Anesthesia Books In The News

This doesn't happen very often, but it occurred twice recently--reviews of anesthesia books. The first one was in the Wall Street Journal. "Anesthesia, The Gift of Oblivion and the Mystery of Consciousness" by Kate Cole-Adams seems to linger on the issue of intraop awareness. The author relates horror stories of patients who are wide awake during surgery and can feel everything.

As if that's not bad enough, Ms. Cole-Adams writes about subconscious awareness during surgery. These patients don't remember anything when they wake up from anesthesia but under hypnosis, they are able to recount words spoken by the OR staff while they are anesthetized.

Though the review was published two weeks ago, it just recently prompted a response from James Grant, MD, president of the ASA. You can read it in the published comments at the bottom of the article and also here on the ASA website. Naturally he defends anesthesiologists as diligent physicians who are looking after the patients' best interests and that any surgical recall is extremely rare, occurring in about one in ten thousand cases.

The New York Times also reviewed the same book from Ms. Cole-Adams but it also reviewed a second book, "Counting Backwards, A Doctor's Notes on Anesthesia," by Henry Jay Przbylo. This review was written by a neurosurgeon/author and is much more sympathetic to anesthesiologists than the WSJ article.

Dr. Przbylo is an anesthesiologist and he relates the history of anesthesia and how it has evolved. He uses the standard analogy of anesthesia as being similar to flying in an airplane. Most of the time the flight is uncomplicated and routine. Occasionally it can be harrowing and rarely fatal. But there is nothing the patient/flyer can do about it except lean back and enjoy the ride.

There you have it. Two books about anesthesia, one more sensational while the other one probably more educational and enlightening. Start off your new year right by reading two books about your profession instead of binge watching another season of "Game of Thrones." You'll feel better equipped to answer questions from your patients when they confront you about the fears of anesthesia.

What It's Like To Be A White House Doctor

Have you ever fantasized about what it would be like to be the doctor to the President of the United States? All the fancy dinners, the exciting overseas trips, and having inside gossip on the president and his staff? Well, a physician who was one has written a book about her experiences. Dr. Connie Mariano, physician to Presidents Bush, Clinton, and Bush, has written an account of her years working in the White House, "The White House Doctor: My Patients Were Presidents--A Memoir."  She tells a story of exhausting work schedules, frazzled nerves, and difficult noncompliant patients (presidents and their families).

Being a White House physician is not like having a normal doctor-patient relationship. Here, the patient outranks the doctor. The president may not follow her orders if it interferes with his tight schedule. Dr. Mariano recounts how she had to threaten Pres. Clinton with Mrs. Clinton's wrath if he didn't follow her doctor's orders to slow down when he had the flu. Mrs. Clinton also wouldn't follow orders when she developed phlebitis during an election year campaign and Dr. Mariano was forced to work around the malady instead of getting Mrs. Clinton to stay at bedrest.

Besides taking care of the president and his immediate family, she and her staff are available inside the White House for anybody who has a medical emergency. During state dinners it is the medical staff, who hover around the edges of the ceremonies, who may have to give a Heimlich maneuver for a choking foreign dignitary.They don't get to drink the champagne or partake of the finger food. Bummer.

Above all, the White House medical staff learned to stay away from the "kill zone". That's the immediate area around a president where somebody is most likely to get shot, either by the enemy or accidentally by the Secret Service. As Dr. Mariano says, "You can't treat the president if you are dead." I guess there is no glamor in presidential medicine either.

Life Lessons from Dr. Seuss

I've read hundreds of books to my kids. Some books I feel like I've read hundreds of times. One of my favorite books is "Oh, the Places You'll Go!" by Dr. Seuss. I would rank this book in his top three, right up there with "The Cat in the Hat" and "Green Eggs and Ham". It was the last book he wrote before he died, being published in 1990. And it is unlike many of his previous books.

"Oh, the Places You'll Go!" is a book about life and the choices we make. Here he returns to basic story storytelling. It forsakes almost all the gibberish that marred his later publications, which depended heavily on make believe words strictly for the purpose of forming a nonsensical rhyme, like "Gox" or "Yink" or "Gack" (All from "one fish two fish red fish blue fish" one of my least favorite Dr. Seuss books) From the very beginning it doesn't read like a children's book. Mature messages include passages like

"You have brains in your head.
You have feet in your shoes.
You can steer yourself
any direction you choose.
You're on your own. And you know what you know.
And YOU are the guy who'll decide where to go."


The book appears to foretell the travails of celebrity and warns of hubris and conceit.

"Oh, the places you'll go! There is fun to be done!
There are points to be scored. There are games to be won.
And the magical things you can do with that ball
will make you the winning-est winner of all.
Fame! You'll be famous as famous can be,
with the whole wide world watching you win on TV."

I used to think that page was about Michael Jordan, especially since 1990 was about the time when Jordan was at his peak. The illustration that goes with that page also shows a boy kicking a ball toward a distant basket. But now, I think the page is more appropriately about Tiger Woods. Because the very next page has this:

"Except when they don't.
Because, sometimes, they won't.
I'm afraid that some times
you'll play lonely games too.
Games you can't win
'cause you'll play against you."

Deep huh? Definitely not your typical elementary school book. This book has lessons that everyone can learn from. So as we start out a new year and new decade, pick up a copy of this book from the bookstore or library. Read what Dr. Seuss says about life, it's triumphs and challenges. And I'll close with a hopeful message from the end of the book:

"And will you succeed?
Yes! You will, indeed!
(98 and 3/4 percent guaranteed.)
KID, YOU'LL MOVE MOUNTAINS!"

Have a happy and prosperous new year (with or without health care reform).