WEBVTT 00:00:01.233 --> 00:00:06.099 HF8241 Threshold. 1969, Length: 00:25:33, B/W, Sound. This Beta SP was duplicated from a 16 mm answer print by BonoLabs 00:00:06.100 --> 00:00:10.700 for the National Library of Medicine, April 2014. 00:00:10.700 --> 00:00:24.333 [...] 00:00:24.333 --> 00:00:35.433 [8,7,6,5,4,3,2] 00:00:35.433 --> 00:00:51.233 [Waves crashing] 00:00:51.233 --> 00:00:52.466 [Doctor:] Are you from anesthesia? [Anesthesiologist:] Yes. 00:00:52.466 --> 00:00:57.532 [Doctor:] This boy apparently was in some sort of...near Ocean Point. I thought you might know something about salt-water drowning. 00:00:57.533 --> 00:01:03.033 [Anesthesiologist:] Right, from animal research studies, in salt-water drowning you have water and plasma pouring 00:01:03.033 --> 00:01:06.599 out of the blood into the lung, which makes the problem worse. 00:01:06.600 --> 00:01:10.900 [Patient gasping for air] 00:01:10.900 --> 00:01:12.300 [Anesthesiologist:] We're having trouble. 00:01:12.300 --> 00:01:15.700 [Doctor:] I think he's just obstructed the upper airway, which is certainly one problem that goes on 00:01:15.700 --> 00:01:20.533 and we must move now quickly to the intensive care unit where we can provide monitoring. 00:01:20.533 --> 00:01:23.833 We'll have to get blood gasses, central venous... 00:01:23.833 --> 00:01:30.333 [Anesthesiologist:] There's a difference in treatment between saltwater and freshwater. Anesthesiology research. 00:01:30.333 --> 00:01:42.833 [Typewriter keys clacking.] 00:01:42.833 --> 00:01:48.899 [Threshold] 00:01:48.900 --> 00:01:52.766 [Narrator:] It's not easy, this anesthesiology story. Patients here, research there. 00:01:52.766 --> 00:01:57.866 Now, if we could emphasize patient cares related to research. 00:01:57.866 --> 00:02:01.166 [Emily:] I don't think we made that point well enough. 00:02:01.166 --> 00:02:04.066 [Doctor:] Emily, you'll be the death of this office. 00:02:04.066 --> 00:02:08.732 [Emily:] Not true. I was having a dinner party and we got on this subject and everyone was fascinated. 00:02:08.733 --> 00:02:12.766 You know, they never really thought much about it, sleep and pain. 00:02:12.766 --> 00:02:14.499 [Doctor:] That's why we're doing the article. 00:02:14.500 --> 00:02:15.533 [Emily:] I want to see. 00:02:15.533 --> 00:02:27.133 [Anesthesiologist:] More. A little more, little more, don't stop, more, more, more, more. Okay, now relax. That's fine. 00:02:27.133 --> 00:02:29.999 [Doctor:] I have a few questions. Do we know what he's doing? 00:02:30.000 --> 00:02:32.233 [Anesthesiologist:] Now, I don't know what Dr. Smith thinks he's breathing right now, 00:02:32.233 --> 00:02:35.233 but I suspect he thinks he's breathing carbon dioxide and he isn't. 00:02:35.233 --> 00:02:37.433 [Emily:] Have you tried it yourselves? 00:02:37.433 --> 00:02:42.833 [Anesthesiologist:] Yes, everything we've done up here, we've all experienced ourselves before we've done it to any patients. 00:02:42.833 --> 00:02:45.633 [Emily:] What do you learn from it? 00:02:45.633 --> 00:02:47.199 [Anesthesiologist 2:] Okay, let's pull out the other way. 00:02:47.200 --> 00:02:54.233 With this apparatus we're studying the effects of slight increases in aspired carbon dioxide, 00:02:54.233 --> 00:02:58.933 which fool the brain into thinking the body's working hard, so we overbreathe. 00:02:58.933 --> 00:03:01.299 We're not studying hypoxia at the moment. 00:03:01.300 --> 00:03:03.000 [Emily:] What's hypoxia? 00:03:03.000 --> 00:03:05.400 [Anesthesiologist 2:] Hypoxia is less oxygen than normal. 00:03:05.400 --> 00:03:10.333 You get hypoxic, moderately hypoxic on the top of Pike's Peak. 00:03:10.333 --> 00:03:11.266 [Doctor:] Pass out. 00:03:11.266 --> 00:03:24.666 [Anesthesiologist 3:] Well, I wouldn't say so. 00:03:24.666 --> 00:03:26.399 [Interviewer:] Could you define unconsciousness? 00:03:26.400 --> 00:03:31.000 [Anesthesiologist:] What is it? Nobody knows. Nobody knows what keeps you awake right now, 00:03:31.000 --> 00:03:47.300 and how anesthetics put you to sleep. 