Managing physiology and ensuring comfort, second by second

Chris Schwan, MD, a second-year anesthesiology resident physician at the University of Florida College of Medicine – Jacksonville, manages anesthesia during a pulmonary vein isolation.
Schwan adjusts a fluid bag during the procedure, which was to correct an abnormal heart rhythm.
Schwan, right, consults with Jason Widrich, MD, an assistant professor of anesthesiology at UF COMJ.
Schwan is one of four second-year residents in the anesthesiology program. He will graduate in 2019.

Resident physician Chris Schwan, MD, deepens his passion for anesthesiology as he works through training program.

Chris Schwan, MD, arrived in the electrophysiology lab before most of the other medical personnel. He wanted to ensure all the necessary lines, fluid bags and monitors were in the proper place and ready to successfully administer anesthesia.

The procedure was a pulmonary vein isolation to correct an abnormal heart rhythm, and Schwan was the resident anesthesiologist. After his initial setup and survey of equipment, he walked down the hall to consult with the patient who would soon be anesthetized.

Schwan created a comforting, welcoming atmosphere as they discussed the anesthesia plan. It is his job to make patients feel as comfortable as possible before, during and after a procedure. It’s a responsibility he takes seriously and approaches with passion.

Schwan is a second-year anesthesiology resident physician at the University of Florida College of Medicine – Jacksonville. In between clinical duties, lectures and other academic activities, he took time out to talk about his journey to Jacksonville, the UF COMJ residency experience and his career goals.  

Shifting focus, finding a passion

Schwan recounts the rush of flying on military helicopters and providing medical support for special operations forces. The locations? Africa. The Middle East.

That’s about all he’s at liberty to say. These were stealth combat operations, and Schwan served as an Air Force Special Operations flight surgeon, who is essentially a primary care physician for a flying squadron.

“It’s a unique and interesting job people don’t often hear about,” said Schwan, who served six years in the military.   

Go back a few more years, when Schwan was an undergraduate student in Texas. He first wanted to be a mechanical engineer. During an internship, however, he soon realized he “loved the physics, but hated the job.”

After this realization, a sustainable agriculture study abroad program gave Schwan the opportunity to interact with several pre-med students. That was the first time he seriously thought about a career in health care. He later got his EMT license “just to check it out” and began ambulance work.

“I liked it so much, I realized I definitely wanted to go on to medical school,” he said.

Schwan joined the Air Force prior to starting medical school to pay down existing college debt. He also took advantage of the Health Professionals Scholarship Program, which absorbed a good portion of his medical school expenses. 

Schwan initially thought he would be an orthopaedic surgeon after completing his military service. But during his time in the Air Force, his daughter was born. He says the new addition to the family changed his perspective, made him mature and caused him to reevaluate his career goals. Family took on greater significance, and he ultimately believed the schedule and demands of a surgeon wouldn’t allow him to commit to his loved ones the way he desired.

All the while, he began to find anesthesiology appealing, largely because of its hands-on nature and real-time application.

“As my priorities changed, I thought anesthesiology was a better fit for me,” he said. “In this role, you’re altering and maintaining physiology to keep patients alive and breathing, from second to second. It’s all in real time, which is really cool.”

Choosing UF COMJ

For family reasons, it was essential for Schwan to train in the Southeast. He picked UF COMJ because it’s in a large city and affiliated with a hospital that has a diverse patient population. Also, the anesthesiology residency program accepts just four trainees each year. The smaller program size and large case volume appealed to Schwan, as did the expertise of the faculty.

“This seemed like a good fit,” he said of the three-year residency, which has a linked preliminary year in the department of surgery to help prepare trainees for the program. “It was an easy sell, and everything came together very nicely.”

Because UF Health Jacksonville is home to TraumaOne, the only adult and pediatric Level I trauma center in the region, anesthesiology residents gain exposure to the most complex cases with blunt and penetrating trauma. They get to work alongside physicians in specialties such as neurosurgery, orthopaedic surgery and pediatrics.

