A rotation in the Post-anesthesia Care Unit (PACU) is a requirement of the American Board of Anesthesiology and an introduction to where you will spend much of the rest of your career. Immediate postoperative care has several idiosyncratic concepts not found in any other critical care setting, making it foundational wisdom of our specialty. On your ultimate certification exam, an oral board discussion, fifteen minutes will be dedicated to the postoperative management of a case you will have just finished. This month long rotation has a Study Guide, assigned reading, and an X-ray file for review with the Medical Director, Dr. Chad Couremanche. Nearly five days per week, the day begins by providing anesthesia for electroconvulsive therapy (ECT) with members of the Department of Psychiatry. These challenging anesthetics add yet another layer of complexity to a uniquely varied experience. A faculty member is assigned to the Inpatient PACU each day for guidance and supervision. Patients in the PACU are turned over to the senior resident on call at the end of the day.