Douglas R. Bacon, M.D., Editor

To Serve Them All My Days

s a first-year medical student struggling with the intellectual load of classes, labs and exams, I had one guilty pleasure. Each Sunday night on PBS there was a terrific miniseries titled “To Serve Them All My Days.” An adaptation of R.F. Delderfield’s novel, the storyline was that of a Welsh miner’s son, David Powlett-Jones, who had been field-promoted to the officer corps in the British Imperial Army in World War I. Among his fellow officers, drawn exclusively from the aristocracy before the war, Powlett-Jones is looked down upon as being somehow unworthy and only in his position because of the horrific casualties and the inevitable lack of male offspring of the peers of the realm.

Powlett-Jones’ combat experiences leave him “shell shocked.” Seeking employment after his military service, he was accepted as a teacher at Bamfylde, an elite private boarding school in West Devon. While not possessing a university degree, Polwett-Jones becomes one of the beloved teachers at the school. The series tracked his career from a fragile solder to the position of headmaster during the two decades between world wars.

Although now available on DVD, I have not watched it since the original broadcast. My memory has most likely romanticized certain parts, but the internal struggle to transform from an officer to a civilian, coupled with the memories of trench warfare, remains vivid. The lead character flirts with communism and realizes that he must prepare his students, as the 1930s progress, for another inevitable war. Throughout the series, he rails against the romantic notion of war as noble and notes the sacrifice made by the men of his generation.

More germane to anesthesiology, however, is the notion of service. Powlett-Jones dedicates his life to the students and to Bamfylde. It is the day-to-day caring for individuals — in the miniseries, the students, and, in professional terms, our patients. We need to take a moment to stop and consider our level of commitment. As physicians first and anesthesiologists second, there is an obligation to the patient that forms the core of our professional being. Stuart C. Cullen, M.D., writing in Anesthesiology in 1960 may have hit on the essence of what this means when he wrote:

[An anesthesiologist] who appl(ies) the basic principles of good medical practice... has no difficulty in identifying himself with the patient… before, during and after an anesthetic procedure. This is the physician who realizes that even though he may not have sole responsibility for the care of the patient, he is obligated to contribute everything he can to the patient’s welfare. This is the physician who recognizes that all therapy, including his, is designed to benefit the patient… the privilege of treating a patient can be earned only by consistent and assiduous demonstration of his professional skills day after day to individual patients and individual colleagues.¹

Dr. Cullen’s image of service to the patient and equally to colleagues — be they surgeons, operating room staff, nurses, nurse anesthetists or anesthesiologist assistants — remains a most vivid image. This is the very core of what it means to be an anesthesiologist.

Within the pages of this ASA NEWSLETTER, one form of service to both nation and patient is well defined. Military anesthesiologists have once again stepped into the chaos of war and found ways to better treat their patients. Read with pride how the difficulties of transporting critically wounded men and women were overcome. What anesthesiologist, pain specialist or critical care physician would have thought about the issues of automated infusion devices functioning at 30,000 feet? Who among us would have considered transporting critically injured and ill individuals halfway across the world?

Solving these impediments has allowed the wounded to get out of an unsafe environment and be cared for at a facility better able to accommodate their needs. But the individual anesthesiologists have served their patients well by being dedicated to one of the pillars of professionalism, the best interests of the patients. Like Powlett-Jones, they are serving with a dedication that goes beyond the ordinary and is an example that we should emulate.

There is, though, another side to military anesthesia often overlooked because of the strong attitudes and personal feelings surrounding the armed forces. Anesthesiologists in the armed services have been going out regularly to Third World countries on medical missions. Residents in the military look forward to this experience, as does the attending staff. It is a chance to provide anesthesia services in an austere environment, a chance to sharpen problem-solving skills and learn to give anesthetics without all the trappings of a tertiary care medical center. Lessons learned here translate to better care on the battlefield — but it also allows these military physicians to answer the call to provide health care to those in need.

Early in Operation Iraqi Freedom, Brian P. McGlinch, M.D., ASA director from Minnesota and an activated reservist, spoke to the Board of Directors about his experience at Walter Reed Army Medical Center. He spoke with passion about the soldiers and Marines he had cared for and to whom he had become attached. Transferred from Germany, many of these casualties were less than a week away from the sand of the Middle East. Clearly, Dr. McGlinch, like so many of the physicians working in and for the military, was moved beyond patriotism, beyond the traditional physician-patient relationship, to serve these brave people. Each author in this NEWSLETTER has that motivation.

The ASA House of Delegates approved a resolution to help those reservists maintain their active memberships while serving on active duty. It is a small reduction in dues, but in an instance of increased financial pressure on the activated reservist, it is a welcome relief. It is a small way our Society could help its members caring for those who are fighting on our behalf. It is another way ASA continues to serve its members — even a small minority doing very important work.
We, as ASA, have another opportunity to serve our brave men and women fighting for and maintaining our freedoms here at home. We need to make our voice heard in Washington, D.C. concerning issues related to the health care of the troops and our veterans. How a society treats those who are vulnerable speaks to its greatness. As a Society, we have spent millions of dollars and countless hours working political issues to the benefit of anesthesiologists. These endeavors are critical to the survival of our specialty — economically as well as politically. It is service well rendered by those charged with these duties.

Yet, personally, I would like to see us engage in another lobbying effort. The popular press is full of stories about returning veterans and their care, both physical and mental. The VA, which has done groundbreaking work on electronic medical records and health maintenance, needs additional resources to adjust to the demands of returning veterans. The needs of these young people are not the needs of the World War II generation, nor of the Korean and Vietnam vets, and there is need for flexibility within the monolithic system to adjust to the new demands these veterans are placing on the system. If we, as ASA, were to add in a talking point about improving veterans’ care during our annual trek to Capitol Hill this spring, would it not be the height of service to those who have given so much for us? And for one moment, we would not be talking about anything that directly benefitted anesthesiologists — just patients whom we decided to serve so long ago when we accepted the invitation to go to medical school.

David Powlett-Jones winds up serving the students of Bamfylde all his days. As physicians first, and anesthesiologists second, we serve our patients each and every day of our careers. Even when retired, many ASA members continue their tradition of service, always ready to come to the aid of those in need. Our military component has placed a new standard for service before us. We, as a professional Society and individuals, need to look to the next anesthetic as a service opportunity. To give our best each and every day, serving our patients and the staff around us, is the mark of a professional. To set our sights on the good of the specialty as a whole, and health care globally, goes beyond the simple definitions of professionalism. To make the effort to change health care delivery in a meaningful way will leave a lasting mark upon history. We are at a juncture where it is possible to change elements of health care and leave evidence for posterity that we were professionals first who were able to disengage self-interest for the greater good.

What will you do? Are you willing to take up the examples of our military colleagues and the fictional David Powlett-Jones?

— D.R.B.

Reference:
1. Cullen SC. Attitudes and practices. Anesthesiology. 1960; 21(3):322-323.

return to top