David was a consultant anaesthetist at Great Ormond Street Children’s Hospital before becoming the country’s first professor of children’s anaesthesia. Taking up magic after retirement, he is an Associate Member of the Magic Circle and currently their Welfare Officer. He won the Fellowship of Christian magicians’ stage competition in 2014, and is a founder member of Woodford Wells Ecumenical Church. He and his wife Rita have four children and eight grandchildren.
Describe something that has recently amazed you and how it made you feel.
Six weeks ago I had the privilege of interviewing Dr. Richard Harris, the Australian anaesthetist who played a vital role with the team that rescued the young boys from the flooded cave in Thailand. Their courage, professionalism and teamwork in the face of outrageous danger left me with a sense of awe and admiration which has stayed with me ever since.
How would you personally define wonder, awe and curiosity? And how do they relate to each other?
Curiosity is a search for truth. A sense of curiosity is innate, almost primal, I think, which even a newborn baby can express. It’s part of our survival mechanism. Our eyes and ears are provided to satisfy curiosity even before speech. And when children speak, very early on “Why?” is endlessly repeated. Wonder is a reaction to something unexpected or unusual, normally new, though sometimes familiar things such as Elgar’s violin concerto or a famous painting can give rise to an ongoing sense of wonder. Awe is an intensified sense of wonder, sometimes accompanied by fear or dread. Curiosity, although a purely cerebral activity, can give rise to wonder and even awe. Wonder and awe come from the heart, though the intellect can also be deeply stirred by, for example, a brilliantly clever piece of writing or by scientific discoveries.
Where do you think our sense of wonder comes from and what can we do to cultivate it?
Wonder is a God-given gift. The wonder expressed by a child in response to an illusion is one of the best rewards a magician can experience. Sadly people seem less able to express wonder as they grow older, so we can cultivate it by striving to avoid cynicism and self-centredness which may be factors in the decline in our ability to receive this God-given gift. I fear that the next generation’s obsession with screen-based technology may cripple their ability to appreciate the wonders of the world around them.
What do you love about magic (the performance by magicians on stage/TV etc.)? And what do you dislike about magic and/or the performance of it?
The fact that I took up magic was not related to my previous career. My sister had a magician out of the yellow pages for her 60th birthday and he was so bad that my wife challenged me to do better! There is a common link between magic and anaesthesia, they both share a sense of wonder at something so dramatic yet inexplicable.
What I like most about magic is the reaction it produces in an audience. As a performer I love the wide range of methods and materials through which I can express my personality to entertain others. What I dislike most is magicians who are only interested in method, and their ability to demonstrate how well they can perform an illusion. Finger-flicking card flourishes are my bête noire.
How has the role and technology of an anaesthetist changed over the years?
Since the first anaesthetics were given with ether and chloroform in the 1840s anaesthesia has changed from a crude art requiring little skill to the most scientifically based and largest speciality in hospital medicine (one in seven doctors in NHS hospitals is an anaesthetist). We are highly respected by our peers in other branches of medicine. The first anaesthetic I gave was chloroform on an open mask as a medical student with virtually no training or supervision. Nowadays it takes seven years after medical qualification to become a fully trained anaesthetist. Today’s anaesthetist is the patient’s personal physician before, during and after surgery. Most intensive care units are run by anaesthetists and some specialise in the management of acute and chronic pain. Improved training and technology has reduced anaesthetic mortality from one in two thousand to one in two hundred thousand in the last fifty years.
In the early days of ether and chloroform anaesthetists had very few drugs available to them and sometimes in order to provide optimal conditions for the surgeon they had to give much more than was necessary to keep the patient unconscious during surgery. Nowadays we have a huge range of drugs with different properties; loss of awareness, pain relief, anti-sickness, muscle relaxation, control of blood pressure etc. The drugs we use are tailored to the individual patient and the planned surgery. Eye surgery, for example, is more likely to cause postoperative nausea. The modern concept is called ‘balanced anaesthesia’ whereby we only give the dose of each drug required to produce a specific effect, thus reducing side-effects.
Modern anaesthetics are eliminated from the body very quickly. It is usually the overall experience including the surgery and change of environment, especially in elderly patients, that delays recovery. We still need more research on the long-term effects of anaesthesia.
What happens to someone’s consciousness when they go under general anaesthetic? Is there a natural equivalent?
Since we still have little understanding of how anaesthetics work the answer to this question has to be more philosophical than scientific. Natural sleep is the nearest equivalent, but where is consciousness then? Perhaps sleep is a form of hibernation.
There is some evidence, at present unconvincing, that anaesthetics do not alter consciousness at all, only the ability to recall events. Even though this rather frightening possibility is unlikely, there is strong evidence that outcomes are better when specific drugs and techniques are used to prevent pain, even during anaesthesia. Epidural injections, for instance, are used to block the pain of Cesarean section whether carried out on the conscious or anaesthetised patient. Anaesthesia has little effect on memory.
Over your career you must have experienced numerous teams in an operating theatre. And you must have experienced a number of different styles of leadership and atmospheres. In the room who is really in charge? What are the ingredients of a good leader and a good team?
When I was a junior anaesthetist in the 1960s there were still surgeons around who thought we were there to be told what to do. The fact that many anaesthetists relied on the surgeon for their private practice didn’t help. Nowadays we work as a team, respecting each other’s contributions. Dysfunctional teams risk being hauled before the General Medical Council, as it is accepted that they put patients at potential risk. I was fortunate to work with superb surgeons who respected my skills.
We are lucky in this country in being appointed to specific operating lists, so we may work with the same surgeons for many years. In this situation we get to know each other so well that the question of who is in charge doesn’t really arise. Each member of the team has their own area of responsibility. It’s like asking who is in charge in a marriage. I got to know, for example, when a surgeon was in trouble and needed absolute support or when he/she was getting tired and would welcome a joke or other light relief. In a crisis it was always clear who would take the lead. In America you may be rostered with different surgeons every day, so the situation is quite different.
How does it feel to have so much power and responsibility over another person?
Any power I had during my career came from the drugs and techniques which have been developed by others over the years. I felt like a pilot taking my passengers safely from one destination to another in an amazing, state of the art machine. In over thirty five years of practice I have never ceased to be in awe of the miracle of anaesthesia.
It is humbling to realise that people entrust their lives (or in my case often the lives of their children) to my care at one of the most frightening times they have experienced. My sense of responsibility was always greatest when the child was critically ill and the parents knew that this could be the last time they saw their much loved son or daughter alive. For me the challenge has always been to remain professional without becoming hard-nosed and apparently uncaring. As a professional I obviously could not allow my emotions to affect my performance, but had to have confidence in my training, experience and ability, together with that of everyone in the team, doing everything possible for the patient, whatever the outcome. The rest I left to God.
What’s the most remarkable think about a human?
I would say that the ability to express wonder and awe are uniquely human. The ability of humans to withstand extraordinary suffering and degradation as Fergus Anckorn did on the Kwai during WW2 is also amazing. However, despite our capacity for evil, for me the ability to love trumps everything and is reflected in the fact that we are the only species that challenge Darwin’s theory of the survival of the fittest. Some of the most outstanding humans have sacrificed themselves for love of others.
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