Hidden Specialties
Meet the doctors of sleep, images, and microscopes
Anesthesiologists like to maintain they could make a lot more money in other specialties. But they also take considerable pride in the special magnetism of their field. Anesthesiology residency and post-residency programs are "often able to attract the best and the brightest" medical students, Apfelbaum says, even if many of them entered medical school with specialties that are more glamorous, like surgery, in mind. "You get to see physiology, pharmacology, all these things you studied in school, right before your eyes," says Apfelbaum. "There's the immediate gratification of seeing your intervention do something dramatic."
Beyond the OR. Until recently, gratification was mostly to be found in the operating room. But now anesthesiologists work throughout the hospital, from the ICU to the maternity ward, where Kenneth Rodino has spent all night helping to dull the pain that medical texts commonly label the most intense of all: labor. He administers epidurals, the shot of anesthetic near the spinal canal to numb the lower body. But that's not all. Especially when complications are a risk, he says, "the main thing is to take care of the patient," monitoring her condition and watching for trouble. Managing chronic pain is another recent mission (Page 54).
But it is surgery that remains anesthesiology's main focus. Back in OR 13, the surgical team is finally coming to the end of what turned out to be a very difficult case. Klafta and Schure have been adjusting drug dosages for an hour, gradually bringing their patient closer to consciousness. He begins to stir just as the final sutures go in. "Mr. Christian," Klafta asks gently, "how do you feel?" Eyes opening for the first time in eight hours, Christian blinks, shakes his head, and hesitates as if he can't quite believe the answer. "Fine," he says at last. "I feel fine."
RADIOLOGY
'Oh, there's always a patient" is what Emily Conant will say if asked if she has someone waiting. What? Don't radiologists lurk in windowless basement offices, safely shielded from the messy world of patient care by layers of X-ray films?
Most of them did, and many still do--the stereotype isn't completely unfair. A radiologist in a candid mood will even say it's one reason some fellow practitioners chose the specialty. But radiologists are moving out of the shadows. On any given day, Conant, chief of mammography at the Hospital of the University of Pennsylvania in Philadelphia, sees dozens of patients, not just to take a quick snapshot but to counsel and care for them. "Every patient is different," says Conant. "It's so important to spend time with them, so you can help make a potentially bad situation better in any way possible and help them move on to the next step."
Neat new tools. There are still plenty of X-rays of broken arms and sprained ankles to read, and such familiar work makes up the bulk of radiology practice at any general hospital. At Penn, that includes some 350,000 patient examinations a year, from prenatal ultrasounds to bone density scans to detect osteoporosis. The radiologist's tool kit has expanded, however, as new technologies have come onboard--CT scans in the late 1970s for creating 3-D images of hard and soft tissue, followed by MRIs and PET scans that can produce yet more detailed images and even detect and depict the metabolic activity of organs and cells. And the specialty itself is branching out in unexpected directions.
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