In COUNTING BACKWARDS, A Doctor’s Notes on Anesthesia, Henry Jay Przybylo, MD, artfully blends stories from his career with useful information about anesthesia and the specialty of anesthesiology. At the start, he declares: “I erase consciousness, deny memories, immobilize the body; I alter heart rate, blood pressure and breathing. And then I reverse these effects.” He goes on to detail the equipment and drugs required to accomplish all that, and discusses eliminating pain during surgery and treating it post-op.
The book covers the early history of anesthesia, from the synthesis of ether by August Frobenius in 1729, and nitrous oxide by Joseph Priestley in 1772, to Crawford Long’s successful use of ether for surgical anesthesia in 1842, Horace Wells failed demonstration in 1844, and William Morton’s triumphant public success in 1846.
Doctor Jay (the name the author goes by) describes the anesthesiologist’s “command center,” the anesthesia machine and accompanying monitors, the equipment used to secure the airway, and the use of regional blocks. He talks about dreaming of railroad tracks on the anesthesia chart and the challenges to making that a reality. He explains the importance of NPO and illustrates it with a case of a four-year old who managed to sneak eat Captain Crunch cereal before his surgery. (Spoiler alert: the child threw up but didn’t aspirate.)
Doctor Jay specializes in pediatric anesthesiology, including pediatric cardiac procedures. As a result, his patient stories lean heavily in that direction. He describes his techniques of distracting children prior to induction, including asking about boyfriends, girlfriends and the latest gossip about music groups and TV stars.
Doctor Jay also details his reaction when he himself needed anesthesia for a shoulder dislocation and when his adult son went for brain surgery. He even describes how he once gave anesthesia to a young gorilla. He tells of the agony he felt during a trip to China when he saw a child writhing in pain following surgery and not receiving adequate treatment for it.
His discussion on pain treatment covers the challenge posed by the potential for narcotic abuse and the cruelty of inadequate pain relief. He describes the role of epidurals, PCA, and the benefits of ketorolac.
Inevitably, Doctor Jay makes some observations and comments other anesthesiologists are likely to dispute. I was particularly surprised when he wrote, “In all, from the first time I meet patients, families, and loved ones until the trip to the anesthetizing area begins takes about three minutes.” I am quite certain that most of us spend far more time in pre-op. Perhaps Doctor Jay can do it so fast because he works in a teaching hospital and residents precede him. But he doesn’t mention that anywhere near the part about three minutes, and I think the book gives an incorrect impression about how much time anesthesiologists spend with patients and families prior to a procedure.
Overall, however, Doctor Jay describes our specialty well and comes across as a caring and thoughtful physician. He details concerns, responsibilities, and procedures done by anesthesiologists clearly and more completely than any other general audience book I have seen. Readers will come away with a better understanding of anesthesia and the role of an anesthesiologist.
Counting Backwards is an informative and engaging book that I highly recommend to both doctors and lay readers.
For more information on the author and the book check out the wonderful interview on NPR’s Fresh Air with Terry Gross: For Anesthesiologist, Easing Pain And Erasing Memories Is All In A Day's Work.