Laughing and Crying about Anesthesia: A Memoir of Risk and Safety.

Like you and me, Gerry Zeitlin is an anesthesiologist. He has been around medicine since starting medical school at Oxford in 1954. In 1958, he had his first encounter with a giant in anesthesia, Sir Robert Macintosh, was hooked, and commenced a lifetime professional journey that enabled him to learn about anesthesiology during the time (from the late 1950s to the dawn of the twenty-first century) when it developed and matured into its contemporary form. His book recalls these most important years.

Education in England and anesthesiology practice in England and the United States armed Zeitlin with knowledge and skill to help patients for more than 40 yr. His patients, whom he loved and respected (as you can tell from reading his book), benefited in countless ways from his application of our curious and essential medical specialty. Anesthesia patient care permitted his patients to comfortably and safely undergo surgical, diagnostic, and therapeutic procedures that would have been impossible and unbearable without anesthesia. Reading his words in Laughing and Crying about Anesthesia , it is quite obvious that Gerry Zeitlin loves his specialty, loves the environment, respects the other “players” (our surgical colleagues), and loves his patients. One of the meanings of love conveyed to the reader by Zeitlin is respect, respect for his charges and his colleagues, both of whom placed their well-being into his hands:

“We anesthesiologists should never forget that it is our privilege to have been invited in by our courageous, skillful and thoughtful surgical colleagues. Nor should we forget all those millions of people we call patients who trust their surgeons, and us.”

The timeframe of Laughing and Crying about Anesthesia  spans the years when mortality directly related to the administration of an anesthetic morphed from 1 in 5,000–10,000 to the present-day 1 in 200,000. These were the years when Zeitlin learned and practiced our specialty and was a most observant “fly on the wall.” In his book, he recalls many of the defining changes to anesthesiology that so many of today’s practitioners haven’t a clue about and therefore can’t benefit from grasping how much better we currently are able to care for our patients. Zeitlin’s narrative of the most recent 50-yr history of the maturing process of anesthesiology is reason enough to read Laughing and Crying about Anesthesia . I, too, remember common practices recounted in this book; for example, it was common practice to wear conductive shoes in the operating room to reduce the possibility of a static spark igniting an ether-fed explosion, injuring a patient and those caring for her. I thought cyclopropane was the “champagne of bottled gas,” yet am so happy our modern inhalation agents don’t explode or wreak havoc on the heart. Do you remember when your surgical colleagues commented after making the initial incision that the blood was dark? Zeitlin juxtaposes this with our modern use of oximetry. When the Spanish and American philosopher George Santayana penned his insightful statement, “Those who cannot remember the past are condemned to repeat it,”¹he was really encouraging positive, rather than negative, action; his encouragement was to motivate us to know history and allow it to serve as a foundation upon which we learn what worked in the past and what didn’t and to use this knowledge to build a better future.

The schizophrenia of anesthesiology arises from, on the one hand, the wonderful fact that while under the influence of anesthesia, patients are comfortable during what would otherwise be a painful assault to, on the other hand, the scary fact that the coma, respiratory and cardiovascular depression, and weakness induced by anesthesia may be harmful to a patient who would otherwise not be subject to such effects. This dichotomy plagues Zeitlin throughout the book and undoubtedly has done the same throughout his professional career. To his credit, Zeitlin has (for the most part) not allowed this fear to paralyze his actions. This theme of his book pervades most of its pages and provides the majority of the final chapters as a history lesson Zeitlin wishes to tell.

Anesthesia patient care is scary AND yet so important that patient safety must guide our patient care. I’m reminded that, having lived the events of the death of John Kennedy, such personal knowledge makes it possible for me to apply learned lessons from the former President as a role model. In similar fashion, Ellison (Jeep) Pierce was a patient safety role model, a giant in our specialty to which we should aspire. Zeitlin describes Jeep through their personal interactions and provides an understanding of how anesthesiology has become the patient safety role model for all of medicine. I again stress the need for young anesthesiologists to read Laughing and Crying about Anesthesia  for another history lesson about patient safety, the current sentinel topic for our patients and their practitioners.

While Laughing and Crying about Anesthesia: A Memoir of Risk and Safety  is a bit chatty and perhaps too personal and intimate at times, reading this book is something I encourage you to undertake. Zeitlin states that his book “is intended for the interested nonmedical reader” to educate this group about what we really do and enlighten them to the seriousness of our purview. I believe that the interested medical-anesthesiology reader will also gain a much-needed perspective when reading this book, and I encourage this group to gain the advantage of understanding Zeitlin’s biases by reading and reliving his journey, much of which the reader may never have experienced.

The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. mailto:schwartza@email.chop.edu