00:03:47.300 --> 00:03:55.400 [Anesthesiologist:] We do not understand what anesthesiology is all about, we don't understand the state of anesthesia. 00:03:55.400 --> 00:03:59.266 [Anesthesiologist 2:] Well, yes, even now after 20 years and seeing a patient go to sleep every morning 00:03:59.266 --> 00:04:06.399 and injecting a drug that completely paralyzes them, it's an aweing experience. 00:04:06.400 --> 00:04:11.866 I was on airplane last night and one woman didn't want to hear anything 00:04:11.866 --> 00:04:16.732 about the fact that this man had all our lives in his hands really. 00:04:16.733 --> 00:04:20.066 I sort of felt, well, I'll be very happy when we land in Philadelphia. 00:04:20.066 --> 00:04:28.432 I think people feel the same way about anesthesia and that you tinkered with a very significant part of their brain, for example. 00:04:28.433 --> 00:04:32.533 [Anesthesiologist 4:] Right. Eventually some chemical reaction must take place, 00:04:32.533 --> 00:04:37.799 which turns something off or turns something on or changes something. 00:04:37.800 --> 00:04:40.533 Not a cellular level, but the molecular level. 00:04:40.533 --> 00:04:43.733 How does it do what it is doing? 00:04:43.733 --> 00:04:49.333 And that's related to this shape that the molecule will assume in the body. 00:04:49.333 --> 00:04:50.366 [Interviewer:] What do you mean, shape? 00:04:50.366 --> 00:04:54.266 [Anesthesiologist 4:] Will it occupy this particular shape or indeed will it occupy this one? 00:04:54.266 --> 00:04:55.999 Literally nobody knows, 00:04:56.000 --> 00:05:01.666 at a molecular level now, what's going on and what those anesthetic agents do. 00:05:01.666 --> 00:05:05.166 What we're really talking about is the function of the human brain. 00:05:05.166 --> 00:05:10.932 [Anesthesiologist:] What's going on inside, how the anesthetics change what's going on. 00:05:10.933 --> 00:05:13.099 [Interviewer:] Do volunteers understand what's going to happen? 00:05:13.100 --> 00:05:15.766 [Anesthesiologist:] We show them a study actually in progress. 00:05:15.766 --> 00:05:20.466 And we'll say, "This is what you will look like, you will be on that table." 00:05:20.466 --> 00:05:22.999 And a great many number of these people are willing to do it. 00:05:23.000 --> 00:05:25.366 [Emily:] There are people who like to be right up against a problem. 00:05:25.366 --> 00:05:27.332 [Interviewer:] How does it feel? 00:05:27.333 --> 00:05:36.199 [Anesthesiologist:] Stewart will feel numbness and tingling, the sounds will become louder, he's spinning down a long corridor. 00:05:36.200 --> 00:05:43.766 Dr. Nae himself has breathed this mixture and knows exactly what these feelings are. 00:05:43.766 --> 00:05:47.199 [Nurse:] 15 seconds to sample three. 00:05:47.200 --> 00:05:48.300 [Interviewer:] It's a countdown? 00:05:48.300 --> 00:05:57.300 [Anesthesiologist:] When the countdown reaches zero, radioactive krypton is suddenly switched into the breathing system. 00:05:57.300 --> 00:05:59.000 [Interviewer 2:] Is that a radioactive tracer? 00:05:59.000 --> 00:06:07.700 [Anesthesiologist:] Yes. The krypton emits small amounts of radioactivity, which tell us how much energy his brain cells are producing. 00:06:07.700 --> 00:06:10.133 [Interviewer 2:] So, what do you think you'll be working on next? 00:06:10.133 --> 00:06:15.899 [Anesthesiologist:] We would bring this massive amount of equipment into the operating room. 00:06:15.900 --> 00:06:24.100 We've now been able to identify rather special problems in anesthesiology and we see that these traditional drugs really don't fit. 00:06:24.100 --> 00:06:30.300 [Dr. Nae:] Yes, since the days of chloroform, about 20 additional anesthetics have been given. 00:06:30.300 --> 00:06:39.500 So powerful that we've got to know from second to second the exact concentration that the patient's breathing. 00:06:39.500 --> 00:06:46.266 We found recently that as soon as he went to sleep, his oxygen fell. 00:06:46.266 --> 00:06:53.399 In essence, it's due to the anesthetic drugs, and we take constant sampling. 