Well, the challenge....
I guess part of that is the fact that just getting here is the hardest thing I have ever done. I really mean, school was tough. Never worked so hard in all my life.
Also, there's the challenge of a particularly difficult case, such as open heart surgery when coming off pump, or carotid surgery, or intercranial surgery. In most cases, there are a lot of different actions that could be taken at any particular juncture. Making the right choices, improving the patient's physiological status. Having the surgeon complement you at the end of a case, ask for you for future cases, because s/he knows you can be trusted to take the best possible care of the patient.
Best parts? Man, thats a big question. I don't currently do OB, but there is enormous satisfaction in putting an epidural into a woman in labor, and watching her relax over a period of just a few minutes as it takes effect. The look she gives you as you leave the room. Coming back a few hours later to be present for the birth of a baby, to help with starting that baby out in life. "ahh yep that's what it's all about!!"
Or going to see a patient preoperatively, finding out they are in terrible pain and frightened to boot. Being able to prescribe something to relieve that pain, and the anxiety as well. Or the feeling waking a patient up in the recovery room, and having them tell you the pain they had before surgery is gone. No, I don't do the surgery, but it wouldn't be possible without me. "ahh yep that's what it's all about!!"
Or, like yesterday. Doing a monitered anesthesia care (MAC) case. These can be most challenging, since the patient is never put fully to sleep. The procedure is done mostly with local anesthetic, but you must be there to monitor, provide sedation. At the end of the case yesterday, the patient told me she was very nervous going in, but just the sound of my voice, confident and comforting (her words, not mine) really helped her get through a very scary experience. "ahh yep that's what it's all about!!"
Kevin McHugh, CRNA