“Just started,” an attending anesthesiologist welcomed me into the OR. Everything was new to me – the dim lights, blue gowns, beeping of the pulse ox machine. I opened my mouth to introduce myself when it happened.

The surgeon unleashed some choice words.

Was it something I did? Couldn’t be. But why was he shouting in our direction?

I peeked over the drapes and realized I wasn’t the intended recipient of his vitriol. And for the matter, neither was the anesthesiologist. Turns out the World Cup game “just started” and the United States team conceded an early goal. Who knew he was such a soccer fan?

Just as soccer is the world’s game, the relationship between the surgeon and anesthesiologist is just as classic. Even though my observations have been at academic centers and VA institutions on the west coast, maybe you’ve seen similar cases.

“Peter, what do you see?”

Star struck I couldn’t believe it.  The same guy I read about in the university newsletter on my phone earlier just walked into the room. He was highly recruited and a coveted asset – friendly with staff, published meaningful research, and accomplished being one of the top surgeons for this type of surgery. Something like one surgery a day!

We ran into some unforeseen circumstances. While trying to evaluate one of the valves he couldn’t get an accurate read. “Peter, what do you see?” Little did I know I was standing by the anesthesiologist who was also recruited and worked with him for more years than I’ve spent walking.

In that moment it really sank in – what a trust they had built. I’ve even seen this happen even with surgeons and anesthesiologist who have worked together for far less time. When surgeons are simply assigned an anesthesiologist without input and then get upset, I totally get it.

“Bring a pen and piece of paper”

Sensing a lull in the action after induction on my anesthesiology elective, I asked my resident to use the bathroom. Hurrying back trying to swallow the all too dry energy bar my phone buzzed in my shirt pocket. “Bring a pen and piece of paper” my resident texted me. I had no clue why I would need a piece of paper in the OR.

Turns out, that was how we communicated the next two hours. The surgeon had a policy – no music, no talking. At first it perplexed me. But once the case was done the resident kindly explained it to me.  While a casual observer could try to make the surgeon out to be demanding and controlling in reality it was mostly because of another thing altogether.

The surgeon really cared about the patient.

Turns out they had some bad outcomes lately. She wanted to make the environment as safe as possible in the best way she knew how.

My anesthesiology resident was happy to oblige. He knew what was important and what didn’t need to be quibbled about. She didn’t tell us what anesthetic to use, pester us to go faster, or change overall anesthetic management. If we needed to speak up in regards to patient care we could freely do so. And besides, I appreciate her being upfront about her own idiosyncrasies which helped facilitate communication.

The strawman argument personifies a bad surgeon as one that could have more tact, deliver words in a less personal way, and be less narrowly focused. And on the flip side a bad anesthesiologist wouldn’t have to order every pre-op test, cancel cases because the patient isn’t fully optimized (or took a bite of food), and not be so passive aggressive.  It is easy to stereotype and in reality we must acknowledge there are all kinds of surgeons and all kinds of anesthesiologists. The good ones that do actually exist and I’ve seen understand that on the other side of the curtain is usually someone who shares the same goal-  to have the best patient’s interest in mind.

“Little delayed coming up”

A neurosurgery resident, anesthesiology resident, and me are in the hallway. This isn’t a joke but hopefully will make you smile. We’re transporting a patient up to the ICU after a successful uncomplicated surgery. As we’re turning the corner the bed gets locked on the door. My instincts tell me to pull the bed back but it doesn’t budge. The neurosurgery resident’s attempt to push the bed to the side clearly doesn’t work. The anesthesiology resident reaches his arm out to prevent the door from swinging back.

Turns out we all have to count to three, move an incredibly heavy bed, and then answer truthfully why we were a ‘little delayed coming up.’

Silly as that moment may be it left an impression on me about the fact you already know – anesthesiology and surgery really need one another. It is not always easy – critical moments, highly trained individuals – sometimes it’s on the surgeon, other times it’s on the anesthesiologist (and sometimes there is a door in the way). We work together. We depend on one another. And when done properly the patient benefits, and we do, too.

What are your thoughts about the surgeon anesthesiologist relationship?

These experiences represent what the author observed as a medical student, not as an anesthesiology resident physician.


Daniel Orlovich, MD, PharmD, is a resident physician. He has written for the KevinMD, American Society of Anesthesiology, California Society of Anesthesiology, Anesthesia Patient Safety Foundation and Anesthesiology News.