…It’s Friday afternoon and I am at home and thoroughly bushed.  I’ve had a Coke and a cup of ultra-strong coffee (Peet’s Major Dickason blend–amazingly flavorful), done 20 minutes of hypnosis (Tom Nicoli tape), and taken a nap, and I am barely beginning to feel human again (after a short but intense morning of ENT (ear nose throat) cases at work).  Yesterday was crazy.  I was “in charge” for anesthesia.  By the end of the day I was reminded of the difference between an anesthesiologist and a nurse anesthetist.  Want to hear it?

First let me say that this is not a diss on CRNAs (certified registered nurse anesthetists)–I have the utmost regard for them after many years of working with them.  They work hard, are very committed to patient care, and tend to practice more conservatively than MDs, which is usually good.  Many years ago a CRNA friend of mind told me a semi-joke:  Question: “What’s the difference between an anesthesiologist and a CRNA?” Answer:  (spoken by a CRNA)  “When Barbra Streisand comes into the operating room with a hot appendix, YOU get to intubate her.” (Intubation is where a plastic breathing tube is placed between the vocal cords, and must be done carefully to avoid damaging them.)

While I would agree with that witticism, there is a second difference.  An anesthesiologist has to cancel cases, which is an exhausting medical and political process.  (“Cancel” is shorthand for postponing cases or rescheduling them to a hospital rather than an ambulatory surgicenter.) Following the rule “First, do no harm”, i.e. protecting the patient against the system, is often very hard to do.