Early in my internal medicine training, I believed perioperative care consisted of risk scores, medication adjustments, and the familiar directive to “avoid hypotension.” That confidence quickly dissolved when I entered anesthesiology and encountered the reality of moment-to-moment physiologic management, airway crises, active hemorrhage, and medications whose effects are measured in heartbeats. This chapter reflects the perspective gained through dual training and the humility it instilled. Ultimately, perioperative medicine succeeds not through dominance of one specialty, but through genuine partnership.