00:06:53.400 --> 00:06:58.433 What we've done is to establish a laboratory right in the middle of an operating suite. 00:06:58.433 --> 00:07:06.566 This brings research techniques in a daily availability so far as patients are concerned. 00:07:06.566 --> 00:07:07.766 [Interviewer 2:] This is one reason you're in it? 00:07:07.766 --> 00:07:12.066 [Anesthesiologist:] Oh it certainly is, the notion that anesthesia is something that can be improved. 00:07:12.066 --> 00:07:14.599 [Interviewer:] What about how anesthesia used to be? 00:07:14.600 --> 00:07:24.400 [Anesthesiologist:] Paradoxical as it may sound, the attitude just 15 years ago was that this was 00:07:24.400 --> 00:07:32.900 a fairly simple procedure which could be carried out by our dumbest intern or a technician for that matter. 00:07:32.900 --> 00:07:39.133 Being dumped into anesthesia under those circumstances, not really knowing any more, 00:07:39.133 --> 00:07:45.366 any less than that of the rest of the people, horrified me so much that I think it had something to do 00:07:45.366 --> 00:07:49.699 with influencing me towards getting into the specialty myself. 00:07:49.700 --> 00:07:58.833 [Doctor:] Anesthetists have an extraordinary advantage than, you see, to study man and to find out ways of relieving his various symptoms. 00:07:58.833 --> 00:08:04.566 [Dr. Nae:] In the clinical situation is where you get the ideas for your next research project. 00:08:04.566 --> 00:08:14.032 It has a unique feedback in that you can go back to the laboratory with a host of ideas, not only for what is interesting to study next, 00:08:14.033 --> 00:08:19.733 but also about what is important to study next. 00:08:19.733 --> 00:08:25.333 The need for new agents usually arises from one's bedside experience. 00:08:25.333 --> 00:08:34.033 [Doctor:] Yes, the interactions that occur in patients between the medicines, drugs, and other chemicals 00:08:34.033 --> 00:08:40.599 that they take in this rather frenetic world in which we live and how these drugs interact with anesthetics. 00:08:40.600 --> 00:08:45.700 [Anesthesiologist:] You know really, when you're anesthetized, that simply is not enough. 00:08:45.700 --> 00:08:50.900 A surgeon requires a great deal more than that in taking care of people. 00:08:50.900 --> 00:08:54.866 One you can see, gee, if I had a drug like this that would be just what he would need. 00:08:54.866 --> 00:09:01.199 And the next step is to go to an organic chemist, say, "Hey, can it be made?" 00:09:01.200 --> 00:09:03.666 Once we get the drug we have to test it. 00:09:03.666 --> 00:09:07.899 And it gives us particular insight into the mechanism of action. 00:09:07.900 --> 00:09:11.266 We then study these things in animals. 00:09:11.266 --> 00:09:17.566 The animal is anesthetized and we record the movements of the muscles based on the stimulation of the nerves. 00:09:17.566 --> 00:09:23.866 So, you can see then the decrease in muscle activity as a result of this drug. 00:09:23.866 --> 00:09:28.699 You can see the twitch now recovering. The drug is wearing off. 00:09:28.700 --> 00:09:34.100 [Emily:] It isn't just research. There you are with a person and you have to do something. 00:09:34.100 --> 00:09:39.766 [Anesthesiologist:] Oh, yes. The nerve stimulator that we use in the laboratory 00:09:39.766 --> 00:09:44.632 has spawned the Block-Aid monitor that we use in the operating room. 00:09:44.633 --> 00:09:48.366 This allows us then to monitor this particular drug, 00:09:48.366 --> 00:09:56.899 so we can have some idea as to the profoundness of the effect and the time scale as to when it is beginning to wear off. 00:09:56.900 --> 00:09:59.133 And that's very important in anesthesia. 00:09:59.133 --> 00:10:03.633 Because you are different from anybody else ever created. 00:10:03.633 --> 00:10:09.899 Each drug, therefore, may well have a different effect on you as a different entity from him. 00:10:09.900 --> 00:10:11.300 [Interviewer:] And children? 00:10:11.300 --> 00:10:18.666 [Anesthesiologist:] One of the erroneous concepts, I think, in terms, or at least in the minds of most laymen, 00:10:18.666 --> 00:10:21.632 is that a child is a miniature adult, 00:10:21.633 --> 00:10:25.066 and nothing could be further from the truth. 