Anesthesiologist are service oriented professionals who make crucial decisions and perform critical, sometimes lifesaving procedures behind the scenes. The absence of drama usually implies a job well done. But after thirty eight years of private practice, I realize there is an important and intriguing story that needs to be told. A key part of this story is the history of how new intraoperative monitors, improved alarms and safety upgrades on anesthesia machines along with better drug and syringe labeling in the 1980’s dramatically decreased the risks associated with general anesthesia. In the 1990’s we saw an explosion of technology with the internet, cell phones and the early phase of computerized records. We also experienced the end of one medical corporation and the rapid growth of anesthesia services with a new one. The new millennium brought continued growth with advances in equipment, new technology and new sites of practice. The big surprise was a complete takeover of our hospital be a mega hospital system ( Carolinas HealthCare System ) in 2007.Unfortunately, these upgrades in our everyday practice were accompanied by a tragic death of a beloved partner, the demise of the county’s leading industry and the incarceration of my oldest son. With all the destabilizing factors surrounding our medical practice, it is noteworthy that some basic principles were immutable. Personal dedication and vigilance remained the core virtues required in our daily practice. The basic skills of airway management and circulatory support with IV access were ever critical to the successful practice of our art. Other skills and concerns at times gained center stage; but one could safely say: the more things changed, the more they stayed the same. So in these confessions I have dealt with a number of important issues; the changes in my medical practice, political and economic changes at the local and national level, personal and family instability, and lastly my own struggle to search for meaning and logic to these events. I think anyone who struggles in their career can relate to the need and sense of satisfaction in gaining that insight.