A Lesson From the Movies
Nothing makes me appreciate the work of ASA NEWSLETTER
editors more than sitting before a keyboard and attempting
to compose a column that will be both interesting
and informative to the membership. Thankfully I only
have to do it once a year rather than for every issue.
The NEWSLETTER would be pretty sparse if
filling it was dependent on my creativity and imagination.
Being ASA Treasurer (1999-03) provided some pretty
predictable financial subjects. What is a natural
subject for the First Vice-President? I do not think
that the title suggests that I write about vice!
I have long been a fan of the series of novels written
by Patrick O’Brian about Lucky Jack Aubrey and
his staunch friend, Dr. Stephen Mauturin. The Jack
Aubrey character is a British naval officer, and the
story begins in 1800. The books are incredibly well-written
with marvelous detail about life in that period.
Young men became officers by serving an apprenticeship
as midshipmen. Being selected by a knowledgeable and
evenhanded officer such as Jack Aubrey was a goal
of many upper-middle-class youth.
Two of the novels were combined into the 2003 film,
“Master and Commander: The Far Side of the World.”
The movie also is an accurate portrayal of life in
the British Navy in the 1800s. Of course I went as
soon as it was released.
Early in the movie, the most endearing of the midshipmen
sustains an open injury to his elbow. After sitting
through enough morbidity and mortality conferences,
you usually know what is coming next. Sure enough
he soon becomes septic, and his only chance for survival
is amputation.
Even though I knew it was only a movie, I really felt
uncomfortable during the amputation scene. I wondered
if the nonanesthesiologists in the theater had any
concept of what an arm amputation without anesthesia
would be like. Then the realization struck me —
this was real life before the 1840s and Crawford W.
Long, Horace Wells and William T.G. Morton. I left
the theater with a renewed appreciation of what anesthesia
is and what a gift the relief from surgical pain is
for humankind.
Anesthesia makes surgery and much of modern medicine
possible. It is easy to forget this fundamental truth.
We get wrapped up in the unpleasantness of the practice
— the unreasonable surgeon, the malpractice
insurance premium, the denied claim, the demanding
patient — and we forget the profound importance
of our vocation. We render our patients completely
defenseless in order to make them insensitive to pain.
And we do this so often and so well that we and the
public tend to take the gift of anesthesia for granted.
Only when things go awry does anesthesiology make
the headlines such as it has with the two recent deaths
at a prominent Manhattan cosmetic surgery hospital.
Bad outcomes are always a tragedy but particularly
when the tragedy is preventable. Senator Richard J.
Durbin (D-IL) recently spoke against tort reform on
the floor of the U.S. Senate. These are part of his
comments.
“ … [M]ore than twelve hours into labor,
the doctor decided an emergency C-section was necessary
and paged the anesthesiologist to come to the delivery
room. The anesthesiologist failed to return the
page and numerous pages after that.
“Finally, an hour after the doctor had decided
on an emergency C-section, the anesthesiologist
showed up, and the procedure began. The doctor discovered
that the uterus had already ruptured. The baby had
been without oxygen for 10 to 15 minutes. This baby
is quadriplegic and spastic. He cannot walk, talk
or feed himself and will require full-time care
for the rest of his life on earth. This baby had
no injury to his cerebrum, so he has normal cognitive
thought, meaning he thinks like a normal child but
is trapped in a body he cannot use.
“During the trial, a nurse working the night
of Andrew’s birth testified that the anesthesiologist
was with her in a private room on the hospital’s
fourth floor and that he ignored three different
pages to respond to this emergency C-section before
going to the fifth-floor delivery room …
Anesthesia is a gift, and we are its custodians. Tend
the gift with wisdom and integrity.
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