00:10:25.066 --> 00:10:26.732 [Interviewer:] Do you give a different dose? 00:10:26.733 --> 00:10:29.499 [Anesthesiologist:] With some muscle relaxers I might give them a larger one. 00:10:29.500 --> 00:10:38.900 As a matter of fact, if we used that same amount of anesthetic on a weight basis and gave it to you, you would be dead. 00:10:38.900 --> 00:10:41.700 [Interviewer:] Well, what kind of operations do you have to do on children? 00:10:41.700 --> 00:10:47.033 [Anesthesiologist:] Well, sometimes the arteries will wrap around the air passages and constrict them. 00:10:47.033 --> 00:10:51.966 Sometimes the spine is born open and this has to be closed immediately to prevent infection. 00:10:51.966 --> 00:10:52.999 [Emily:] On the first day? 00:10:53.000 --> 00:10:54.233 [Anesthesiologist:] On the first day of life, yes. 00:10:54.233 --> 00:10:56.999 [Emily:] I can't image that. A first day baby. 00:10:57.000 --> 00:10:59.766 [Interviewer:] It's like my brother's child, they didn't dare operate. 00:10:59.766 --> 00:11:03.466 [Anesthesiologist:] Yes, pediatric surgery is a relatively new form of surgery. 00:11:03.466 --> 00:11:11.532 It's only been since the early 1940s that major operations have been performed with success on infants. 00:11:11.533 --> 00:11:15.533 Concentrating on supporting the patient's life systems. 00:11:15.533 --> 00:11:17.466 [Interviewer:] You're practically breathing for him. 00:11:17.466 --> 00:11:22.766 [Anesthesiologist:] Yes, understanding how he's breathing and understanding how his heart is beating or his brain is functioning. 00:11:22.766 --> 00:11:24.566 [Emily:] It isn't just putting him under. 00:11:24.566 --> 00:11:30.932 [Anesthesiologist 4:] Well, it became very clear to me, very soon after I began to do anesthesia, 00:11:30.933 --> 00:11:40.166 that preventing pain and putting the patient to sleep was only a small part of what an anesthesiologist did... 00:11:40.166 --> 00:11:47.299 that a great deal of what he did was keeping the patient alive during a very critical period in the patient's life, 00:11:47.300 --> 00:11:50.533 the two, three, four hours that he was being operated on. 00:11:50.533 --> 00:11:52.866 [Interviewer:] Well, what about people outside of surgery? 00:11:52.866 --> 00:11:59.932 [Anesthesiologist 4:] We began to be called into handle patients who weren't being operated on, but who needed this intensive kind of care. 00:11:59.933 --> 00:12:01.466 [Interviewer:] It's all part of the same thing. 00:12:01.466 --> 00:12:07.566 [Anesthesiologist 4:] It isn't different. That's the point that I like to get across. 00:12:07.566 --> 00:12:12.032 [Interviewer:] What would put people into intensive care besides surgery? 00:12:12.033 --> 00:12:19.633 [Anesthesiologist:] Well, you have the traffic injury, you have certain neuromuscular diseases and emphysema, chronic bronchitis, 00:12:19.633 --> 00:12:22.133 many of the patients with heart failure. 00:12:22.133 --> 00:12:27.233 Pointing out that you cannot separate the function of the heart and the function of the lung. 00:12:27.233 --> 00:12:32.166 And the thing is, that if you can breathe for such an individual... 00:12:32.166 --> 00:12:39.266 [Doctor:] The crucial thing about breathing is that you have no reserves for oxygen at all and so that your, 00:12:39.266 --> 00:12:48.032 the minute you stop breathing your brain becomes inoperable due to lack of oxygen and dies in a matter of minutes. 00:12:48.033 --> 00:12:52.366 [Dr. Nae:] Yes, very recently we had a more old-fashioned type of chest injury. 00:12:52.366 --> 00:12:57.566 A farmer was charged by his bull and he was unable to breathe for himself. 00:12:57.566 --> 00:12:58.866 [Interviewer:] Getting better? 00:12:58.866 --> 00:13:00.366 [Farmer:] Yes, much. 00:13:00.366 --> 00:13:02.932 [Interviewer:] Your jaws are still wired together? 