LET us go then, you and I,
When the evening is spread out against the sky
Like a patient etherized upon a table:
These are the first three lines of T.S. Eliot's poem ‘The Love Song of J. Alfred Prufrock,’ published in 1915. Ever since I first read the poem I have wondered why he entrances us with the first two lines and then, blam!, hits us in the face with the mundane image in the third. I have searched widely for an explanation why he used that particular image. Later in ‘Prufrock’ Eliot writes,
It is impossible to say just what I mean.
This just reflects his inherent modesty. In this essay I intend to show that Eliot did know just what he meant. In retrospect it seems he found in me an understanding reader, or, for that matter would have, in any Board-Certified anesthesiologist he met.
Eliot died on January 4, 1965 and was cremated the same day at the Golders Green Crematorium in London, about a quarter mile from Golders Green Station on the Northern Underground line. That is where I changed from train to bus on my way home from work at the Middlesex Hospital. Instead of mounting my usual number 83 bus, an incomprehensible force compelled me to walk to the Crematorium. That afternoon I had read of Eliot's death in the Evening Standard.
Polished hearses hovered there, polluting the front courtyard. They disturbed me, so I walked through an archway into the quiet rose garden behind the crematorium. The rose bushes had been pruned down for the winter but already showed signs of renewed life. A gardener whom I asked told me Eliot had just been incinerated.
In life Eliot was known as a reticent man but as his volatile remnants drifted out of the brick tower and far away across the damp sky his soul, which had remained behind, spoke to me.
I heard Eliot say that ‘Prufrock’ was intended as a paean to anesthesia. Its subject was the escape from the agony of surgery. It seems hard to believe that none of the literati whose writings I consulted could have revealed this. But none of them had undergone the wrenching experiences anesthesiologists, surgeons and their patients have, and that Eliot understood completely. In Prufrock anesthesiologists will find the truth about our practice that Eliot intended with that third line.
For example, further in the poem he says,
In the room women come and go
Talking of Michelangelo
That is, our predecessors felt excluded, just looking in. This metaphor reflects anesthesiologists' struggle for status and recognition in the medical firmament.
In the poem's fourth stanza Eliot encapsulates the history of our specialty. It is evident he is talking of the time between October 1846 and now with a profound understanding of our everyday work lives when he writes:
Time for you and time for me
And time yet for a hundred indecisions
And for a hundred visions and revisions
Before the taking of a toast and tea.
Earlier in the poem he addresses the importance of anesthesiologists acting as perioperative physicians:
Oh, do not ask, ‘What is it?’
Let us go and make our visit.
Eliot understood the distress felt when reading the scheduling white board attached to the O.R wall at 6.30 AM, finding one has been assigned to the M.R.I. room far from the Main O.R., and help.
And when I am formulated, sprawling on a pin,
When I am pinned and wriggling on the wall,
His insight into our daily lives is astonishing; for example he appreciates the significance of doing a 15 h neurosurgical case with little hope of more than a single brief caffeine-break:
For I have known them all already, known them all:-
Have known the evenings, mornings and afternoons,
I have measured out my life with coffee spoons;
Eliot is aware of the horrid realities of taking in-hospital overnight call and of having to eat hospital cafeteria food. He is so distressed by this that he is only able to describe it in poetic terms:
The muttering retreats
Of restless nights in one-night cheap hotels
And sawdust restaurants with oyster-shells:
With his last stanza Eliot transcends these irksomenesses by revealing the glory and satisfaction our specialty provides. In this coda he describes the feelings of the patient, waking in the recovery room. The patient ‘drowns’ in the ecstatic understanding that with our care she has survived the surgery:
We have lingered in the chambers of the sea
By sea-girls wreathed in red and brown
Till human voices wake us, and we drown.
© 2011 American Society of Anesthesiologists, Inc.