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Wednesday, August 17, 2016

She's used to making individuals unconscious. What's better, she does it for a living! Dr. Saloni Paranjape, Attending Consultant, Dept. of Anaesthesia, Fortis Flight Lt. Rajan Dhall Hospital speaks to Monarose Sheila Pereira about the relatively less-known aspects of being an anaesthesiologist

On Education
I did my MBBS and DNB in Anaesthesiology. I work at the Fortis Flight Lt. Rajan Dhall Hospital, New Delhi. After completing the four-and-a half year MBBS course, internship is the time a medical student realises what the profession is all about. Dealing with patients and their families is very different from textbook description and diagrams. It is also the time to work short stints in various specialties and decide what you like best to specialise in. Being undecided between being a physician or a surgeon, I chose to become an anaesthesiologist, a peri-operative physician working closely with different surgical specialties.

I like the idea of being able to relieve the patient of all pain during surgery, render them senseless while a surgeon operates and to help the patient awaken at the end of the procedure to complete consciousness. It is a new patient each time even if it is the same surgery. The pre-existing medical conditions the patient has, or the surgical difficulties are different each time so it is never monotonous. The challenge of understanding the requirements of an unconscious patient, through various monitors and treating the patient appropriately keeps you on your toes all day.

On Training
The three year Post-graduate (MD/DNB) training period is very hard work. Every third day would be a 24 hour schedule, followed by the next working day, which meant working for 30-32 hours! Of course it is exciting to learn the trade and every patient would teach you something new, way more than any textbook or article can ever teach. Learning how to put a tube in the windpipe, introducing catheters into arteries and veins, injecting local anaesthetic drugs around nerves or around the spinal cord is all hands on training, so anaesthesiology trainees are always scuttling around looking for more opportunities to practice. It does get a little less laborious in the final year when you start getting some weekly time off to prepare for the exams.

On Sound Basics
Anaesthesia requires sound knowledge of Physics, basic Math, Chemistry, and all medical subjects like Anatomy, Physiology and Pharmacology to name a few. You never know what you will encounter in your next patient and every little bit of knowledge you have acquired over your MBBS will be of use. Continuing to read, even when there are no exams is imperative as medicine makes advances each day, and keeping up to date is important.

On A Typical Day
My morning starts with meeting the first patient posted for a surgery, pre-operatively, discussing his medical problems, plan of anaesthesia, risk benefits, alleviating anxiety, and wheeling the patient to the operation theatre. Then the process of actually anaesthetising the patient, managing the pain, fluid requirements, monitoring heart, lung functions, temperature throughout the surgery, administering blood or products if required, and keeping the patient anaesthetised, for as long as required. At the end of the surgery, waking up the patient, ensuring he's breathing well, not in pain or nauseous or cold, and then deciding when he’s well enough to go to his room or even discharged home, after a small day-care procedure. The process repeats for all the surgeries scheduled in the day. A patient goes to a cardiologist for his heart, nephrologist for his kidney and orthopedic surgeon for his spine, but when he requires a surgery for his appendix, the anaesthesiologist looks after his kidney, heart, lung and the rest while the surgeon operates.

On Fees & Earnings
Any MD program at a teaching government hospital will have approximately Rs.10,000/- fee per semester. A stipend of approximately Rs.40,000 per month is paid during the three-year PG program. Private medical colleges, and DNB courses in private hospitals are likely to charge higher fees. Earnings for a fresher range from Rs.60,000 to Rs.80,000 per month as a full -time anaesthesiologist. After the three-year Postgraduate course, a three year senior residency is required in most hospitals in North India before you are employed as a consultant. Most hospitals in Mumbai have no such fixed requirements, but vary from place to place. A Fellowship or super specialisation (cardiac anaesthesia, neuroanaesthesia, pediatric anaesthesia, critical care, transplant anaesthesia) will give an added advantage. As an established professional, you can earn between Rs. 1 to 4 lakh per month.

On Advantages & Disadvantages
Anaesthesiologists working at tertiary care centers have the advantages of working in a department with fixed emergency duties. So though you do work nights, it’s fixed to 5-6 per month and you can be assured of fixed hours on the rest of the working days. Further specialisation with a DM or Fellowship in neuroanaesthesia, cardiac anaesthesia or critical care medicine makes you a super-specialist allowing you to work in your area of interest only. Some anaesthesiologists also prefer to specialise in chronic pain, providing interventions in chronic pain and palliative procedures. The difficulties are mainly because of the fact that an anaesthesiologist cannot work alone in a clinic (except chronic pain specialists) and will always be dependent on a surgeon and hospital for work. The emergency and night duties are a part of the job which requires an understanding and supportive family. Stress is a part of the job, as anaesthesia involves dealing with the sickest of patients and complex surgeries, with surgeons and families looking up to you to save the day.

On Right Advice
My advice to those who want to take up this profession is - Anaesthesia is a demanding, yet satisfying career. Working hours are long, night and emergency calls are a part of duty. But seeing a patient wake up pain-free after surgery, marvel at how wonderful it was not to have realised that he was operated upon or to resuscitate a patient who collapsed in the emergency ward, makes it all worth the time and effort.

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