00:13:02.933 --> 00:13:04.366 [Farmer:] Yes. 00:13:04.366 --> 00:13:07.999 [Interviewer:] What was the last thing that you remember about the bull? 00:13:08.000 --> 00:13:09.700 [Farmer:] He started shaking his head. 00:13:09.700 --> 00:13:11.966 [Interviewer:] How did you feel when you woke up? 00:13:11.966 --> 00:13:13.866 [Farmer:] I was awful thirsty. 00:13:13.866 --> 00:13:15.032 [Interviewer:] Did you feel alone? 00:13:15.033 --> 00:13:20.033 [Farmer:] No. Not a bit, because there's always somebody right there. 00:13:20.033 --> 00:13:28.699 [Anesthesiologist 4:] I think the most immediately striking thing about any intensive care unit is that it contrasts with 00:13:28.700 --> 00:13:32.600 the notion that most people have about a hospital. 00:13:32.600 --> 00:13:33.800 [Interviewer:] It looks anything but restful. 00:13:33.800 --> 00:13:46.100 [Anesthesiologist 4:] Yes. You don't see a quiet comfortable bedroom with nurses quietly moving around. 00:13:46.100 --> 00:13:52.900 It's the kind of place where nurses and physicians are living with a patient and treating the patient 00:13:52.900 --> 00:14:03.000 on a moment to moment basis, and that means that the place is equally active at 12 noon or at 12 midnight. 00:14:03.000 --> 00:14:06.833 [Surgeon:] Boop, boop, boop, boop, boop, boop. 00:14:06.833 --> 00:14:08.599 I was only gone a second. 00:14:08.600 --> 00:14:12.066 We just operated on him a week ago. He was in, he's been in there three weeks. [Interviewer:] Thomas? 00:14:12.066 --> 00:14:13.299 [Surgeon:] Yes. 00:14:13.300 --> 00:14:20.000 [Surgeon:] Thomas has had a prolonged problem centering around obstruction in his lower air passages. 00:14:20.000 --> 00:14:27.666 You see that he's still on a ventilator, because if we let him breathe on his own he will very soon become exhausted and die. 00:14:27.666 --> 00:14:28.732 [Emily:] He'd die? 00:14:28.733 --> 00:14:32.366 [Surgeon:] Oh, yes. This is the kind of youngster that wouldn't survive 00:14:32.366 --> 00:14:36.399 without an intensive care unit and a whole intensive care philosophy. 00:14:36.400 --> 00:14:41.466 The equipment and the means just wouldn't be there. 00:14:41.466 --> 00:14:44.299 [Interviewer:] And over here? 00:14:44.300 --> 00:14:46.433 [Surgeon:] He has a major heart problem. 00:14:46.433 --> 00:14:55.033 It's a tiny baby. Not normal yet in his breathing. 00:14:55.033 --> 00:15:00.499 The little one was born with a major narrowing of his nasal passages. 00:15:00.500 --> 00:15:13.533 He still needs to be watched carefully. 00:15:13.533 --> 00:15:17.433 [Interviewer:] He looks as if he's fighting it. 00:15:17.433 --> 00:15:20.199 [Anesthesiologist:] Yeah, patients who have respiratory disease do struggle. 00:15:20.200 --> 00:15:27.266 Our research is to help us first decide when a person is working too hard and when we must take over. 00:15:27.266 --> 00:15:29.932 [Emily:] By hand? [Anesthesiologist:] Just by feel. 00:15:29.933 --> 00:15:41.433 The educated hand. When you have a patient's life at your fingertips, very hard on you emotionally. 00:15:41.433 --> 00:15:46.066 [Nurse:] I think he'll be okay. 00:15:46.066 --> 00:15:53.099 [Anesthesiologist:] And we know now that tragically many patients are dying because they do not get the benefit of care 00:15:53.100 --> 00:15:54.866 for lung disease which is reversible. 00:15:54.866 --> 00:15:58.099 And I think we have curable disease that is not really being treated. 00:15:58.100 --> 00:15:59.300 [Interviewer:] And that's costly. 00:15:59.300 --> 00:16:01.233 [Emily:] What's going to keep research going? 00:16:01.233 --> 00:16:04.666 [Anesthesiologist:] If we had more money we could expand our resources. 00:16:04.666 --> 00:16:08.432 [Doctor:] It may seem crass when we're speaking of human life to talk about money, 00:16:08.433 --> 00:16:11.933 but we have to face the fact that money is human life in a hospital. 00:16:11.933 --> 00:16:15.099 If we had more money we could save more lives. 00:16:15.100 --> 00:16:18.533 [Interviewer:] Where do we stand on government support for research? 