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Laughing and Crying About Anesthesia: A Memoir of Risk and Safety

Zaidan, James R. MD, MBA

doi: 10.1213/ANE.0b013e31826bb2d5
Book, Multimedia, and Meeting Reviews: Media Reviews

Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia,

Conflicts of Interest: Dr Zaidan is the current Chair of the FAER Board of Directors, and some portion of the revenues derived from the sale of this book accrue to FAER. The foreword of the book explains this relationship.

Laughing and Crying About Anesthesia: A Memoir of Risk and Safety is on the surface an autobiography, a tale of the personal growth of an anesthesiologist who, as a professional, accepted social responsibility. The book is also an intertwined story of our medical profession that challenges or even dares other disciplines to become as safe as anesthesiology. According to the author, “the book is intended for the interested nonmedical reader … that is not to forbid anesthesiologists and other medical persons from ‘looking inside.’” The book is a fun read written by an anesthesiologist who lived through many transitions in our field. I recommend reading this delightful recollection of events that highlight the road to anesthesiology’s reputation as the safest specialty in medicine.

While in medical school, Dr. Zeitlin witnessed a series of pulmonary-related complications that began to lead him toward anesthesiology. We are fortunate that he made this decision. His colorful descriptions of life’s bad days are entertaining, evoking at least a snicker, but also makes us feel Dr. Zeitlin’s pain. In one example, “As I entered a roundabout on the North Circular Road I did the proper mild centrifugal lean but this time, skidded and fell. As I lay there in the wet gloom, briefly stunned, yet intrigued by the iridescent colors in the oil slick on the road that had spilt me, unseeing cars nearly ran me over.” In describing his own need for an internal cardioverter defibrillator he says, “The way things are going, there’s a risk I might live forever. What a mess.” The descriptions of his bad days and of his personal worries about his patients bring a very strong human aspect to the book. He uses appealing lay explanations such as the ones used for the iron lung versus positive pressure ventilation during the polio epidemic in the 1950s that drew even the experienced anesthesiologist (the “consultant” in England) into the paragraph. For instance, “If the handles of your bellows have broken off, that is, the muscles of breathing are paralyzed, there are only two remedies. … Place the bellows inside an airtight box with only the nozzle protruding into the atmosphere and arrange for a pump to cyclically suck the air out of the box. That, in turn sucks air through the nozzle into the bellows.” He goes on to explain positive pressure ventilation using the same terms, which would be easily comprehended by the lay public. What he achieves by using these earthy explanations is an informed lay public that will now begin to understand and appreciate the extent of the knowledge and insight of physicians in anesthesiology. His personal asides such as “Gobbledygook is a brilliant American invention,” and his description of a “patient covered in a lasagna of blankets” forces the snicker to become a full-fledged smile, and his tangential zinger about the Afghan war startles. Dr. Zeitlin also talks about knowledge that all of us gain over time: When a patient hears the word “surgery” or “operation,” their minds switch off. Dr. Zeitlin thinks, “The permit [consent] in no way comforts me. If I do not trust my doctors what use are written permits?” Then he goes on to say in what I now call “Zeitlinian language” … “[permits] are the invention of that devil, the hospital’s lawyer.”

Chapter 14, “Some Surgeons,” presents an interesting viewpoint on how to manage personalities, the difficult ones that all of us see daily in our operating rooms. One surgeon was described as impossible and Dr. Zeitlin decided to smother him with love. It worked. Read this chapter for his insights about getting to know your colleagues. In a non-chapter called an Intermission, “Cast a Deep Sleep,” Dr. Zeitlin struggles with the definitions of sleep and anesthesia. Get ready, however, to break out a copy of the Old Testament and read several verses of Genesis. Incidentally, the first anesthetized patient at the Massachusetts General Hospital felt some scratching but not pain. Was he partially asleep?

What Dr. Zeitlin really does in this book is to provide those who did not live through the transition of anesthesiology to the Six Sigma environment a history of the struggles involved in these changes. He starts with the controversy about chloroform and the extensive period of time it required to make proper changes around its use, based on accumulated evidence, and brings the reader to the present time. Along the way, he talks about anesthetic agents, lawsuits, dank operating rooms, conducting cases without close supervision, difficult airways, and reasons why patients die. Sprinkled throughout the book are social comments that briefly slow the speed-reader while accelerating the thoughts about the issue, case in point, prenatal care in poor populations and its relation to outcome. I mention Dr. Zeitlin’s discussion about Dr. Jeff Cooper’s process of gathering data to examine anesthesia accidents and their relations to humans, because I remember this interview back in maybe 1974. What I remember is pain during the interview.

In one section, Dr. Zeitlin talks about the lack of a postanesthesia care unit in one hospital. Currently, it takes superb negotiating skills to arrange for a patient not to go through the postanesthesia care unit after surgery, and we forget where we and our traditions came from. Dr. Zeitlin reminds us of the mistakes and important issues and places them in perspective. I put down my book about George Washington to read Dr. Zeitlin’s book. Dr. Zeitlin brought back memories for me, but I hope the lay public gains insights into our lives, and I also wish for our junior residents to gain even deeper insights that will lead to intense scrutiny of our established practices. Please take a look at this one.

James R. Zaidan, MD, MBA

Department of Anesthesiology

Emory University School of Medicine

Atlanta, Georgia

© 2013 International Anesthesia Research Society