2016 Covers & Artwork

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December 2016, Volume 123, Issue 6

This month's cover transports us to the perplexing world of hemostasis monitoring. The image epitomizes our limited capacity to measure an extraordinarily complex process with an overwhelming number of moving parts. Despite our best technology we have yet to advance beyond simply ascertaining the time it takes for liquid blood to solidify. Articles contained in this issue will begin to explore concepts that breach this perimeter and advance our current knowledge.
Naveen Nathan, MD
Cover Editor and Illustrator
 

November 2016, Volume 123, Issue 5

This month's issue invites readers to immerse themselves in the discussion of anesthetic mechanism. Decades of work have resulted in our basic understanding of the role of monovalent anionic influx through the putative inhibitory receptor in the central nervous system. Contemporaneous work uncovers the veil further to expose a multitude of working constructs ranging from indiscriminate intercalation into neuronal membranes to stereospecific modulation of both excitatory and inhibitory effectors. What this cover might look like several decades from now is as uncertain as how exactly our patients descend into sleep.
Naveen Nathan, MD
Cover Editor and Illustrator
 

October 2016, Volume 123, Issue 4

Fans of Goya's The Sleep of Reason Produces Monsters will instantly recognize this month's cover. Little more than the slumped over figure is retained from the original 1798 etching yet both iterations reflect the nightmarish onslaught of forces beyond our control. In the original artist's case, creatures of the night likely stand in for political suppression. In this journal the would-be tormentors transmogrify from a subject's psyche heavily influenced by opiates.
Naveen Nathan, MD
Cover Editor and Illustrator
 

September 2016, Volume 123, Issue 3

The formidable challenge of chronic pain management is often cast through a lens with a medium range of focus. We often do not appreciate the enormous burden it places on a more expansive, societal level. Its impact can reverberate as much into the realms of socio-economics as it can psycho-social well-being.
As such, a planet earth ensnared in the tenacity of barbed wire seemed an appropriate choice for this month's cover. The global burden of chronic pain has challenged everyone from the clinician to the bench scientist who, in this image, has traded in a microscope for a telescope for the long view. It is this panoramic vantage point that defines the true cost of chronic pain.
Naveen Nathan, MD
Cover Editor and Illustrator
 

August 2016, Volume 123, Issue 2

Open any reference text on anesthesiology to the chapter on volatile agents and without exception the priority of organ system effects is consistent: cardiovascular, respiratory, neurologic, etc. This is predictable since much of anesthetic practice is characterized by rectifying the problems that arise from the very anesthetics imposed. Do we then define success by shepherding patients through the treacherous course of apnea, hypotension, and paralysis? Our true impact may in fact lie in the obscure changes we invoke on the immune system, no less than that which holds the ultimate sanctity of patient well-being and fitness. The cover image captures the moment at which volatile agents meet head-on with an unsuspecting neutrophil forever reshaping its fate.
Naveen Nathan, MD
Cover Editor and Illustrator
 

July 2016, Volume 123, Issue 1

Fans of the steampunk movement will no doubt appreciate this month's cover artwork which realizes vaguely familiar cardiac anatomy in a blatantly mechanical context. Modeled loosely after a V-twin motorcycle engine, the industrial-strength heart is as much at home representing a journal of scientific investigation as it is a creature born of Mary Shelley's imagination.
Given our sometimes oversimplified notions of cardiovascular integrity and injury, the decision to reduce a biologic phenomenon (perioperative myocardial stress) to a purely mechanized construct was intentional. It explicitly questions if we are little more than the instantaneous summation of vehicular performance versus redox imbalance. We are, of course, so much more, and yet have leagues to go before we find out by just how much.
Naveen Nathan, MD
Cover Editor and Illustrator
 

June 2016, Volume 122, Issue 6

We assume that study subjects are cloaked safely in the anonymity of a multilayered and hyper-processed transposition; one which begins as a tangible patient experience and ends with the banal existence of a digital spreadsheet cell. Though we would ideally prefer our patients to transgress dark matter and emerge as their unrecognizable constituent parts, current scientific methods may not assure the dissolution of identity. This month’s cover is a reminder: not so much that patients live behind the questionably opaque curtain of data, rather they are the data.
 

May 2016, Volume 122, Issue 5

Readers of Anesthesia & Analgesia may find themselves inexplicably subdued by the spell of déjà vu. Only but one year ago the journal asserted with certain conviction that the qualifications of the individual were a direct forecast of patient outcome. At the time, the cover image likened the patient experience to that of a veritable “luck of the draw.” This month, we revisit and deconstruct our conclusions. Utilizing no more than the fixed focal length of the editorial lens limits our full comprehension and cripples the greater broadcast message. Accepting the multifocal vantage points of a crowdsourcing community allows us to embrace differing perspectives with humility. It gives science a conscience. The journal’s commitment to integrity in reporting is underscored by revisiting the discussion as nothing less than the lead article this month. Correspondingly, the cover reflects the healthy skepticism that lives between an ace of spades and a wildcard.
Naveen Nathan MD
Cover Editor and Illustrator
 

April 2016, Volume 122, Issue 4

This month's cover derives expressly from the profiled article in which we explore our true value in the world of outcomes-based care. A fairly simple plot casts forth resources and observes how quality in turn predictably behaves. Critical appraisal of this relationship allows us to reach a seemingly observable optimum on this curve. However the actual value of our craft has yet to be realized because it stands in defiance of any one true definition.
Naveen Nathan MD
Cover Editor and Illustrator
 

March 2016, Volume 122, Issue 3

Thematically, the article collection contained herein casts its lens on disparities in health care. The contributing authors address everything ranging from the asymmetry of access to critical anesthetic drugs to unbalanced drug quality standards that track with socioeconomic strata. The White Rabbit (mixed media on board) plays to the core affair of inequality. It entertains no less than 8 metaphorical overtones related to the journal's subject matter, which would consume far too much real estate to describe in this margin. The reader is encouraged to (most importantly) read and process the cover articles and secondarily muse over what messages the cover attempts to echo.
Naveen Nathan MD
Cover Editor and Illustrator
 

February 2016, Volume 122, Issue 2

This month's cover unapologetically laments centuries of discrimination and spilled blood that saturates and stains the history of our social evolution. Our delusions that even the purest and most righteous of professions is immune to such racial bias is underscored by yet one more account herein. Although this month's lead article illustrates racial disparity very specifically in the context of obstetric anesthesia, the lens is pulled back to consider the issue comprehensively. The journal's cover article and editorial thematically echo a long-surmised notion: that from the standpoint of racial justice, the treatment of minorities in the grim periphery of our society to within the sanctity of an operating room is less of a polarity than we think. Regrettably, it may be a continuum.
Naveen Nathan MD
Cover Editor and Illustrator
 

January 2016, Volume 122, Issue 1

Old-world puppet theater reflects just how antiquated it may seem in the face of current technology to be manually administering powerful anesthetic drugs to ill-defined endpoints.
Against the backdrop evocative of the passage of time, our patient descends into sleep while a powerful figure, an overseer of her consciousness, inundates her with hypnotic elixir.
The background is part of a larger, original work in wax color on board. The inset line drawings attribute to D. Rose, Edited by H. W. Dulcken: “Popular History of Rome, A” (1886) and Hone, William: “Hone’s Everyday Book” (1826), both of which may be found at fromoldbooks.org.
Naveen Nathan MD
Cover Editor and Illustrator