Editor’s Note
To the Edge and Back
“You saved my life.” Anybody who has practiced medicine for any length of time has heard those dramatic words. Although I frequently think the comment is the result more of perception than reality, it is true that our patients sometimes walk the precipice between life and death and that sometimes we successfully yank them back. But occasionally, we put them on that cliff only to, we hope, pull them back to safety.
I remember the first time I participated in the cardioversion of a patient with atrial flutter. Clearly, the patient needed to be “rescued” from the rapid heart rhythm that was causing his dropping blood pressure and shortness of breath. Yet, I shuddered when, after the electrical shock was applied, his EKG showed a flat line for what seemed like an eternity. Finally, his heart kicked in with a normal rhythm that restored his blood pressure and cleared his symptoms. A few seconds of jeopardy followed by a “save.”
Luckily, primary care internists don’t have to endure too many of these heart-stopping, anxiety-riling, gray-hair- promoting moments. But for anesthesiologists, this is their daily fare. Consider what happens with general anesthesia: A conscious and alert person lies down on a bed and allows a masked person in a funny-looking shower cap, whom they just met, to place them in a state of deep sleep for the next minutes or hours using toxic chemicals. They trust that this same person will have the skill, knowledge, and inclination to wake them up and restore them to their previous self. A recent New England Journal of Medicine review of the physiology of general anesthesia put it in stark terms: “At levels appropriate for surgery, general anesthesia can functionally approximate brainstem death, because patients are unconscious, have depressed brain-stem reflexes, do not respond to nociceptive stimuli, have no apneic drive, and require cardiorespiratory and thermoregulatory support.”
Placing a patient in a state of brainstem death is quite a responsibility. So it’s no wonder that anesthesiology has been at the leading edge of the patient safety movement. Long before “patient safety” was the buzzword it is today, anesthesiologists borrowed lessons from the airline industry and looked at what they did each day, analyzed when and why things went wrong, and built systems to prevent things from going wrong. Those systems have cut the rate of complication and death associated with all forms of anesthesia, which should make patients a whole lot more comfortable with that doctor behind the mask.
Increasingly, those masked doctors do a whole lot more than put people to sleep. Using ultrasound to find nerves long since forgotten from anatomy lessons, they administer innovative regional anesthesia, which minimizes narcotic use and shortens recovery time. The mushrooming of outpatient procedures has forced anesthesiologists to adjust and adapt, retooling the education of students and residents and bringing their equipment and skills into new environments such as interventional radiology suites and pain clinics.
Part of the drama of saving lives is the very undramatic focus on patient safety. Whether they are sitting in the OR squeezing the bag or in the clinic tackling pain, anesthesiologists will continue to teach, preach, and practice safe medicine.
Charles R. Meyer, M.D., editor in chief, can be reached at cmeyer1@fairview.org