manuscript — one year to write, another to edit — came the challenge of finding a publisher. “In anesthesia, I’m an expert,” Novak said. “In the literary world, I’m an unknown.” After 207 responses of “no, thanks” or no answer at all, he landed an agent. Two months later, she informed him that Pegasus Books had bought his debut novel.
“I started crying,” Novak admits. “I have a third grader and at the time the big word the class was learning was ‘perseverance.’ That was it exactly.”
Dr. Joseph Andresen, Editor, Santa Clara County Medical Association Medical Bulletin, from the January/February 2015 issue:
BOOK REVIEW “THE DOCTOR AND MR. DYLAN”
This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel The Doctor and Mr. Dylan. Rick and I go way back. It was my first week of residency at Stanford when we first met. A newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely.
Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was new to me as I sat down and opened the first page of The Doctor and Mr. Dylan. I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words. “life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of and free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys.
Rick, I can’t wait for your next book. Bravo!
Hibbingite writes twisted medical tale
HIBBING — Readers who are looking for a whodunit that will keep them up all night are in for a treat.
Hibbing native Rick Novak recently released his first book “The Doctor and Mr. Dylan,” a fiction set in Hibbing that merges anesthesia complications, a tumultuous marriage and the legend of Bob Dylan.
“The dialogue is sometimes funny, and there are lots of plot twists,” he said.
Novak said the book will not only entertain readers, but teach them about anesthesiology, Dylanology, the stressful race for elite college admission, and life on the Iron Range.
“The book is very conversational and streamlined,” he said. “I try to write as one would tell a story out loud.”
Novak said “The Doctor and Mr. Dylan” took him three years to perfect. He is currently working on his second book.
This review is from: The Doctor and Mr. Dylan (Kindle Edition)
Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.
Learn more about Rick Novak’s fiction writing at rick novak.com by clicking on the picture below: