ANESTHESIOLOGY

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" emergencies.