Schwan and others also work on a host of cases in general surgery, cardiothoracic surgery, gynecologic surgery and high-risk obstetric care, oral and maxillofacial surgery, and plastic surgery.

Carol Diachun, MD, MSEd, a professor of anesthesiology and director of the anesthesiology residency program at UF COMJ, says strong acute pain and regional anesthesia training, as well as quality-improvement and patient-safety training, sets this program apart from others in the country.

“Our graduates are leaders in these areas when they move on and start in their new positions,” Diachun said. “In addition, being a smaller program allows us to tailor schedules and the order of clinical experiences toward the future goals of our residents. It makes us more individualized in our educational programming.”

Gaining and applying knowledge 

Back in the electrophysiology lab, treatment of the patient’s abnormal heart rhythm has begun. Schwan, dressed in scrubs and covered in heavy anti-radiation gear, is positioned near the patient’s head, monitoring and adjusting anesthesia by the minute — sometimes by the second.

As the cardio team starts the pulmonary vein isolation, Schwan pivots back and forth from the patient and the fluid lines to a nearby computer. He’s focused and locked in. But interestingly, depending on your position in the room, you possibly wouldn’t even realize Schwan was there — and he says that’s somewhat of a good thing.  

“If you do everything correctly, it should look smooth and people may assume there’s not much going on,” he said. “But behind the scenes, there is a whole lot happening.”

The day before a surgery, the anesthesia team reviews the patient’s charts and medical records, ensuring the patient is in optimal condition to undergo a procedure with anesthesia. Factors such as comorbidities and past anesthesia records help them choose the appropriate method of care. “We want to ensure we’ve devised a plan for safe, effective delivery of anesthesia,” Schwan said.

“We’re then in the operating room well ahead of the procedure to get ready, setting up IV lines and airway equipment,” he said. “We execute a plan that accounts for the time before, during and after an operation. We aim to make sure pain is well-controlled after the patient emerges from surgery.”

As residents move through the training program and gain experience, they are granted more autonomy and take on leadership roles in developing and executing individual anesthesia plans. Schwan says on average, he handles anesthesia for 10 to 15 procedures per week. On extremely busy weeks, though, he can be involved in as many as 10 cases in a single day.

And when he’s not consulting patients or working in the OR, Schwan is refreshing his medical knowledge and staying abreast of the latest evidence-based approaches. Residents must devote certain days each month to lectures and didactic sessions.

Schwan says it’s a challenge to balance clinical duties and academic responsibilities, as well as maintain a life outside the medical realm. Many long days are involved, as he often arrives at work before the sun emerges and doesn’t leave until long after it has set. Twelve-hour night shifts are commonplace. 

But Schwan keeps in mind the long hours are part of residency training and he’s preparing himself to work in a field he loves. He views anesthesiology as both an art and a science, and it’s a specialty he finds extremely gratifying.

“You’re literally taking somebody’s ability to stay alive away from them when you anesthetize them for surgery. That’s a huge responsibility,” he said. “You don’t get a chance to redo it. You get one shot, and you need to do it well.”

Schwan, who will graduate in 2019, is looking at the possibility of a fellowship in pediatric anesthesiology or going straight into private practice — preferably near relatives in Florida’s Panhandle. Diachun says when it’s time for Schwan to move on to that next stop, his meticulous nature and organizational skills will serve him well.

“These are especially desirable traits for an anesthesiologist since we are constantly multitasking while remaining vigilant,” Diachun said. “Chris is extremely calm in stressful OR situations and manages any type of crisis in a structured manner. We teach these crisis-management skills in our program, but Chris came in with them, likely from his military background.”

From caring for soldiers on the frontline to overseeing anesthesia during surgery, Schwan has always remained fully committed to providing the best care possible for patients while continuing to learn and grow in the process.

Click here for more information about the anesthesiology residency program at UF COMJ.

Featured Faculty

Carol Ann B. Diachun, MD, MSEd

Carol Ann B. Diachun, MD, MSEd

Associate Dean for Educational Affairs