August 2002
Volume 66 |
Number 8
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| Pretty in Pink |
Salomea Kape, M.D.
The majority of us don't know the odor of ether, and yet ether's
"fame" survives and serves as a memento that a smelly
gas can give anesthesia a bad name. Let me share with you my experience
with the notorious agent.
I started my first year of anesthesiology training in 1958 when
ether was the unchallenged "King of Anesthesia." Ether
depolarized all parties involved: the patient who dreaded its
odor, expecting the unavoidable, exhausting postoperative retching
and vomiting; the surgeon who could not use cautery, which alone
doubled and tripled the surgery time; and the anesthesiologist
who felt like he or she was working in a minefield where every
spark could cause an explosion.
Ether also penetrated into my hair and my clothing, forming a
smell around me easily identifiable with a hospital or an operation.
Just the name "ether" caused a rush of appalling images
to mind.
I enjoyed lots of space in crowded buses or trains, and I was
lucky to be married before selecting anesthesiology as my specialty
– for who would like to sleep in the same bed with a can
of ether? My husband, a highly decorated WWII soldier, had adjusted
somehow to the smell and hazards of ether but blamed its bromide
effect for almost everything that went wrong in our marital life.
Chloroform was odorless and not explosive but had the bad property
of melting the liver. Ether, on the other hand, was an anesthetic
with a wide safety margin. Size of the pupils told us volumes
about the depth of anesthesia, and the stethoscope was the only
monitoring device. We, the ether anesthesiologists, became watchers
with many eyes and listeners with many ears.
I was two months into my residency program when I was assigned
to give open ether anesthesia to a 5-year-old boy for repair of
inguinal hernia. He was a beautiful and friendly child with big,
dark eyes, and his long eyelashes threw a shadow on the peachy
glow of his cheeks. His smile had brightened up the operating
room. He recharged maternal instincts in all females present in
the O.R., and the glint in our eyes added wattage to the O.R.
lights.
The child, as if by osmosis, reciprocated our supercharged maternal
feelings by responding with joyfulness and trust. He clung to
me and even let me put a mask over his face; he struggled a little,
battling the unpleasant odor of ether. In a matter of seconds,
the pink color of his skin changed into blue, dark blue and purple,
while his lips and nails followed the same metamorphosis. The
boy now looked like a blue, lifeless edition of himself, and a
penumbra of death surrounded him. The stethoscope taped to his
chest transmitted to my ears the mad gallop of his heart and that
his lungs were covered by a blanket of silence. The diagnosis
screamed out at me that this tachycardia could easily change into
ventricular fibrillation.
Death from anesthesia was terra nova to me, a nascent anesthesiologist.
Acting more on instinct than experience, I had stopped ether and
gave pure oxygen. The attending towering over me had not lost
his sangfroid, though. His observant eyes were fixed on the child
and my moves, and he said with an authority in his voice, "He's
only withholding his breath, and the accumulation of CO2 will
force him to breathe again."
Sure enough, the boy had taken a deep breath, and the deadly
colors disappeared as quickly as they had arrived. I had taken
a pimple for a pox, but I did not stumble badly in my handling
of crisis. I was devastated, however, and scared seeing the thin
line separating life from death and the dark colors accompanying
the transition.
A zigzagging thought of abandoning anesthesia for another specialty
entered my mind. Dermatology? Radiology? Little did I know then
that dermatology and radiology would develop into invasive, risk-loaded
fields of medicine. A few years later, the odorous ether made
an exit forever and was replaced by modern anesthetic gases that
do not smell exactly like roses but are better tolerated by patients.
A new Gestalt of anesthesia emerged; free of ether vapor and paralleling
anesthesia's progress, my marriage survived and bloomed.
A Freudian aversion to dark-brown lipsticks, noir-nail polish
and black eye shadow is deep-rooted in my mind. I love pink and
bright-red colors, the redder the better. We all – men, women
and children, young and old – are splendid-looking in our
natural colors of life and good health: we are all pretty in pink.
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Salomea
Kape, M.D., retired from practice in 1991. She currently serves
as a review physician for the New York State Department of
Social Services. |
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