One of the most profound challenges I encountered during my anesthesia rotation as a third-year medical student wasn’t mastering a technical skill or memorizing drug dosages – it was learning to sit with uncertainty in the operating room (OR).
I’ve always found comfort in having a clear plan – a defined diagnosis and a path forward. It feels like a warm safety blanket, especially as a new learner navigating a daunting field full of unknowns. Medicine often feels like solving a puzzle, but anesthesia demands a different kind of thinking. The OR forces you to make quick decisions with incomplete information and in moments in which the stakes are high. Hesitation can have serious consequences.
During what I anticipated to be an uneventful hernia repair on a male patient with a history of liver transplant and daily cannabis use, a severe bronchospasm struck shortly after induction.
Preoperatively, the patient denied respiratory symptoms. His chart revealed some airway obstruction on a previous bedside pulmonary function testing – but no formal asthma diagnosis or treatment. Yet suddenly, during induction, ventilation became extremely difficult. Standard maneuvers didn’t improve the situation. After rapid intubation, we encountered copious amounts of secretions, high airway pressures and a severely obstructed capnography pattern. We treated aggressively with salbutamol, epinephrine and magnesium sulfate, struggling to oxygenate him throughout.
What caused this bronchospasm? Was it inadequate anesthetic depth? A low dose of ketamine? An undiagnosed obstructive lung condition worsened by smoking? A combination? The truth was, we didn’t know. And that uncertainty was terrifying.
But the experience taught me a vital lesson: anesthesia is less about having all the answers and more about thinking critically under pressure, balancing risks and acting decisively.
As a medical learner, uncertainty is everywhere—especially in anesthesia.
As a medical learner, uncertainty is everywhere—especially in anesthesia. Perioperatively, you don’t have the luxury of time and can’t wait for investigations and results to return. At times, the ambiguity felt overwhelming, even frightening. I worried that not knowing meant I wasn’t doing enough for my patient.
But I’ve come to appreciate that this discomfort is a rite of passage in medicine. I’m learning that true competence lies not in certainty, but in intellectual humility, situational awareness and teamwork.
Watching staff anesthesiologists calmly navigate crises, I see how experience refines this ability – not by erasing doubt but by helping them carry it with grace and clarity.
Moving forward, I want to lean into these uncomfortable moments rather than shy away from them. I’ll seek out opportunities to observe and ask how others process uncertainty. I’ll practice staying mentally agile and ready to pivot, even when the cause isn’t immediately clear.
As I progressed through the remainder of my clerkship, I learned that this mindset doesn’t just apply in anesthesia – it’s relevant to all learners stepping into the unknown, where protocols don’t always fit and textbook answers are rare. Embracing uncertainty fosters resilience, sharpens clinical reasoning and, ultimately, improves patient care.
There’s a unique thrill in the rapid mental dance anesthesia demands – the challenge of piecing together clues in real time and working seamlessly with a team to keep patients safe. That blend of high stakes, cognitive rigor and collaboration is why anesthesia is so captivating.
Though the unknown can be daunting, I hope to find calm within it – a confidence that I can face uncertainty head-on and still deliver excellent care.
