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2014 Covers & Artwork

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October 2014, Volume 119, Issue 4

The cover photograph is meant to symbolize the stark contrast between the highly technical models that describe front-end kinetics of intravenous anesthetic infusions, and their immersion in highly dynamic, real-world scenarios. Despite the extraordinarily elegant descriptions that characterize the rise to steady-state plasma and effect-site propofol concentrations, the sands of time do indeed funnel towards a critical sinkhole at the bottom of which lies the syndrome of airway obstruction. This month the journal offers yet another vantage point to reflect on our understanding of this unwelcome relationship.
Naveen Nathan MD
Cover Editor and Illustrator

September 2014, Volume 119, Issue 3

The invaluable articles contained in this month's journal observe the complex, multilateral interpretations of the literature related to outcomes between regional versus general anesthetic techniques. The Certainty of Doubt (51cm X 76cm acrylic and wax color on board) offers a tongue-in-cheek impression of this perpetual contest. A reptilian conglomerate of strategically arranged general anesthetic equipment emerges from the shadows. Its adversary, armed with the mother of all epidural needles lowers his weapon and sheds his shield in a state of reflection. He wonders if there can ever be a true winner in this duel.
Naveen Nathan MD
Cover Editor and Illustrator

August 2014, Volume 119, Issue 2

The Birth of Melancholia (35cm by 28cm, acrylic and wax color on board) was created to illuminate the darkest adaptations of a postpartum reality.
For some, the most romanticized version of childbirth mutates into dense saturations of despondency. The afterglow of childbirth is replaced by the wistful spirit of one who has lost the sanctuary of coherence. As all the order of linear thought disarticulates into inexplicable guilt and self-loathing, women are far too often left to languish as prisoners of their own minds. A host of metaphors and allusions is meant to capture this disharmony, the most subtle of which includes hidden pharmacophores known to influence mood disorders. Fragments of biogenic amines and steroidal hormones can be found woven into the web that binds the mask to the figure.
Readers of this journal likely have a comfort zone defined by the amelioration of physical pain. We are now encouraged to expand our intellectual orbit such that our patients' emotional suffering may yet someday meet with its conquest.
Naveen Nathan, MD
Cover Editor and Illustrator

July 2014, Volume 119, Issue 1

There is arguably no work of art more recognizable and misunderstood than Grant Wood's American Gothic. So amenable to parody is this work, many versions of which have graced the covers of everything from TIME magazine to cult horror films, that its true artistic value lies in its ability to reach such expansive latitudes of alternative representation. Herein is presented another reincarnation and one devoid of any frivolity and mirth. In fact the image conveys two alternate realities that evolve in the aftermath of intraoperative awareness and recall.
Both figures have endured awareness under anesthesia. The woman, despite her look of consternation, represents a sense of resilience sufficient to overcome the psychological devastation of posttraumatic stress. The male figure, on the other hand, is held captive by it. An editorial by Drs. Mashour and Avidan offers an illuminating contextual framework for the cover article and all are encouraged to receive its lessons.
Naveen Nathan, MD
Cover Editor and Illustrator

June 2014, Volume 118, Issue 6

On this month's cover the camera's shutter has caught a glimpse of the first droplet of allogeneic blood piercing through the surface of saline within a drip chamber. In doing so, a displaced, upsurging wavefront billows forth. The juxtaposition of blood against saline could not be more ironic visually. The calm, transparent quality of routine intravenous fluid attains a sense of order bordering crystalline geometry; all of which becomes disarticulated with an opaque scarlet incursion. The journal's cover image captures not only this physical event in a literal sense, but also that absolute, instantaneous moment when we transform into the role of a tranfusionist. That critical decision similarly sets forth a current of risks, responsibilities and expectations, all of which may be perceived variably depending on the lens used.
Naveen Nathan, MD
Cover Editor and Illustrator

