What compelled you to become an anesthesiologist?

Frankly? $600. In med school a stipend was offered for an anesthesia rotation. I poured the money into a set of kick-butt stereo speakers and a copy of Bruce Springsteen’s Born to Run. The experience in the OR opened my eyes to the breadth of the field. Then, during residency, a wife, house, three kids and a dog finished the deal. Surgery had some major flaws of which too much time below the poverty level was one. Anesthesiology provided me with stimulation and an income.

What were some of the earliest-known cases where anesthesia was successfully used?

During the Civil war, many thousands of men received anesthesia by gas for pain-free amputations. Then, at the end of the century, Halsted, the Hopkins’ surgeon, developed increasingly complex procedures, impossible to perform without anesthesia.

What are some of the latest advancements in the field?

Major advances over the past decade have been few. Applying the techniques of the previous decade, for example ultrasound technology to accurately place local anesthetics on nerves for prolonged pain relief, has grown greatly.

You’ve administered anesthesia to an animal before. Are there any differences between how anesthesia effects humans versus how it effects animals?

When it comes to gas, the volatile anesthetics, the dose is remarkably similar across species. The IV anesthetics on the other hand are very different. The smaller the animal, the larger the dose of medication needed to be effective. The dose of anesthetic drug to anesthetize an elephant leaves the mouse staring at you. The biggest issue in my mind is how to handle breathing. Anatomy varies so greatly between different species. Placing an endotracheal tube to maintain an open airway in a rabbit or pig is a monstrous accomplishment for me.

You include several anecdotes about administering anesthesia to children in the book. Is it harder to work with children?

Children are so different. First, what age? The younger the child, the more precise the anesthetic care required. The bull’s eye shrinks. Older kids are a psycho-social challenge. After the initial three minutes of meeting, the following two minutes, between separating from parents until anesthetized, challenges every skill imaginable. Connecting with these ages to lessen anxiety…boy, this is what peds anesthesia is all about. Being able to converse with these kids on topics ranging from Elmo to Taylor Swift keeps me on my toes once my clinical day is over to remain anywhere near current. Then comes the piggies story. Once the mask goes onto a three-year-old, talking about the imaginary trip to the zoo while they breath the increasingly stinky gas calls on acting skills. “Hey, how many piggies do you smell?…Three? That’s a lot of piggies in the mask.” The eyes gently close.

Perhaps one of the most remarkable parts of your job is that you spend so little time with each patient you treat, yet there’s such intimacy in those few moments. Do patients ever keep in touch with you or stop by to thank you and check in?

Imagine: Give me three minutes, then give me your life. That’s so astounding to me even after thirty-plus years. Most of my patients are one timers. Never remember my name. And if I do my job right, perhaps they shouldn’t remember my name. The ones who do come back tend to be those with more complex and critical health issues. Often in that group I receive a phone call. “Will you be available?” And I’m honored when people ask if I’ll provide the anesthesia for their loved ones. I’ll tell you though, the first time I was asked to care for a child of a child I provided the anesthesia for was traumatic to me.

Have you ever “been under” yourself?

Yeah. Dumb Turkey Day Football game blunder. In the ER, you know you’re in trouble when the radiology tech bounds down the hall announcing “We have a winner!” A four-part fracture of the head of the humerus, the upper arm, that needed surgery to remain functional. I’ve got a whole story to tell about that experience. And the pain relief after. Nothing bad, just different. Now giving anesthesia to your own child? I’d do it again. I hate surrendering that control. And in my hands, I know they’ll be safe.

Do you ever think we’ll fully understand how anesthesia works?

For the intravenous meds probably. The gas agents are another story. Heck, we don’t understand consciousness or memory let alone how that gas impacts one but not the other. That all boggles my mind.