It's twenty years today since I started my anaesthetic training, at Charing Cross Hospital. In that time I've looked after many thousands of patients, placed innumerable cannulas, injected rivers of propofol, and stuck a pine tree's worth of needles into people. 🧵

Thousands of people have trusted me enough to let me render them unconscious and look after them while they are totally vulnerable. It's an immense privilege, which I feel whenever I'm looking after someone, not least as visceral unease if I move more than about 5m from them.

I've been lucky to have worked with some truly amazing doctors and nurses and ODPs over that time, some doing extraordinary stuff, and others doing basics brilliantly. My colleagues have been there for me whenever I or my patient have needed them, never more so than during Covid.

Anaesthesia is the most populous hospital specialty; I've always said we're like rats, in that you're never more than six feet from an anaesthetist in a hospital. And yet we've been understaffed in pretty much every department I've ever worked in, becoming ever more so over time.

Anaesthesia is an enabling specialty. We facilitate other specialties to do their work by getting the patient through the unpleasantness, pain, fear or physiological disruption that otherwise would make that work unbearable for the patient or impossible for our colleagues to do @rcoanews.bsky.social

Some of my weirdest moments have been funny in retrospect: the surgeon who refused to stop operating despite flooding literally carrying equipment down the corridor outside theatre; or transferring a patient and the ambulance being repeatedly diverted to accidents on our way back to our hospital

Or watching a famous surgeon eviscerate an interviewee visiting in theatre to discuss a fellowship role, while he operated endoscopically per rectum (like an anal laparoscopy) in front of an entourage of >10 residents who winced along with me as the poor guy went bright red

Or the pt who *insisted* on dictating a lengthy farewell note to his mum before he'd allow hand-saving surgery - I had to stop him when he then started a note to his sister as well, lest he bleed to death while contemplating his own mortality (he was fine, as I knew he would be)

Less fine was the furore the next morning when I arrived at 8am to find Recovery in chaos with dozens of relatives round his bed. Moreover the hospital had to be locked down because his large family had kicked off when his attackers turned up and machetes had been produced... 😬

Or the prone neurosurgical pt being extubated while I was giving a colleague a coffee break by someone standing on the tubing, and me reintubating him prone and then nonchalantly telling my colleague "It's been fine, no problems" when she got back, while the poor ODP sputtered protest behind me

Or the time I got lost in the hospital's basement corridors, unable to find my way back and with all the swipe card door panels refusing to recognise my card until I finally found one that let me back upstairs, to find myself about half a mile away from theatres by the post room.

I should add that the first anaesthetic I ever gave was actually aged 17, to Drosophila fruit flies for A Level Biology, so I could sort them for breeding. They all survived, but by month 2 I think I'd bred them for resistance as some were literally coated in ether, wide awake 🪰

I've experienced a few serious mishaps along the way, fortunately none with lasting impact on the patient. Often the day was saved by quick-thinking colleagues and our irreplaceable skills from lengthy, rigorous training; we give up those standards at our patients' peril.

And there have been the patients who didn't make it, whose injuries or disease were unsurvivable, but for whom we tried our best; the anaesthetist is there with the rest of the team, doing the needful until the end. These patients aren't many, but one remembers them.

I've liked most places I've worked, but am very pleased to be a consultant where I started, at Charing Cross Hospital and at St Mary's. Along the way I've worked in 14 different hospitals in 20+ rotational placements across London and Essex, sometimes for as little as 3 months.

My current team are the best, and we grew even closer during covid, when we looked out for each other and our patients together under intense circumstances. We came out of it with a bond I'm lucky to experience in the workplace, and working here is still great. Thanks guys! 💙