Dr Richard Marks
Consultant, interviewed Feb 2010
“It seemed that all the interesting parts surrounding the surgery apart from
actually doing the cutting was the anesthetist’s job.”
Why did you choose anaesthesia as a specialty?
You always think you may want to do anesthetics, but you don’t really know. I
don’t think anyone going into medical school absolutely knows where they want
to specialize. When I left medical school I didn’t know what I wanted to do, I
considered neurology or general practice. It wasn’t until I did my foundation year
that I happened to work at a place that had a really good anesthetics department
and I thought what they were doing was actually quite interesting.
I remember I was doing surgery at one of my rotations in my foundation year and
it was quite boring although there are some interesting bits and that’s what the
anesthetist was doing. For example, the anesthetists dealt with the sick patients
and they also decided whether or not patients were fit for surgery. The medical
workup and assessment of patients were actually done by the anesthetist. They
also dealt with pain relief after surgery. It seemed that all the interesting parts
surrounding the surgery apart from actually doing the cutting was the
anesthetist’s job.
This was in the early 1970s and 1980s and I was really into computers and this is
right when personal computers really came on the market. At this time, the
professor of anaesthesia had just got an Apple 2, which I couldn’t afford, and he
said, “Everyone who is into anesthetics is into computers.” It was a combination
of gadgets and computers and what they were doing looked interesting. Also, I
figured if I didn’t like it I wasn’t completely wasting my time because the skills you
pick up will transfer to other parts of medicine. I was never completely sure that it
was what I wanted to do, but there seemed to be a lot of good sides so I gave it a
try.
Was there a particular piece of advice you received that helped make your
decision?
After I did some rotations in my foundation years I went back to see the professor
of anesthetics, who I knew from medical school, and I told him that I was thinking
about anesthetics. He told me that if I was going to do it I should do something
else besides just my foundation years. He suggested I do six months of
something else, and I choose Accident and Emergency (A&E) training because I
figured it would be useful if I choose a different specialty. Then I he got out his
diary and told me that if I do six months A&E then I could start anaesthesia on a
certain date and that was it, I got the job right then.
Is anaesthesia what you expected?
I didn’t really know exactly what to expect. I went through a very rough time in
terms of career because there was a real lack of consultant positions, so it was
very difficult to find a job. When you go through the rigorous interview process
over a period of months it becomes very clear that you must be fully committed to
the idea that this specialty is right because you have to be determined. If you let
slip that this might not be right for me, then no one will hire you.
Is there a best part of anaesthesia?
The fact that it is a niche - you are doing something that no one else in the
hospital can do. There are niches within the specialty as well, for example I do
mostly pediatric ENT (Ear, Nose, and Throat). I think generally in anaesthesia
once you can do it you have this set of skills that no one else in the hospital has.
Also, you are called for all the good stuff: cardiac arrest, resuscitation, and pain,
basically all the really good stuff. I think that’s quite appealing. Also as an
anesthetist you get an operating list and there is a beginning, middle, and an
end. With most other specialties in the hospital there is no end, but I know there
is a last patients and they go into recovery and I hang around for a bit to make
sure they are doing well and then I get to go home. I like how you can
compartmentalize your life.
People say that anaesthesia is 99% boredom and 1% terror. The terror you
should be able to deal with and the boredom is all right.
Are there any downsides?
Well the biggest one is probably status. You are going to have to live with the
fact that you are always going to be secondary to the surgeon and some people’s
egos don’t let them do that. Also when things go wrong it is always your fault,
you get the blame and sometimes there are really difficult cases that you may not
be told about until the last minute. As you get older and develop as an
anesthetist you become more confident in what you can and can’t do. You have
to know when to say no.