Anesthesiology is characterized by the extremes of certainty and the unknown. We plan meticulously for the next exigency, the next step in the operation. We are to come prepared with Plans A, B, C and D (if not E, F and G!). And yet, we do not really know from one minute to the next what our fate shall be. Arriving at work ready for the three scheduled cases, one learns that a victim of a motor vehicle accident (MVA) with a ruptured spleen, multiple fractures and loss of consciousness at the scene will bump their cases, with an arrival in the OR in 10 minutes, no less. We respond, because we are prepared. And yet, when, exactly, did this preparation begin? Was it that morning with a nutritious breakfast? That prior evening with a prudent decision to retire early ensuring a full night’s sleep (and perhaps health and wealth, to boot!), or was it much longer ago? Did the preparation for this case start in training with the hours of clinical work moving us from a clumsy novice to expert clinician? For our physicians, was it medical school in which the foundations were first laid, and for our CRNAs, was it nursing school? Before this, even?

Where does preparation begin for those who must respond at a moment’s notice ready and able to save a life? Hard to say, yet each step along the way matters. At the most base level, we understand that having our medications and equipment ready is necessary preparation. Staying current in the literature and leading quality improvement agendas are forms of preparation. Maintaining the physical and mental health necessary to bring our full attention to any crisis is preparation too, without doubt.

For in each of us on the front line of care, there is neither beginning nor end to the preparation. There is only the simple truth that our patients depend on us and commit to us in a sacred bond of trust in which only we are the guarantors of true readiness. I am so very proud of the preparation I see each day in this Department. Your work, the hours of study, and the honest effort at self-improvement matter. Don’t ever stop, because surely, in our profession when we fail to prepare, we are preparing to fail. And that is something we can never let happen.