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Counting Backwards: A Doctor’s Notes on Anesthesia Przybylo博士在书中分享了他在麻醉学科临床执业30年以来的轶事。在书中，他写道 “Luck is for sports and betting. Mine is a world of skill.” Anesthesiology allows little of what was learned in medical school to be forgotten. Perhaps no other specialty remains as expansive or inclusive, covering all the basic sciences (anatomy, pathology, physiology, pharmacology) and all fields of clinical medicine (internal medicine, surgery, pediatrics, obstetrics, and even psychiatry), and interacting with every other conceivable specialty. On any given day, any page of the physiology, pathology, or pharmacy texts may need to be scoured for a reference. From the time we meet in the pre-anesthesia area until the point that, after the procedure is over, I’m assured my patient has returned to a state of comfort and is prepared to reunite with loved ones, I am the primary care physician. During my anesthesia care, I become the internist, the ob-gyn, the pediatrician. The child scheduled to have a skin mole removed might have a failing heart; the woman whose brain aneurysm has burst might also suffer the pain and deformities of rheumatoid arthritis. When things take a turn for the worse during a procedure, when the blood loss climbs or the heart rhythm goes awry, it’s left to the anesthesiologist to make life right.
从事麻醉工作意味着要牢记在医学院的全部所学。或许没有哪个专业学起来如此昂贵又内容广泛，涵盖了所有的基础科学（解剖学，病理学，生理学，药理学）和所有的临床医学（内科学，外科学，儿科学，产科学甚至精神病学），并且和其他所有可能的学科都有交集。随时都有可能要把生理学，病理学或药理学书上某一页的内容翻出来做参考。从麻醉前与病人见面直到手术结束，我要保证我的病人术后感到舒适，并准备好和爱的人重聚，这时候我像是他的家庭全科医生。实施麻醉的时候，我则变成了内科医生，妇产科医生，儿科医生。安排了择期行皮肤痣切除术的孩子可能有颗功能衰竭的心脏；脑动脉瘤破裂的女人可能长期忍受着风湿性关节炎带来的疼痛和关节畸形的折磨。当术中情况恶化的时候，当病人失血越来越多或心跳的节律开始不对劲的时候，只有麻醉医生能让生命重回正轨。Over 170 years ago, inhaling a gas was shown to render a person senseless and thereby allow invasive medical procedures. Health care exploded. The magnitude of this medical discovery remains obvious today. The number of patients receiving anesthesia grows every year. The renowned New England Journal of Medicine recently polled its readers to select the most important article the magazine had published in its distinguished history. The “resounding favorite” its readers settled on was the NEJM’s 1846 article by Henry Jacob Bigelow about the demonstration showing that inhaling ether allows for pain-free surgery. (“Anesthesia” as a term had not yet been coined.) This article, published just a few months after the historic demonstration at Mass General’s Ether Dome in Boston, bested every advance made since then, including the introduction of antisepsis, of X-ray imaging, and of antibiotics. 170多年前，吸入一种气体可以让人失去感觉从而使有创的医疗操作得以实施，医疗保健行业急剧扩张。现在看来，这项医学发现的重要性显而易见。接受麻醉的病人逐年增加。著名的新英格兰医学杂志（New England Journal of Medicine）最近向读者发起投票活动，以选出其璀璨历史中发表过的最重要的文章。读者们将Henry Jacob Bigelow在1846年发表于NEJM上，阐述吸入乙醚实现无痛手术的文章冠以"令人瞩目的经典"之头衔。（那时候还没有" 麻醉(Anesthesia")这个词）。在波士顿马萨诸塞州总医院乙醚厅内历史性演示发生的几个月之后，这篇文章的发表使当时其他先进的医学理念包括抗菌术，X线成像和抗生素等概念的提出相形见绌。More than a century and a half later, I am unable to provide an answer when patients and families ask the most basic question of my specialty: how the gas I use anesthetizes. Despite decades of research, its mechanism of action remains a mystery. I must have faith in my anesthesia gas. It’s an irony of our work that patients and their loved ones place faith in the anesthesiologist, who in turn places faith in the gas. In many ways, I’m a faith healer.而一个半世纪之后，在患者和家属问起我的专业中最基础的问题时，我仍不能解释清楚我是如何用气体麻醉药让他们进入麻醉状态的。尽管已经研究了几十年，它的作用机制仍是个谜。我必须相信我的气体麻醉药。患者和他们的挚爱信任麻醉医生，麻醉医生转而信任机理不明的气体麻醉药——看起来我们的工作好像有些讽刺。从很多方面来说，我是个信仰疗法治疗师。I routinely ask patients to count backwards as the anesthesia medications are introduced. Counting backwards in this way is a time-honored anesthesiology tradition.When rapid-acting barbiturates were introduced half a century ago, making it possible to induce loss of consciousness in a matter of seconds, an anesthesiologist likely asked a patient to start at 100 and count back, curious to determine the speed of induction. 100 . . . 99 . . . 98 . . .In my experience, patients never make it out of the 90s.用药物开始麻醉诱导时，我总会让病人开始倒数。像这样倒数的方法是一个由来已久的麻醉传统了。半个世纪前，速效的巴比妥类药物被引进，几秒钟就可以实现意识消失，麻醉医生好奇诱导过程到底有多快，总让病人从100开始倒数。100...99...98...
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