Douglas R. Bacon, M.D., Editor

Christmas Lessons for Anesthesia From Dickens and Schultz

ach year the holiday season just doesn’t seem complete unless I have read Charles Dickens’ A Christmas Carol and watched the Peanuts special A Charlie Brown Christmas. The first tradition began in medical school — exams were over, and while waiting for the inevitably delayed flight back to Buffalo from LaGuardia, it seemed a perfect time to read. The words of Dickens are special and conjure an image that only Patrick Stewart has come close to conveying on either the big or little screen.

A Charlie Brown Christmas is a personal tradition that dates back to my early childhood. I have watched the show for almost the entire 40 years it has aired, and I was even given the VHS tape a number of years ago as a present. Yet both Dickens’ classic tale and Charles Schultz’s animated special have lessons to teach us.

Scrooge, a mean spirited man, is the central character in Dickens’ work. His transformation from miser to philanthropist covers the entire novel. In the course of events, Scrooge is shown how his love of money has denied him many of the joys in life, including a caring wife and family. His poor assistant, Bob Cratchit, lives in misery, with a small son who is handicapped. It is Tiny Tim who tugs at the readers’, and ultimately Scrooge’s, heartstrings. The fear Scrooge feels at seeing his future, unmourned, unloved and unknown, is the final blow that changes him. The world around him changes as well, and I’ve often wished I could be present to see the look on Mrs. Cratchit’s face when the turkey is delivered to her door!

There are those in anesthesiology who resemble Scrooge. Three years ago at the Annual Meeting, a special reference committee was convened to hear testimony about a possible change in reimbursement methodologies. The committee met all afternoon until everyone who wanted to have a say was allowed to speak his or her piece. The conclusion was that anesthesiology should not change its cost computation methodology, although the use of time in our equation has caused much concern with the Centers for Medicare & Medicaid Services (CMS) and other private health insurers. The idea of eliminating time remains one of the most cherished beliefs in the anesthesiology community. Yet is it a chain that weighs us down, like the chains Scrooge was forming as his former partner Jacob Marley showed him?

What if we eliminated anesthesia time? Would we no longer be the nail that sticks out, needing to be hammered down by CMS? Would we not fit better into the house of medicine, like the renewed Scrooge fits into Victorian England? Are we so wedded to that which we have done that change is impossible? While this issue is not on the forefront of any political agenda at the moment, it shall return. How we as a specialty address this issue will have a lasting impact not only on our economic viability but on the survivability of our unique practice in the future.

The ASA Political Action Committee (ASAPAC) could benefit from a reformed, or Christmas morning, Scrooge. Alabama once again won the race for greatest support of the PAC (see page 18). Hard work by individuals in Alabama, educating their members to the issues and the need for the specialty to address those issues at all levels of government, opened purse strings and helped ASAPAC to grow. In this season, even though our current election cycle is complete, there remains a great need for our ASA members to contribute again. We need to rebuild our PAC coffers and be prepared to face the multitude of challenges the coming year will bring. Yet without a renewed spirit of generosity, like Scrooge on Christmas morning, we will not have the resources to fight as effectively as possible.

So how does A Charlie Brown Christmas fit into all of this?

One of the recurrent themes of the television special centers around a Christmas tree. Charlie Brown and Linus Van Pelt leave the other children at the schoolhouse and go to find a tree. Contrary to the opinions of his peers, Charlie Brown picks out a small, scraggly little pine tree. When he brings it back to the school house, he faces the derisive laughter of his contemporaries. Taking the tree home, he attempts to trim it with one of the ornaments from Snoopy’s award-winning, gaudy doghouse decorations. The tree bends over, and Charlie Brown believes he has killed it and walks away. The children who made such fun of him at school come, and with Linus’ “a little love,” they transform the “dead” wood into a beautiful Christmas tree.

If for a moment we can liken anesthesiology to Charlie Brown’s tree, some interesting introspection occurs. What is essential to the specialty? What are the limbs of our “tree”? Are we bending with the weight of the changes imposed upon us, or are we breaking? Can we transform ourselves into a beautiful symbol for the house of medicine? What is the “love” that is needed to make anesthesiology all that it can be?

At the moment, anesthesiology is under siege from a number of sources looking to strip the needles from the tree. As John P. Abenstein, M.D., points out in his “Administrative Update” on page 3, sedation practice is slowly eroding away some of our traditional practice. CMS continues to apply the teaching rule, which unfairly penalizes academic departments so critical to the next generation of anesthesiologists and the future of the specialty. Our relationship with organized nurse anesthesia remains one of caution and concern. Our part of the National Institutes of Health research dollars is less than our proportion of practicing physicians. Research holds the key to the next generation of innovations in the practice of the specialty.

Yet, like the tree in A Charlie Brown Christmas, there is “a little love” and many helping hands to create a beautiful Christmas tree. We have four large beautiful ornaments, our foundations. The support for their endeavors has never been stronger — if the recent 100th anniversary Gala is any indication. The house of medicine has tried to imitate our innovation, the Anesthesia Patient Safety Foundation. We have many bright lights on the tree. Our journal Anesthesiology remains the premier journal of the specialty. We are active in providing critical care and pain medicine to patients everywhere. Indeed what other medical specialty is dedicated to the relief of pain and consequently suffering in the operating room, pain clinic and intensive care unit? We have much to be proud of in our daily practice.

As this holiday season is celebrated, and as we approach the new year, it is a time to reflect upon where we as a specialty have gone and where we should be traveling. Our leadership is strong, not only within the ASA officer corps and the ASA staff, but among the rank-and-file anesthesiologists of the Society. Rejoice in the triumphs of the year, however small, and look toward next year with renewed hope. It is all of us working together, like the chorus at the end of the Peanuts special, that will make the transformation complete. Anesthesiology, often thought of as the scrawny tree within the house of medicine, has become the beautiful Christmas tree. Let us dedicate ourselves to continuing this tradition each and every day in the coming year — just as Scrooge promises to keep Christmas in his heart each and every day.

— D.R.B.

return to top