00:16:18.533 --> 00:16:21.966 [Doctor 2:] Well, medical research is a very expensive proposition, 00:16:21.966 --> 00:16:29.866 and just the instruments and the manpower that are involved is something that no one institution could possibly afford. 00:16:29.866 --> 00:16:31.999 [Interviewer:] But in the National Institutes of Health? 00:16:32.000 --> 00:16:37.066 [Doctor 2:] The National Institute of General Medical Sciences was created to take care of general problems, 00:16:37.066 --> 00:16:41.199 such as anesthesiology, that are important to many different diseases. 00:16:41.200 --> 00:16:43.066 [Anesthesiologist:] It acts as the patient does. 00:16:43.066 --> 00:16:49.799 [Doctor 3:] Putting the funds into this sort of thing in order to improve patient care, the patient is the taxpayer. 00:16:49.800 --> 00:16:56.500 Is that a little better, yeah? I hope so. I hope so. 00:16:56.500 --> 00:16:58.033 [Interviewer:] So you've never gotten bored? 00:16:58.033 --> 00:17:01.133 [Doctor 4:] No, not in this kind of work. 00:17:01.133 --> 00:17:02.499 [Interviewer:] How did you get caught up in it? 00:17:02.500 --> 00:17:10.733 [Doctor 4:] I come from a background that these days I suppose would be classified as underprivileged, 00:17:10.733 --> 00:17:18.333 and was very fortunate indeed to be able to go to college at all in the depths of the Great Depression. 00:17:18.333 --> 00:17:20.533 [Doctor 3:] Is that better? Is that a little better? 00:17:20.533 --> 00:17:29.599 [Doctor 4:] At that time a whole new world of knowledge and culture opened that I never even knew existed. 00:17:29.600 --> 00:17:37.000 I thought in those days that I would stay in the humanities and probably become a professional philosopher. 00:17:37.000 --> 00:17:42.733 As I look back on it, it was an exciting and wonderful idea. 00:17:42.733 --> 00:17:44.866 [Interviewer:] Was leaving philosophy a mistake? 00:17:44.866 --> 00:17:49.732 [Doctor 4:] If you think of the humanities as being in place of hard science. 00:17:49.733 --> 00:17:57.633 People are complicated, they require and need somebody who really knows the scientific facts. 00:17:57.633 --> 00:18:03.233 Also knows what he doesn't know and brings compassion along with it. 00:18:03.233 --> 00:18:08.766 [ Baby crying ] 00:18:08.766 --> 00:18:11.599 [Doctor 4:] He's scared. 00:18:11.600 --> 00:18:17.166 [Anesthesiologist 2:] They learn anxiety, even though they don't relate pain to anxiety. 00:18:17.166 --> 00:18:23.766 You've heard the phrase, "Scared to death," this has a good deal of scientific validity. 00:18:23.766 --> 00:18:35.932 [Doctor:] Well, certainly when you go to the bedside of a sick man or an injured man you find tremendous anxiety. 00:18:35.933 --> 00:18:40.499 I don't know which is worse, whether pain is worse than nausea or nausea's worse than pain. 00:18:40.500 --> 00:18:45.600 Each one as it exists, when it exists is dominating. 00:18:45.600 --> 00:18:46.833 [Interviewer:] You can measure it. 00:18:46.833 --> 00:18:49.866 [Doctor:] One can put numbers in front of subjective items, yes. 00:18:49.866 --> 00:18:51.666 That's what we've been doing with pain for years, 00:18:51.666 --> 00:19:04.299 and also with nausea and drowsiness, we've studied some 20 subjective responses. 00:19:04.300 --> 00:19:09.133 [Anesthesiologist:] Had we not made these observations on patients who were receiving drugs, 00:19:09.133 --> 00:19:12.466 we certainly would never have come up with that concept. 00:19:12.466 --> 00:19:16.599 [Emily:] My friends think of anesthesiology as just a painkiller and a put-to-sleeper. 00:19:16.600 --> 00:19:20.866 [Anesthesiologist:] It's no longer just take away pain, it's what is pain? 00:19:20.866 --> 00:19:21.932 [Interviewer:] You mean we don't know? 00:19:21.933 --> 00:19:28.466 [Anesthesiologist:] Well, you saw, of course, the four micro-pipettes which permit the intercellular recording 00:19:28.466 --> 00:19:38.066 and also the application of very very minute amounts of drugs to study the mechanism of pain, reaction of cells. 00:19:38.066 --> 00:19:38.699 [Interviewer:] What else? 00:19:38.700 --> 00:19:44.466 [Anesthesiologist:] The other area that we're looking into are sociologic and psychologic aspects of pain. 00:19:44.466 --> 00:19:48.732 Trying to decide, what are the factors? 