©Samuel Moore-Sobel and Kate Moore

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Not Going Under

December 1, 2017

Why do anesthesiologists insist on telling their patients just moments before surgery to count backwards? The answer is almost entirely unknown, although one doctor details his common practice of making the routine even harder for his patients. “…I say ok, count backwards from 100 by sevens. They might make it to 93 - they never make it to 86,” Dr. Henry Jay Przybylo says.  



I am listening to Fresh Air, a habit formed early in my childhood. My mother introduced me to Terry Gross’ program, listening to her as we made our way home from school. We were all aware of NPR’s political leanings, yet taught to celebrate talent wherever it can be found. My love for Terry Gross – her interview style and the interesting subjects she invites onto the show - has endured. For no one can get to the heart of the story quite like Terry.


Dr. Przybylo is the author of a forthcoming memoir, Counting Backwards: A Doctor’s Notes on Anesthesia. His writing focuses on his experiences as a pediatric anesthesiologist. His vocation allows him to guide nearly a thousand children a year through surgery. His manner is engaging, reminiscent of a gentle grandfather. Despite my typical wariness when it comes to doctors, he has me at hello.


He describes his methodology for inducing patients to sleep at great length, saying that a mask is placed on each child once they reach the operating table. “…In the mask there is usually some odor, some bubblegum, some cherry, some laughing gas to take the edge off…” he tells Gross with excitement in his voice. After listening for just a few minutes, I am sold. The next surgery I undergo, I want this man to be my anesthesiologist.


Gross leads him to the point that terrifies most patients; mainly, that they will fail to wake up once they receive anesthesia. Przybylo refers to the process of putting someone to sleep as “a complete paralysis.” Your basic brain functions, such as your heartbeat, are still working. “…But in terms of the upper brain functions, you have no sensibility for what’s going on,” he says matter-of-factly.  


      “Do you worry that they won’t come out of it?” Terry asks.

      “Oh, never, never,” he responds.

      “40 million times a year people receive anesthetics – and they              wake up. It’s a rare one who doesn’t wake up…” he says rather            assuredly.


His words are reassuring, although not enough to completely eradicate my own fear. One would think that after years of practice the prospect of going under would lessen in severity. Somehow, the passage of time has the opposite effect. The last operation I underwent, friends and family soon learned what a treat it was to endure the Samuel show on surgery day. Nervous text messages declaring that if I died on the table they must know how I felt about them. Revealing financial disclosures to my family, nervous that I had not yet completed a will. Although this may not entirely be my fault – maybe I just needed Dr. Przybylo to be my doctor.


Near the end of the interview, it is revealed that the author’s wife recently passed away. Intending to write about caring for his wife in the days preceding her untimely demise, he demurred after receiving thoughtful advice. “You can’t write through tears,” someone told him. Hence the reason our book has been more than eight years in the making. The tears had to abate before revealing and thoughtful words could be placed on the page.  


This interview coincides with an upcoming operation looming in my near future, the prospect of which generates both excitement and a sense of dread. The doctor believes that more can be done to save my collapsing nose, my right nostril continuing to cave in at record speed. While excited at the thought of securing increased airflow, my trepidation over going under the knife again is impossible to deny.


I am fearful, fearful not only for the operation itself but for the aftermath. My worries extend far beyond dying on the table. I wonder if this surgery will have a similar effect as past experience tells me it may - that the pain in the same areas affected more than eight years ago will generate a flood of emotions and memories threatening to consume me. I worry that this operation will set off a rather unpleasant chain of events that will last much longer than the expected hour and a half surgery.


Dr. Przybylo, perhaps sensing the discomfort of Terry’s listeners, worked hard to reassure all that anesthesia is not as dangerous as oftentimes believed.  “It just works,” he told Terry Gross. “Healthy patients come in, and healthy patients go out…it works, but I can’t tell you why.” Perhaps this time will be different. I will choose to allow logic to trump emotions, clinging to the desire that after all I have been through God’s sense of poetic justice does not include death on the operating table. Or a long and drawn out recovery.


Much work remains to be done, words of hope to be offered and stories of healing to be shared. Every experience is one to be learned from – no matter how harrowing or unpleasant. “Let me know how the surgery goes,” a friend recently offered. “You’ve been through much worse.” The past provides a roadmap for the future. This time, pitfalls can be avoided, fears quieted. Surviving challenges big and small reveals a latent resilience and the ability to stand firm in the face of the storm. In the words of the inimitable Frasier Crane, “…I know that no matter what the future holds in store for you, you’ll handle it.” Even if Dr. Przybylo is unable to serve as my anesthesiologist, and cherry odor won’t make its way into my mask.

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