Meet the doctors of sleep, images, and microscopes
By Thomas Hayden
Printed 7/12/04 in US News and World Report
The focus of the "America's Best Hospitals"
rankings is on medical specialties that most of us have come
to recognize. From cardiologists to neurosurgeons to psychiatrists,
practitioners of these specialties are stage front and center,
the public face of hospital medicine. There's more to the story,
however. Behind the scenes, doctors, nurses, and technicians
you may never meet play vital roles in other specialties. This
year we pull back the curtains for a closer look at anesthesiology,
radiology, and pathology--three of the "hidden" specialties.
The night shift is still on the job when Jeffrey Apfelbaum
starts his normal workday. Pulling into a parking garage at
the University of Chicago Hospitals at 6 in the morning recently,
his car is one of only five. The other four, like Apfelbaum's,
belong to anesthesioalogists.
"We're the first to arrive and usually
the last to leave," says the genial Apfelbaum, more pleased
with the dedication of his fellow specialists than distressed
by the long days. As chair of anesthesiology and critical
care at the five-hospital complex on Chicago's South Side,
Apfelbaum is a little miffed that his specialty has such a
low profile. "Sometimes a patient will ask, 'Well, what
does my doctor think?' and I have to explain that I am
their doctor," he says. "A lot of people
don't really know what it is we do."
The day officially begins with the swipe of
a mag card through the ScrubStation, an automated vending
machine that dispenses fresh sets of purple surgical scrubs.
There are 25 operating rooms,and this particular Friday, the
agenda will include complicated blood vessel grafts for Charles
Christian, a retired police officer in his 70s suffering from
severely limited blood circulation to his legs. Without treatment,
he'll most likely lose his legs.
In many hospitals, anesthesiologists are becoming
the human face of surgical care. "From the time patients
are scheduled for surgery until they've recovered from the
stress of surgery," says Apfelbaum, "the anesthesiologist
is responsible for their medical care. Not the surgeon, not
their internist or general practitioner." Christian's
anesthesiologist, Jerome Klafta, and senior anesthesiology
resident Annette Schure spend almost half an hour with Christian
and his family before the surgery, conducting a final examination
and answering questions. "The bottom line," says
Klafta, "is that patients are usually scared and they
want to talk." Taking the time to listen, he says, "is
part of what we do."
More than sleep. But
ministering to patients undergoing some 71 million surgeries
a year in the United States is no longer all that anesthesiologists
do. "People have this impression that we just put people
to sleep and wake them up again," Apfelbaum says. "Thirty
years ago, there might have been some truth to that, but we've
made a lot of advances."
Besides conducting presurgery tests and assessments,
five of the hospitals' six critical-care doctors in the surgical
ICU--their "intensivist" subspecialty is relatively
new--are anesthesiologists. Others work in the burn ward and
the outpatient pain clinic. And because they're specialists
in resuscitating patients, the anesthesiologist on call is
often the first doctor to respond to "code blue"
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