The exam room seemed somewhat small for the medical equipment. A nurse’s workstation, a small vital sign monitor, and an oversized examination table. Two cheap, small plastic chairs lined the wall. It all seemed crammed. I kind of like what they’ve done to the place, I thought to myself, somewhere on this floor, maybe right here, I used to sleep in a call room.
I was on the fourth floor of the UCSF Mount Zion Medical Center, now renamed the UCSF Mt. Zion Cancer Center, accompanying a family member to an oncology appointment to help translate the medicalese to English. The science behind modern oncology, genetics, receptors and DNA mutations is beyond comprehension to many college graduate-level patients, straining even this middle-aged anesthesiologist’s mind. As “the doctor” in the family, translating is one of the things I do to help, as I’m sure many of you do as well.
The neighborhood seemed to be the same—still a bit rougher than the glass and polished chrome sprouting up everywhere across San Francisco. The old place had been remodeled, complete with a fancy meditation room and uniformed parking valet. I could see the bits and pieces of the old walls, some old paneling creeping out behind the wall ornaments, and of course the plastic chairs.
As we sat there waiting, beneath the upgraded façade, the memories of my old UCSF Mt. Zion teachers Jeffery Katz, Bill Shapiro, Thien Ng and my beloved advisor, Toni Magorian came flooding back. To those who remember them, I remain convinced that there is not a teaching anesthesiologist in the world that is better or more fun than that group.
They, and many others, taught me all the basics of the practice of anesthesia, such as starting IVs, intubating, airway management, and the mysteries of anesthesia pharmacology, but most importantly, they taught me what the practice of anesthesiology was about—the fun, somewhat loose culture rooted in the gravity and responsibility of patient care. Live it, breathe it, be it. Be an anesthesiologist and love it.
The Mt. Zion crew made being an anesthesiologist an engaging and attractive career to look forward to. This was in 1995, a low point for the entire specialty, including private practice and academic anesthesiology. The Wall Street Journal highlighted the crisis facing anesthesiology in a profile of Patrick Kwan, a young medical school graduate who crisscrossed California living in his car, picking up part time work anywhere he could. At that time, tighter health insurance payments for services were eliminating jobs in anesthesiology.
On the private practice side, anesthesia fees had been pushed to historic lows. No practices were hiring. It seemed as though large physician groups, hospitals, insurance companies, and policymakers were attempting to push physician anesthesiologists out the door in an effort to lower health care costs.
Academic anesthesia centers were suffering too. They were facing rapidly-declining rates of residents matching in anesthesia, because many had concerns about their future employment prospects. Several residents in my cohort withdrew from our entering anesthesia class at UCSF over these concerns. I had my own concerns as well—what did the future have in store for me and my career?
A few months into my year as a CA-1, I began having doubts about the direction of anesthesia and the entire field of medicine. In the waning days of my internship, I had interviewed for, and later had been offered, a position at a prestigious management-consulting firm based in San Francisco. A high-paying job and a shiny new waterfront condo, which was actually affordable at the time, but not on a paltry resident salary, beckoned. Was it time to switch?
Toni, my advisor and often attending anesthesiologist, would take me under her wing. We would have hours of conversations about anesthesia practice, the field of medicine, sailing (one of her passions), and life in general. My life as a poor anesthesia resident in San Francisco didn’t seem so bad.
She taught me so much about the practice and the culture of anesthesia, literally how to walk and talk in the OR, and how to maintain control of the operating room as an anesthesiologist. One of her greatest tricks she used to do as an attending was telling me to close my eyes. “Don’t worry, I’ll watch, “she would soothingly promise. “I just want you to feel the OR.”
Feel the OR I would. I would hear everything: the patient’s breathing on the ventilator, the audible pitch of pulse oximetry, all the beeps and chirps of our monitors, the rustling of the drapes, clanking of instruments, suctions, and the constant buzzing of the electrocautery. Most of all, I could feel the movements of others, from the surgeons to the tech to the circulating nurse. I could feel their steps and sense their motions. I still like to imagine the irritated surgeon with a smiling anesthesia resident closing his eyes.
“Your brain should always be linked to what’s going on in the room, you are the protector of the patient,” Toni would summarize at the end of the day. “That’s what a great anesthesiologist should do.” Toni Magorian was a great attending, my Yoda attending if you will.
I remember coming home after one of those close-your-eyes-feel-the-force days. They were personally transformative, the days where I became committed to be an anesthesiologist, to be an advocate of the practice of medicine, to forever be a protector of the patient.
I once asked her why she made such an effort. She told me I was worth it, that she could see me making a difference and a real contribution to patients and their care. It was just the kind of inspirational advice a young resident physician needs to hear.
Looking back, I’m convinced that if I had taken the consulting job, I’d be somewhere in management in the health insurance or hospital industry. Who knows, maybe I’d be working in opposition to the CSA. I would certainly be less connected to the patients I care for today.
Twenty years later, as I sat in the plastic chair in the new fancy UCSF Mt. Zion Medical Center, I nostalgically remembered Toni and the fun-loving attending gang that populated the OR back then. Toni would die years later from a tragic accident, leaving many of us without an opportunity to say how much she meant to us.
On National Teacher’s Day, I’d like to honor of all of my teachers, attending anesthesiologists at UCSF, Stanford and elsewhere. Perhaps you will as well. Let us reflect on their contributions to scholarship, research, and teaching.
I grew up to be a contributing physician anesthesiologist and advocate for patients, guided by the ideals that were taught and demonstrated to me in residency training. In short, I made something of myself. Thank you so much.
In one of Toni’s favorite expressions she might say “Groovy.”
Dr. Chow is a frequent contributor to CSA Online First. He completed residency training in anesthesiology from UCSF in 1998. Currently he is in private practice in San Jose with CEP Anesthesia and is on Advocacy Steering Committee for CEP America. He also holds an adjunct community faculty position at Stanford School of Medicine, and is the current Chair of the Hospital-Based Practice Forum for the California Medical Association.