- Anesthesiologists have been called to the front lines in the COVID-19 pandemic.
- One of their chief tasks is the intubation of a patient who needs to go on a ventilator, a delicate process that exposes an anesthesiologist to potential infection.
- Anesthesiologists say there’s also an emotional component they fill, because the families of COVID-19 patients aren’t allowed to visit.
- Anesthesiologist organizations are reaching out to members with programs to help with mental health issues.
Six months ago, you might have heard the job title and thought, “They put people to sleep for surgeries, right?”
Today, mention an anesthesiologist and the response might be immediate: “Hero.”
Anesthesiologists have been called to the front lines of the war on COVID-19 for a simple yet vital and dangerous job.
They operate ventilators, one of the top weapons in fighting severe cases of this new coronavirus.
They’ve accepted this frontline assignment with a shortage of equipment and at risk to their own health.
The world is starting to notice.
“We are the people who can stay calm in the middle of stress, think on our feet, and be creative,” Dr. Mary Dale Peterson, MSHCA, FACHE, FASA, president of the American Society of Anesthesiologists, told Healthline. “Most patients don’t realize this (and we downplay it in a way so as not to scare them), but we are the people who get them through (anesthesia during surgery), one of the greatest stresses a body can face.”
Their job goes beyond the complicated and ever-evolving world of pain medication, nerve blocks, and general anesthesia.
“In the [operating room] we have to be the diabetes specialist, the asthma specialist, the heart disease specialist, and more,” Peterson said.
That kind of training, she adds, means anesthesiologists “can be called into play whenever there’s a need.”
During the COVID-19 pandemic, anesthesiologists are facing long hours, additional training, the fear of bringing sickness home to their families, and the emotional toll of being the compassionate bedside friend to seriously ill people whose family members can’t visit them.
“This definitely has been a different experience,” said Dr. Sasha Shillcutt, MS, FASE, a cardiac anesthesiologist and a professor in the department of anesthesiology at the University of Nebraska Medical Center. “There is a level of high alert, from the moment we exit our own vehicles, that we’ve never experienced before.”
Shillcutt told Healthline that the natural inclination for an anesthesiologist is to rush toward the need.
Now, she says, they must stop, don their personal protective equipment, assess the situation from a personal health angle, and then charge ahead.
“I’ve never walked into a hospital thinking that I may get sick before,” Shillcutt said.
Now that has become paramount.
“There is a feeling of, if you get sick you’ve done something wrong. You’re letting everyone down,” she said.
Shillcutt, who created a program called Brave Enough, says she realizes that to the public, the act of intubating a patient is what draws the “hero” moniker.
Intubation is a key part of what anesthesiologists do and why they are crucial in this fight.
When a person can no longer survive breathing on their own, the anesthesiologist is called on to intubate them.
Intubation is the process of inserting a tube, called an endotracheal tube, through the mouth and then into the airway.
This is done so a patient can be placed on a ventilator to assist with breathing during anesthesia, sedation, or severe illness.
The tube is then connected to a ventilator, which pushes air into the lungs to deliver breaths.
It is, in the case of treating a patient with COVID-19, the moment a care provider is at the highest risk of exposure.
That’s true, Shillcutt says, but the challenge anesthesiologists face here isn’t just about that.
“There is the emotional responsibility, too,” she said.
In some cases, the anesthesiologist may be the last person a COVID-19 patient speaks with or sees.
“We have to be present for them, and it can be a lot,” Shillcutt said.
Shillcutt says anesthesiologists are taking steps to help one another with this burden.
Buddy systems, checking in on one another (her 11,000 group members do mental health check-ins twice a day), and just being aware of one another is working, she says.
“I’ve never seen such support among physicians,” she said. “I could cry now just thinking about it.”
At Michigan Medicine, Dr. Danielle Faysal Saab has been on the front line as an anesthesiologist since the start.
It has been mentally and physically exhausting, but what she sees happening on that front line makes her proud of her career choice.
“Our department has mobilized and adapted so quickly to this pandemic. I’ve never been more proud to be a part of University of Michigan,” Saab told Healthline.
“From the top down, so many have mobilized into roles they are not usually in,” she said. “Leaders are making their presence known. They could be up in their comfortable offices, but they’re here on the front line, too. It means a lot.”
For her, the strangeness of having to stop and protect herself first before getting to a patient in need is difficult but necessary. And in the ICU, the weight of knowing patients are separated from loved ones is intense.
“It’s hard to watch patients go through this without family by their side,” Saab said. “We do our best to help them and show them we care. It’s a lot.”
“Overall,” she said, “I think what we all feel is exhaustion. This entire disease process is exhausting. We try to disconnect when we get home, but this is a disease that follows you.”
With two small children at home and a husband who is a doctor, it can be emotionally draining.
When the American Society of Anesthesiologists recently offered a new COVID-19 program on its website, the site temporarily crashed when an overwhelming number of members tried to access it.
“That’s us,” Saab said. “Most of us never came to this for the recognition. It’s a bit of a thankless job. But now I think people are realizing how integral we are to the healthcare process. That’s pretty amazing to see.”
Dr. Jeremy Dennis, an assistant professor of clinical anesthesiology at Yale New Haven Hospital in Connecticut, had just passed his anesthesiology board exams late last year and was settling into professional life.
He had chosen his career because of its demand for knowledge in a wide area. He says he thought it would “never let me get bored.”
A few months later, Dennis was called upon to run the COVID-19 ICU at Yale.
While the quick transition was challenging, he told Healthline it also cemented his confidence in his career choice.
“It made me realize right away how versatile and unique anesthesiologists are,” he told Healthline. “We are uniquely trained and can step into roles and give coverage in any department. I’m proud of myself. I didn’t realize just how much I had learned and how much I have to learn.”
For him, the “end of life issues” are what has been most challenging.
“End of care, life goals, family discussions: It certainly has been emotional,” Dennis said. “It certainly takes a toll on you. While I might not choose [to go through this], it certainly is making me a better doctor.”
Peterson says her group and many others are keeping mental health in top-line discussions.
Her association sends out a weekly newsletter that offers support.
“The emotional stress is intense,” she said. “A lot of our members talk about the fact that you may be the last person (the patient) sees in their life. That’s a weight on you.”
It’s encouraging, she says, that the world is recognizing their efforts.
“I think it is awesome and amazing how everyone has stepped up,” Peterson said. “This is shining a light on the value of the anesthesiologist and that we’re here no matter what. I’m very proud of that.”
“We are kind of like the Secret Service of the OR,” she said. “No one knows we are there, and now here we are on the cover of Time magazine. I’m so proud of my profession.”
“I always felt like we were the forgotten doctors,” Dennis added. “Now? It’s always nice to be thanked and appreciated. But we’re not power hungry or after fame. We just want to keep people well.”
“I am so proud to be an anesthesiologist,” Saab said. “And if no one comes back to me to thank me? That’s good. It means they’ve moved on with their life. Life: That’s our reward.”
Photo: Dr. Sasha Shillcutt, a cardiac anesthesiologist, says she and her fellow anesthesiologists are on a “level of high alert” throughout their hospital shifts. Image via Sasha Shillcutt
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