Douglas R. Bacon, M.D., Editor

Two E-Mails and a Joke

ecently, my neighborhood held its annual winter block party. It was my turn to host, and on a crisp, cold night, we gathered, mostly in my kitchen, to get caught up on each others’ lives. Winter tends to isolate the neighbors — no one stays out as long as in the summer unless there is a mound of snow to shovel. So, it was good to see everyone and talk about the little things that make a neighborhood. Two households had moved in just before the holidays, and it was fun to meet the “new” people and welcome them. All in all, the night passed quickly in quiet conversations between friends old and new.

Part of that conversation centered on movies. One of the senior members of the neighborhood is a big John Wayne fan and, like my dad, loves all of the cowboy films the actor made. Very few actors have come to be more strongly identified with the rugged original that is the American cowboy than John Wayne. For the true fan, there is always one movie, one role, that epitomizes both the actor and the character in our mind’s eye. For me, the American cowboy will always be John Wayne in “True Grit.” Rooster Cogburn, although a U. S. marshall, is a tough, determined individual who fights to see wrong made right. This character is as American, at least in our mind’s eye, as they come.

Our cowboy heritage gave us another image, that of branding. In the old west, before technology was created to track individual animals, and stealing cattle was big business, a heated iron permanently marked the skin of young cattle so that their owner would always be known as they roamed the open ranges. That idea, branding, has been taken over in our lexicon to mean ownership of a distinct area. ASA is about to embark upon a “branding” campaign in an effort to create a better image — ownership, if you will — of the activities that define our specialty.

Why is this necessary? The other day, one of our beloved transplant surgeons, Patrick Dean, told me the following joke: An anesthesiologist is returning home with his family from a vacation at Disneyland. The anesthesiologist is in coach. An announcement comes over the loudspeaker: “An anesthesiologist is needed emergently in first class. Is there an anesthesiologist on the airplane?” After a second announcement, the anesthesiologist identifies himself to the flight crew and is rushed up into the first-class section of the airplane. He is brought to the seat of a very distinguished-looking gentleman who does not appear to be in any distress. The anesthesiologist identifies himself and asks how he can help the man. The gentleman replies, “I’m the chief of surgery, and I’m having trouble reading my magazine. Will you adjust the light?”

The root of humor often holds some truth. As a resident, one of my very senior professors told the story of a recalcitrant surgeon for whom no anesthetic was ever adequate. One day, Dr. Terry noted that the operating room light was not focused in the wound and that the lack of illumination was a likely cause of the difficulties the surgeon was experiencing. Taking a moment to adjust the light, the case proceeded with far less aggravation. At the end of the operation, the surgeon complimented Dr. Terry on the excellent anesthetic he had just given. The point of this story to us residents was that there are many factors that make for a smooth-running operating room, and the anesthesiologist needs to be able to manage all of them. We were taught to be facilitators and, whenever possible, to do our job unobtrusively.

One of my colleagues sent me this Web site link: www.youtube.com/watch?v=xuZl9tRqjoQ. In it, a duo sings a song titled “The Anaesthetists Hymn,” which, at least to me, is one of the funniest parodies on anesthesia I have heard in a long time. Many of the elements of the day-to-day practice of anesthesiology that the tune pokes fun at are indeed perceptions of how the specialty is practiced. As a resident, I remember an unacceptable incident whereby a colleague was reading during a prolonged craniotomy. The rebuke was swift and certain, for how could the professional in the room watching the course of the anesthetic give his/her full attention to the patient when distracted by the printed word?

The perception of how difficult anesthesiology is to practice is lost on those outside of our profession. Clearly, the “Anaesthetists Hymn” points this out. The lines about occasionally checking the patient and intervening by giving some propofol hit home harder than we would like. What the parody implies is that we alter the anesthetic when we are forced to rather than when it is appropriate. An understanding of the cognitive process than underlies sound anesthetic management is difficult to impress upon our professional contemporaries — it is even more complicated to teach to the lay public. Our branding campaign will hopefully begin to address these issues.

Finally, the most disturbing description of our specialty was one I received on Christmas Eve. Purportedly from a medical student on a Hotmail account, the message contains the usual account of the lack of respect accorded to anesthesiologists. What was most disturbing was the accusation that somehow our reimbursement for our efforts made the practice of anesthesiology palatable. While physicians in general, and anesthesiologists specifically, are well paid when compared to the median income in the United States, we are also highly trained individuals who have spent a large part of our lives dedicated not to the dollar but to seeing that the anesthetic state and the accompanying surgery are as safe as is humanly possible. The arrogance of the e-mail, in which the medical student claimed to have learned anesthesia in three weeks and was unwilling to spend the four years necessary to begin mastery of the specialty, spoke volumes about the values this individual held. Anyone who views our care as superfluous and who feels that he or she has learned enough to provide safe care in three weeks has little to offer anesthesiology, and I would argue, any specialty.

In the end, the ASA branding campaign has a huge mission to accomplish. The perception of the specialty among physicians and those employed in the health care industry needs to change. Like the uphill battle we have fought on Capitol Hill — the battle to get our legislators to realize who we are and the importance of our issues — the branding campaign needs to change ingrained perceptions on a grand scale. When done well, the anesthetic goes unnoticed. When things go wrong, anesthesia often takes the blame. While our efforts often go unnoticed, the time has come to remove the barrel from our lamp and let the world know the importance of our daily task. We need to express the science that underpins the clinical application and demonstrate our commitment to making the anesthetic state as safe as possible, one anesthetic at a time. To do any less would denigrate the years of hard work by those who came before us and those who will follow.

— D.R.B.

Editor’s Note: Lest you think I have lost my sense of humor, I still laugh when I hear the “Anaesthetists’ Hymn.” I also fully realize, given the date and the e-mail address, that the message from the medical student could well have been someone of my acquaintance trying to “get my goat.”

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