On a hot summer night in Boston in 1999, I was a CA-2 resident on call in Massachusetts General Hospital. Around midnight, a case was booked in for an exploratory laparotomy. The patient was a 78-year-old female with coronary artery disease (CAD) and Alzheimer’s disease (AD). I was well trained in caring for a patient with CAD, e.g., avoiding the reduction in blood pressure and the increase in heart rate. However, I did not know how to provide good anesthesia care, even in principle, for a patient with AD. I called my attending anesthesiologist to ask what I could do for this patient. In particular, I asked what drugs I should or should not use to avoid worsening the cognitive dysfunction symptoms in this AD patient. Hesitating on the other end of the phone, my attending, who was in the call room, finally told me: “Figure it out.”
Unfortunately, even...