00:19:48.733 --> 00:19:57.233 Our pain clinic is really a multidisciplinary facility, whose goal is to provide the environment 00:19:57.233 --> 00:20:03.499 to this team of physicians to work in parallel, rather than, the patient goes to this fellow and to this fellow 00:20:03.500 --> 00:20:07.233 and this fellow and this fellow and the only common bond is the patient. 00:20:07.233 --> 00:20:08.999 [Doctor:] What do you feel here? [Patient:] Numbness. 00:20:09.000 --> 00:20:13.033 [Doctor:] Tell me when it's getting sharp again? 00:20:13.033 --> 00:20:15.033 [Patient:] Now. 00:20:15.033 --> 00:20:17.333 [Doctor:] Do you have to take pain pills? 00:20:17.333 --> 00:20:22.133 [Patient:] I was taking 15 to 17 a day, I think. 00:20:22.133 --> 00:20:28.533 I figured out roughly I've taken between 2500 and 3000 in six months. 00:20:28.533 --> 00:20:33.333 [Surgeon:] No, I don't know the answer to handling chronic pain. 00:20:33.333 --> 00:20:37.366 These people might think I've done successful surgery but they continue to have back pain. 00:20:37.366 --> 00:20:40.766 I'm sure it comes from a variety of causes. 00:20:40.766 --> 00:20:47.232 [Doctor 2:] There does seem to be some relationship between the way that she shows her pain, 00:20:47.233 --> 00:20:49.799 gritting her teeth, but letting you know she really hurts anyway. 00:20:49.800 --> 00:20:54.733 [Doctor 3:] She speaks with love and devotion and gratitude to this process. 00:20:54.733 --> 00:21:00.766 She commented too that if it weren't for the back pain and things were now comfortable enough 00:21:00.766 --> 00:21:04.899 so that they could be having an enjoyable time together. 00:21:04.900 --> 00:21:13.466 [Surgeon:] She is a 53 year old housewife who came to us about a year ago complaining of low back pain. 00:21:13.466 --> 00:21:15.866 [Doctor 4:] Is the pain there all the time? 00:21:15.866 --> 00:21:17.232 [Patient:] No, it isn't. 00:21:17.233 --> 00:21:19.799 [Doctor 4:] How about moving to the side? 00:21:19.800 --> 00:21:22.466 Is that bothersome? 00:21:22.466 --> 00:21:24.132 [Doctor 4:] Anything else make the pain worse? 00:21:24.133 --> 00:21:29.599 [Patient:] Well, I don't give into it at all, because I have to keep the home going. 00:21:29.600 --> 00:21:33.233 [Doctor 5:] Aren't you involved in getting into a new house? 00:21:33.233 --> 00:21:40.666 [Patient:] Yes, I have found a new place to buy, what I wanted and supervised all the moving and everything, so. 00:21:40.666 --> 00:21:42.766 [Doctor 5:] You were doing all of the moving? 00:21:42.766 --> 00:21:44.599 [Patient:] I supervised all of it myself. 00:21:44.600 --> 00:21:48.766 Bought the house, sold the other one, did all the managing myself. 00:21:48.766 --> 00:21:50.866 My husband continued to work every day. 00:21:50.866 --> 00:21:53.066 [Doctor 5:] So, he didn't have to take any time off? 00:21:53.066 --> 00:21:57.232 [Patient:] No, he didn't have to take any time at all off of work. 00:21:57.233 --> 00:22:04.199 [Doctor 5:] It's been my understanding that this is kind of the way you do things, is that you take much of the responsibility. 00:22:04.200 --> 00:22:11.600 [Patient:] I like responsibility, I always did. So, it works real well. 00:22:11.600 --> 00:22:13.433 [Doctor 5:] This has been the case for most of your life. 00:22:13.433 --> 00:22:15.999 [Patient:] All my life it's been the case, right. 00:22:16.000 --> 00:22:18.066 [Doctor 5:] People look to you to... 00:22:18.066 --> 00:22:23.366 [Patient:] Rely on. I started working at seven, when I was seven years old. 00:22:23.366 --> 00:22:25.332 [Doctor 5:] What did you do then? 00:22:25.333 --> 00:22:27.633 [Patient:] I picked cotton. 00:22:27.633 --> 00:22:29.199 [Doctor 5:] Is that so? 00:22:29.200 --> 00:22:31.933 [Patient:] That's right, I picked cotton. 00:22:31.933 --> 00:22:38.099 Saved my money and bought myself a pair of red goose shoes. Just beautiful. 00:22:38.100 --> 00:22:40.700 [Doctor 5:] Was that your first pair of new shoes? 