May 2014, Volume 118, Issue 5

Patient safety has been at the forefront of our motivation as anesthesiologists and to this end we have evolved admirably in our stewardship. We stand now on the fringe of addressing something even more imposing. This month's issue of the journal focuses on the perioperative surgical home.
In addition to patient safety and contemporary, evidenced-based practice, we are forced to reconcile the economics, temporal scale and medical stratification of patients in the grander scheme of perioperative care. These are forces that coalesce to create something far greater than the sum of their respective parts. One does reflect on the fractured, almost entropic approach that has characterized this process thus far. The unification and validation of these forces reflects a sense of order evoked by a solved Rubik's cube. It is certain that deciphering the riddle of this classic puzzle confers the kind of satisfaction we hope to achieve in the comprehensive care of the surgical patient.
Naveen Nathan, MD
Cover Editor and Illustrator

April 2014, Volume 118, Issue 4

Our last hand-off, gently bidding our patient farewell from life, may be our most important. Anesthesiologists, critical care physicians and pain management specialists are uniquely poised to ameliorate suffering, promote autonomy, and provide guidance at the time of their patient's death. When death arrives, as it must for all of us, our medical skills can comfort the patient and prepare the family.
Predicated on the topic of death, it may seem entirely appropriate to invoke the style of Edward Gorey for the journal's cover art. Readers who grew up watching public television's Mystery! series know his work from the animated introduction. Gorey's Edwardian style, although macabre, was not overtly morbid. The brief narrative accompaniments to his images teasingly amplified the grim innuendo. His work typified the mainstream conceptualization of death, vilifying death as the endpoint of human decay.
Cast aside any illusions that the journal's cover panders to the same. Our cover aims to turn our instinctive and conditioned response to mortality on its head. Death appears as a dimensionless entity. It casts no shadow. It transcends time, hence the closed pocket watch. It even brings an umbrella! Death illuminates the dying figure, as the light of the living world fades. Death arrives to provide safe passage for life’s final transition.
Naveen Nathan, MD
Cover Editor and Illustrator

March 2014, Volume 118, Issue 3

Our parturient is contemplative about the poppy plant. She sits high atop a giant serpent reflective of both the somatic (barbed spine) and visceral (unrelenting coils) pain of labor, seemingly unreachable and beyond our capacity to treat. What at first appears to be butterflies are under closer scrutiny the gray matter cross sections of the spinal cord encircling the figure, just out of reach and beyond our conquest. One of them has fully matured into a cherub, a promise of salvation, though it is yet blindfolded, hence compromised. The fainting couch on which she languishes in combination with the umbrella allude to the piperidine and phenyl rings respectively of synthetic opiates. Lastly, hidden in the folds of her gown are the classic and all-too-familiar context-sensitive half-times of fentanyl and its congeners (shown in the inset).
Naveen Nathan, MD
Cover Editor and Illustrator

February 2014, Volume 118, Issue 2

Without warning the sleeping menace awakens. Malignant hyperthermia is amongst the most formidable clinical crises to be contended with in the operating room. On this month's cover we peer down from the cytosol into the sarcoplasmic reticulum through the recoiling subunit gates of an incensed ryanodine receptor. What ensues is well known to us: a powerful and unbridled release of calcium that will send skeletal muscle into a state of metabolic overdrive. This month's issue aims to further illuminate what we know about this dreadful foe.
Naveen Nathan, MD
Cover Editor and Illustrator

January 2014, Volume 118, Issue 1

This month’s cover may seem to be a curious departure from the imagery expected of a refined scientific journal. Rather, it could theoretically stand in as the jacket for the latest crime novel on the best-seller’s list. Indeed there is nothing evocative of any concept remotely related to medical science. Yet, in considering the dissemination of scholarly knowledge, the quality and moral standards of our discourse are inextricably woven into the substance of scientific investigation. One may build, elaborate on, and further characterize a foundation of intellectual property, but at what point does it become their own? This question is raised in every elemental thread of humanity from the arts (consider ironically the November cover of this journal) to scholarly literature. The Journal acknowledges with appreciation the contribution of the Committee on Publication Ethics for the guidelines they developed on plagiarism, and the contributions of the current and a former chair of COPE to the editorials accompanying this issue.
Naveen Nathan, MD
Cover Editor and Illustrator