Review of Breathing for Two by Wolf Pascoe

Whitewater Rafting on the River Styx.

It would be hard to exaggerate the compelling page turning summons of this short book. Perhaps some facts will part convey it. I downloaded it at nine thirty, and it is now twelve thirty and I have not paused for breath although the whole book is about nothing else. For three hours I have been enthralled by the details of a man’s intimate relationship with himself, his patients, his career and maturation, as well as his gratitude to be the beneficiary of a few individuals’ step by step improvisation through the challenge of surgical demands upon that fellow near the head of the temporally insensible…the anaesthetist.

It does go someway to drawing a little of the limelight from the plumber and electrician beavering away on the body structure, down there near the legs or torso. The silent and stiller man is the real hero.

No doubt we have all recoiled from film renditions of battlefield surgery and amputations in the Crimea and even the trenches of France in WW1 with wood clamped in the jaws of agony, but unless we are theatre nurses, we are probably simply grateful that anaesthetics obliterate surgical agony, and think little more about it. What this book does is convey the white water rafting ride of being the man in control of death, and therefore life.

Wolf Pascoe’s confessional analysis of his career learning-curve as Charon , the boatman ferrying the insensible patient across the Styx to death or a new life with restored health is a cliff hanging journey of how the human body’s wisdom ( and idiosyncrasies) governs the possible. As he points out, the anaesthetist is the only general practitioner now left to the field of medicine, and the only one whose job is to take a living body to the brink of extinction, but not beyond. And he has four minutes in which to make the right call if anything has been misjudged.

One comes away from reading this with an awe that anybody can do this day in and day out, and do it without anybody else to call upon ( except in emergency and not always then). He stands like God at the gossamer interface of breath and has to negotiate with the brain’s control centres, and navigate through their programme of authority. The ticking pacemaker in the Medulla which speaks to the bloodstream, about the chemical concentrations in the cells has long been the Captain of the diaphragm and lungs, and is ultimately the Navigator. The anaesthetist is afforded his permitted interruption for very short and confined stratagems. To the portrait of the hazardous emotional demands of this dialogue must be added the clarity in which both the anatomical difficulties are explained about vocal chords, oesophageal and tracheal proximity, and the judgement calls on relaxant drugs and dosages and time.

To convey so much information through the lens of the deeply personal is what makes this book so special.It tells us more about anaesthesia than we thought we wanted to know, but end up richer for.

This book is a gift in other ways. It offers such insight into what we take so easily for granted, surgical procedure, but more deeply it restores our gratitude for the bequests of the historical figures, like Morton that discovered ether, others that juggled with chloroform, and those like Archie Brain that dissected cadavers to design the laryngeal mask, which obviated obstruction by the tongue. One spends the book as an invited and present witness to the intricacy of balanced judgement and responsibility. One comes away with a renewed respect for the human body’s wisdom and intricacy, and an equal respect for anyone brave enough to challenge it.

Only reading of the cases that illuminate this incremental journey can convey the depth of this personal tribute to the profession of which the author is a modest thoughtful, and penetrating thinker whose origins go back to Hippocrates, Diogenes and Aristotle. . It seems that the Hippocratic Oath is still somehow alive and manifest.
For this reader that turned the fascinating into the magical

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