I have a new truck. It has a little video camera that comes up on the navigation screen when I put the car into reverse. I don’t know how to use it.
Huh? you say. It turns itself on and off. What’s to know?
But of course, that’s not the point. For going on half a century, I have used a combination of looking over my shoulders and in my rear view mirrors to guide my vehicle’s course in reverse. The technique changed when passenger side rear view mirrors came into vogue. It changed a little again sometime in the past few years, I realize lately, as shifting in my seat to peer over my right shoulder became less useful, because of the high rear window in my old Sequoia (or maybe I just got lazy?) Now I’ve got this whiz bang video image. Do I watch it while moving. Do I consult it for an instant before I begin? How close am I really to that police car?
I just haven’t integrated it into my technique yet. It’s awkward. New technology is like that. It takes time. And new technology takes many forms. New monitors like the BIS; that’s easy to see. Sevoflurane replacing Isoflurane? Not so obvious, but new technology nonetheless. Integrating Sevo took a little while, and going back to iso for say, a hernia would require some conscious readjustment until I had the slower pharmacokinetics hard-wired back into my implicit memory. Kind of like swinging a heavier bat or something.
Simple changes can have a subtle impact. I remember when disposable gloves basically appeared. For years, anesthesia, like early baseball, was a bare-handed affair. We intubated without gloves, started IV’s, put in NG tubes, for pity’s sake! Herpetic whitlow was an anesthesiologist’s malady. To be sure, we used sized sterile gloves for spinals and epidurals and Swans, but that was about it. Then, Bang! Gloves. NG tubes became a lot easier-you just stuck a finger back there and guided it in. Who knew?
Smart phones are important anesthesia technology. I remember when there was talk of putting reference books on line at anesthetizing locations. Seems quaint now. Try this; “Siri, what’s the starting dose for milrinone?” Post a comment and let me know what she says.
Not to mention Angry Birds at 02:30 AM.
Oh, and Pandora. Huge.
My career has seen a steady stream of new technology, some subtle (rocuronium). Some dramatic (echocardiography). It took me a decade to notice how the technology altered the care, another decade to appreciate how the technology altered the art, and a third decade to appreciate the aesthetics of that continuous transformation. Anesthesia is pretty much fun aesthetically. A real dance, every bit as artful as surgery, at least to my sensibilities. But, hey, I’m biased.
So, it’s midnight and thanksgiving and I’m on call at the trauma unit. Maybe this post is a giving thanks for having found a lifetime of meaningful artful compassionate work. Who knew indeed?