Anesthesiologists: The guard dogs of medicine
According to the Canadian Anesthesiologists’ Society, “Anesthesiology is that branch of medicine that is dedicated to total care of a patient undergoing surgery and the relief of pain.” Anesthesiologists are the physicians responsible for putting patients to sleep and keeping them safe during an operation. In my limited exposure to anesthesiology as a first-year medical student, I was struck by how, very literally, the patients trusted the anesthesiologist with their very lives, including protecting their airway and ensuring that blood continued to reach their tissues. All this while allowing themselves to be paralyzed, sedated, and naked in the operating room of strangers. This is the highest expression of trust a patient can show toward a physician, maybe toward any other living human being, as it puts patients physically, and arguably also psychologically, in the most vulnerable of all possible states. Anesthesiologists, as the guard dogs of the lives of patients undergoing surgery, bear great privilege and responsibility.
Physicians are entrusted with the promotion of the public good, and called upon to uphold both professional competencies and high ethical standards. The anesthesiologist, due to the potentially lethal nature of the agents used and the importance of the body systems which these drugs affect, daily demonstrates and upholds the trust which exists between patients and the medical profession.
Feelings of safety and freedom from fear allow people to sleep peacefully, while pain, worry, and stress contribute to secondary insomnia. Sleep, and all the psychological and physiological benefits that accompany this state of suspended consciousness, is a basic human need. Just as a country’s productivity is impaired by conflict, insomnia disturbs the body’s natural process of restoration and growth, impairing a person’s ability to function. Throughout history people have trusted in various measures to give them peace of mind and safety; these have ranged from social-political arrangements, to First Amendment rights, to guard dogs.
Although in many homes the guard dog has been replaced by a complex electronic alarm system, the image of a dutiful, vigilant, canine servant presiding over the home while the master slept peaceful evokes a strong sense of security, loyalty, and attentiveness. The thief dares not enter for fear of the guard dog; the owner can sleep at ease knowing his capable hound is on duty and would alert him to any changes. Without a sense of safety, without a guard dog, without a watchman, without a guardian angel, without an anesthesiologist, it would be foolishness for a patient to give up their conscious protection of their body and allow themselves to be made unconscious and operated on. Patients allow themselves to be cut open, their bones hammered, their blood vessels rearranged, because they have surrendered their pain sensation, allowing their body to be injured without hurting. Just as sleep is necessary, so the surgery is necessary to restore function, prevent death, and preserve quality of life. More than material possessions in a house, a person’s most valued possession and pursuit, often consciously, but always unconsciously, is their own life and bodily function.
The entirety of human physiology adapts to changes to sustain life. The biological, biochemical, and physical adaptations the body employs to always supply tissues with oxygen are vast and intricate. These include coughing if something foreign enters the airway and changing the rate at which the heart pumps blood. In the metaphor of the guard dog, the owner still retained their instinctive, unconscious reflexes that respond to distress. But to the anesthesiologist, the patient entrusts almost every possible physiological defence mechanism they have, willingly allowing many of the complex adaptations listed above to be incapacitated.
When patients consent to undergoing anesthesia for surgery, they are agreeing to a transfer to another person a responsibility which no marriage vows, no guardianship, no business deal, no blood bond, no pledge of allegiance, can otherwise include: the responsibility for the maintenance of oxygen delivery through the most essential physiological mechanisms. Under some medications, the patient surrenders control of their own airway, trusting that the anesthesiologist will breathe for them in a timely and safe manner. The patient trusts the anesthesiologist to know their body better than it knows itself with regard to how much stress, medication, and oxygen the patient’s body tolerates and requires.
Patients deserve the respect of being participants in decisions which affect their lives. In the case of operations, often it is necessary to render the patient incapacitated for even the most fundamental level of participation such as innate physiological responses, requiring someone to protect the patient in all possible ways. Given that patients trust anesthesiologists with their very lives, anesthesiologists lead the medical profession in altruistic service, expertise, and safety; they are the faithful guard dogs.