I see this in my hospital all the time and I am sure it is seen by anesthesiologists all over the US  – how much sicker our patients are.

It is also evident that surgeons are pushing the envelope further and further. Patients are showing up for surgery whose short-term prognosis (don’t even consider the long term) makes one question the wisdom in a surgical intervention.

Then is the rather formidable (no pun intended) issue of morbidly obese patients who need their day in the OR.

We as anesthesiologist seem to take all these challenges in stride and in most institutions, the daily schedule is hardly affected as these challenging are shuffled through.

We complain about the wisdom of surgically intervening in these instances but since the show must go on, we do what we have to.

I dare to blame us though for these circumstances. Bear with me and I’ll make myself clear.

Imagine an institution where the anesthesiologist cannot manage ASA IVE cases or secure the airway in that 550 lb patient or get that patient through an exploratory laparotomy who just had a myocardial event. Just imagine.

What do you think the surgeons are going to do? Three options – take their cases elsewhere, stop taking these patients to the OR or hire an anesthesiologist who can or is prepared to do these cases.

What if this was a national phenomenon with all anesthesiologist? Maybe the sickest patients will not show up for surgery!

However, we have a specialty that prides itself in being progressive, being evidence-based and seeking to constantly improve itself.

We attract the smartest and most innovative minds.

The result – the ability to manage whatever the surgeons pitch at us!

So they keep throwing and we as trusted batters, always hit the home run.

600 lb? Bring it on!

EF of 15%, cirrhotic and anuric? Bring it on!

Maybe we need to stop complaining and keep on keeping on because maybe, just maybe, we are to blame!