Counting Backwards

Counting Backwards: A Doctor's Notes on Anesthesia

Henry Jay Przybylo, M.D. (W.W. Norton, 2018)

     Anesthesia is a mystery, even to its practitioners. Dr. Przybylo (who goes by Dr. Jay around the hospital) has administered anesthesia over thirty thousand times over his career, and he doesn't exactly know how the gas he uses does what it does. "Despite decades of research, its mechanism of action remains a mystery. I must have faith in my anesthesia gas." He has faith, as well, in his experience; and in his preparation, which is invariably meticulous. A mistake he made in his first year of practice, when he picked up the wrong syringe, led him to work out a standard approach to setting up his operating area. "The basic needs must be within an arm's reach and not concealed in clutter. The anticipated is one step away; the potential, another step beyond."

     From this cockpit, Dr. Jay manages the drugs, both gaseous and intravenous, that render the patient insensible and pain free, to make surgery possible. He has drugs to dispel anxiety, prevent the formation of memory, stop pain, and prevent movement. At the same time, he has to keep tabs on the vital signs of the patient: he doesn't want to suppress the heart rate, blood pressure, and breathing of the patient too much. Depending on what the surgeon is doing, the body may respond with lulls or surges, and the maintenance of stability may require anticipation–verging on art–from the anesthesiologist.

     Because Dr. Jay specializes in the care of children, he has need of a few other arts. While an adult may understand that she needs a shot to begin the process of anesthesia, a child will probably see that as unacceptable. "Since every step taken toward a procedure room increases the anxiety of my patient, my goal is to shorten or disguise the time from that first step until my anesthesia coma is induced. Distraction is a major tool, and maintaining an ability to distract keeps me young, or at least requires that I stay current and informed."

     Indeed, he seems to be a lifelong learner on many fronts. He studies what the other people in the operating theater are doing, learning the rhythms and habits of the surgeons he works with. He understands cardiology, cancer, and diseases of the lungs. He has learned more and more about preventing post-operative pain, and has improved the way he speaks to people he isn't sure can understand him.

    Dr. Jay has a deft touch with the history of his field, from recreational ether to sonar-assisted lidocaine shots. He's also very good with simple explanations of how things work, and what kinds of things can go wrong. But what really makes me recommend Counting Backwards are the lessons that all of us could use. Setting up his space the same way every time, for example, is critically important to working as efficiently as possible; at the same time, it's an exercise in mindfulness, a way of preparing himself from the inside out.

   Thus prepared, he makes the machinery an extension of himself, and, seemingly, vice versa. But he doesn't fall into the machinery completely. No matter how long the procedure goes on, he prefers to stand up and watch over the drapes, rather than sitting down. "Far too often, when the readings waver, all eyes home in on the monitor screen. I've resorted to placing a towel over the screen to stop residents from watching it instead of the patient." As long as the patient is a human being, the doctors have to be, too.

Any Good Books published by email,

March 1, 2019