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Stanford University School of Medicine

An anesthesiologist opens up on the mystery of putting patients to sleep

A conversation with anesthesiologist Henry Jay Przybylo about his new memoir, "Counting Backwards: A Doctor's Notes on Anesthesia."

100, 99, 98, 97... When is the last time you did it -- counted backwards? It could have been in an operating room during those last few moments of consciousness before you lapsed into a deep sleep from anesthesia. You might be wondering, as I have, how exactly does anesthesia work? As anesthesiologist Henry Jay Przybylo, MD, told me in this 1:2:1 podcast, it's a still mystery even modern science can't yet explain:

I think there's a couple of things that make it absolutely mysterious. One is that we don't know how the gas works. We think it has to do with how it's absorbed into the cell membrane. It changes fats or it changes proteins, does something like that. One of the problems is it doesn't explain why it doesn't do that throughout the whole body. Why is the brain itself, or are we not measuring whatever it's doing to the rest of the body, but the brain seems to be a specific target for the gas. We're not sure how it works.

Przybylo, an associate professor at the Northwestern University School of Medicine, has written a new memoir, Counting Backwards: A Doctor's Notes on Anesthesia. Of the procedure, he writes, "I erase consciousness, deny memories, steal time, immobilize the body." A specialist in pediatrics, he calculates he's put more than 30,000 patients to sleep in a career spanning thirty years and yet, "only a handful of times each year do patients or family members ask how anesthesia actually works."

Dr. Jay, as he refers to himself in the book, turned to creative writing as an emotional outlet after the 2015 death of his wife, Sandy, to whom he dedicates the book. Trying to find solace in tragedy, Przybylo enrolled in a master's program in creative non-fiction at Goucher College in Maryland. It was there he gave life to the memoir about his experiences administering medications that he says, "deny memories, steal time, immobilize the body..."

During our conversation we talked about the history of  anesthesia -- physician Crawford Long, MD, first used ether in 1842 to remove a neck mass tumor -- and how the practice of counting backwards came into being. I was curious how quickly it takes for the anesthesia to take over? "They never make it out of the 90s," Przybylo conceded. "I can't ever remember hearing 86."

So if you've ever been intrigued about the mystery of anesthesia, I think you'll find this conversation of interest. And, it begins in 99, 98, 97...

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