By Dr Roshan Radhakrishnan
I want to tell you a story. It may seem like a fairy tale, and in many ways, it is. It is a journey that zigzags across all the corners of the globe over dozens of centuries, featuring saints and sceptics, sleeping chickens and screaming men.
This is the story of how your stay in the hospital became painless.
“The escape from pain in surgical operations is a chimera. ‘Knife’ and ‘pain’ in surgery are words which are always inseparable in the minds of patients”
(Alfred-Armand-Louis-Marie Velpeau, French surgeon, 1839)
As late as 1839, the notion of a pain-free surgery was considered fanciful, and budding surgeons were steeled early on to become indifferent to the screams and cries of patients as they were cut open.
It may seem ridiculous now but once upon a time the options for “pain relief” included:
- Strangle till they suffocate and lose consciousness… and surgery is performed.
- Beaten on the head with a club till they lose consciousness… and surgery is performed.
- Alcohol overdose till they are really drunk… and well, you know the rest.
- Of course, there was always the ever-popular “ten people hold the screaming man” while the surgeon slices him open.
In the 15th century, Paracelsus observed that ether made household chickens sleep and awaken unharmed. He noted it as a possibility for treating painful illnesses. Sadly, no one pursued that line of thought and it became a cheap drinking alternative when the taxes on gin were raised.
The head of my department once told me, “The surgeon is the head of the sailing ship but the anaesthesiologist is the head of a sinking ship.”
Centuries passed by and we disagreed on everything, be it land, women or religion. But we never gave up on one dream… to free our fellow human of pain. There were plenty of failed attempts as the 18th century arrived, with the wrong gas or sceptical mind nixing a good idea in the bud.
Finally, on 16 October 1846, dentist William T. Morton stepped in front of a live audience of physicians and surgeons at the Bullfinch Amphitheatre in Massachusetts General Hospital. The story goes that, annoyed at his late arrival, the surgeon pointed out the patient and told him, “Sir. Your patient is ready.”
Morton allowed the patient, Gilbert Abbott, to inhale the “miracle drug”—our very own ether— he had brought with him from a crudely constructed glass vaporizer and then turned back to the surgeon and countered with the very same words, “Sir. Your patient is ready.”
And for the first time in over 2400 years of documented surgeries, the patient really was ready for surgery.
Gilbert was aware of his surgery but had no sensation or pain. After completing the surgery, a visibly moved surgeon turned to the crowd of his stunned peers and said the immortal lines “Gentlemen. This is no humbug.”
The concept of anaesthesia had finally arrived.
It is now over 150 years since that day when the world changed for medical care. Anaesthesia has evolved and so too have the anaesthesiologists.
The once impossible general anaesthesia is now achieved with exquisite precision, attaining not just loss of consciousness but also muscle relaxation (making the surgeon happy), pain relief (making the patient happy) and of course, stable cardiac vitals (making the anaesthesiologist happy).
Conversely, with a single precise jab of a needle, patients can now remain completely awake with just the operating site rendered numb for the surgeon to do his thing too.
The magic does not end there. Today, anaesthesiologists’ roles extend far beyond to include:
- Being part of the pre-hospital emergency response team.
- Aiding in patient resuscitation in the emergency department.
- Running the Intensive Care Unit (ICU), handling everything from snakebite victims to comatose patients.
- Acute and chronic as well as cancer pain relief via specialized pain centres.
- Providing sedation and anaesthesia outside the operation theatre (radiological procedures, endoscopies etc).
Oh, and en route, anaesthesiologists salved some of the pain points of religion and misogyny too. Dr. John Snow’s administration of anaesthesia to Queen Victoria during the delivery of her child and her subsequent stamp of approval shut the door on religious debates on whether women were “meant to endure pain for their sins.”
Today thousands of women deliver happy, healthy babies every day using labour analgesia. Even in Caesarean sections, spinal anaesthesia ensures the mother is not just pain-free but also able to be a part of the birthing process.
Anaesthesiologists salved some of the pain points of religion and misogyny too… [shutting] the door on religious debates on whether women were “meant to endure pain for their sins.”
When I was a resident, the head of my department once told me, “The surgeon is the head of the sailing ship but the anaesthesiologist is the head of a sinking ship.” The true value of this statement is known to every surgeon who works inside an operation theatre. When things get rough during a surgery, with severe blood loss or a drop in vitals, it is the anaesthesiologist who is looked upon to take over, stabilize and resuscitate the patient.
Sushruta, the Father of Surgery, practiced in Benaras in 600 BC.
Morton, the Father of Anaesthesia, was a New Englander in the 18th century AD.
Think about it. It took 2400 years for these star-crossed fields to meet—2400 years of pain, tears and screams of agony. Today, the only sound you hear during most surgeries is the sound of a healthy bip-bip-bip letting the patient and the surgeon both know that all is well.
One thing does stay the same though. Even today—irrespective of country, creed or religion—in every operation theatre across the world, surgeons eagerly await the same words that were successfully spoken for the first time that day in 1846 at the Bullfinch Amphitheatre: “Sir. Your patient is ready.”
The 16th of October is World Anaesthesia Day. Have you thanked your anaesthesiologist yet?
P.S. This article was originally published in Godyears (by an anaesthesiologist. Because, yes, my role in making you smile extends to social media too!)