00:22:40.700 --> 00:22:43.200 [Patient:] Well, no, it was my first pair of red goose shoes. 00:22:43.200 --> 00:22:45.733 [Doctor 5:] Red goose shoes, I see. I see. 00:22:45.733 --> 00:22:53.299 [Patient:] So, I've worked, kept a four-bedroom home, did all the gardening, all the yardwork, 00:22:53.300 --> 00:22:56.466 and worked 40 hours a week until I hurt my back. 00:22:56.466 --> 00:22:57.832 [Doctor 5:] And how did that change things? 00:22:57.833 --> 00:23:00.133 [Patient:] And all, everything completely changed. 00:23:00.133 --> 00:23:07.733 [Doctor:] I think anyone who says, "I hurt, I'm in pain," I think that it is an emotional experience, 00:23:07.733 --> 00:23:09.099 total experience. 00:23:09.100 --> 00:23:13.266 [Anesthesiologist:] This is clearly one of the major problems of our age. 00:23:13.266 --> 00:23:16.866 Levels of perceptions of just about everything. 00:23:16.866 --> 00:23:22.999 Things that are very hard to define, but they are all related to consciousness in some way. 00:23:23.000 --> 00:23:29.400 Presumably if one could halt the degradation of the body, which is going on every instant 00:23:29.400 --> 00:23:35.833 and to suspend it totally and then reactivate it again on another planet, 00:23:35.833 --> 00:23:40.366 then we could afford to spend literally years, in terms of space travel. 00:23:40.366 --> 00:23:47.632 [Emily:] I suppose the anesthesiologist will be the specialist in long space travel, maintaining us delicately through time. 00:23:47.633 --> 00:23:49.333 [Interviewer:] Back to Earth. 00:23:49.333 --> 00:23:56.433 [Director:] There must be a certain amount of what I call productive leisure, for contemplation and study. 00:23:56.433 --> 00:23:59.399 [Interviewer:] As director of the National Institute of, uh, 00:23:59.400 --> 00:24:01.300 [Director:] General Medical Sciences. 00:24:01.300 --> 00:24:03.600 [Interviewer:] How do you buy brains? 00:24:03.600 --> 00:24:09.533 [Director:] I've never been able to buy brains and I'm not sure anyone else does really. 00:24:09.533 --> 00:24:14.066 You can buy a certain high-grade skill, but you don't buy brains, I'm convinced. 00:24:14.066 --> 00:24:16.532 [Interviewer:] What brings a good man into the field? 00:24:16.533 --> 00:24:28.733 [Director:] The excitement of being able to develop new information and new knowledge. 00:24:28.733 --> 00:24:37.166 And it's particular gripping when clinical research is involved, to anticipate where trends are going to develop. 00:24:37.166 --> 00:24:44.632 It's very much as if one is riding a surfboard just within the fast-moving curl of the wave. 00:24:44.633 --> 00:24:55.166 The crowning point of the whole series of experiments, perhaps involving years of time. 00:24:55.166 --> 00:24:59.999 [Technical Advisor Edgar Lee, Jr., M.D.] 00:25:00.000 --> 00:25:04.966 [Project Supervisor-Helen Neal, Directed by Tracy Ward and edited with Anita Posner, Molly Smollett] 00:25:04.966 --> 00:25:07.832 [Producers Louis Mucciolo, Thomas A. Pyle] 00:25:07.833 --> 00:25:10.866 [Grateful acknowledgement for Leonard Bachman, M.D., Henry K. Beecher, M.D., Henrik Bandixen, M.D., John J. Bonica, M.D.] 00:25:10.866 --> 00:25:15.666 [Robert D. Dripps, M.D., Richard Kitz, M.D., Myron Laver, M.D., Emanuel E. Papper, M.D., Hanning Pentoppiden, M.D.] 00:25:15.666 --> 00:25:20.899 [Theodore C. Smith, M.D., Harry Wellman, M.D., and Dr. Frederick L. Stone, Director National Institute of General Medical Science] 00:25:20.900 --> 00:25:23.900 [Cooperating Departments of Anesthesiology: Hospital of The University of Pennsylvania, Massachusetts General Hospital, 00:25:23.900 --> 00:25:29.600 Columbia-Presbyterian Medical Center, The Children's Hospital of Philadelphia, University of Washington Hospital] 00:25:29.600 --> 00:25:36.633 [Produced by Audio Productions a Division of Novo for] 00:25:36.633 --> 00:25:40.433 [The National Institute of General Medical Sciences, National Institutes of Health, U.S. Department of Health, Education and Welfare] 00:25:40.433 --> 00:25:52.133 [Sound of waves crashing on the beach]