Welcome to the International Museum of a surgical science we are so happy that you could all be here. We are really honored to host the new talk on counting backwards. For those of you that have not been here before the International Museum of a surgical science is a division of the International College of surgeons it was founded in 1954 by dr. Max saw rex. Is housed in this historic mansion. It was built in 1917 for the countess family Eleanor Robinson was a prominent figure in the upper class during the early early 20th century. We are proud to continue that legacy. The museum houses four floors for floors of exhibits on surgical and medical history the main themes in the museum are the development of the understanding of Human Anatomy the development of anesthesia in the development of nsf this. We are really excited today to host this book counting backwards it is a pleasure to be here. A little while back and understand that as one gracefully matures it was a little while back that i was watching one of my sunday morning news shows. And the focus of the segment was the cellist yoyo ma. And he is renowned throughout the universe and he was standing on the side of a divider. On the other side of the divider was someone introducing him. This person was listing off a number of accolades. He sent know thats not true. I have scenes hundreds possibly thousands of introductions for shows and whatnot and quite often the person making the introduction is not fully in the know that there introducing. I said to myself while who can possibly be better in this world embellishing my accompaniments than me. So i decided i would do my own introduction. If youre ready here goes. I am Jay Priscilla and book counting backwards it turns out that im selfconscious. I dont want my accomplishments embellish. I dont even like listening to my own credentials. At that we would take a little bit of a different approach and skip that stuff and i would give you a brief history and i a permit will be brief of how we round up being here tonight. On average summer day i woke nearing the end of the First Quarter of my on this particular life. I had found and looked into the most incredible walnut brown eyes amazing. In that second note was literally a second i was captured. My heart and soul is gone. And by the time the clock struck midnight we were on a quest. And it started with a kiss. You need to understand she was 14 i was 15. The concept was quite different. Lets jump up about seven years and its now december 2317 we are married and im walking to my apartment. In the mailbox has an envelope looking out. This envelope was different. I have already received some of the standard nine by three envelopes with a trifold piece inside that says you have wonderful credentials we were in the middle of the medical school campaign. Here is this big eight and a half by 11 envelope. I pull it out of the mailbox and i look in it as layla University School of medicine. I ran up the steps to my wife and we hugged we laughed, we cried because we were in medicine. Lets go a few more years ahead lets jump three years or four years and its now approaching the end of medical school. It seemed like a nobrainer. I was going to cure cancer. Most of the cancers arent being cured. To be cured is a fiveyear process. Im just not that patient. So i realized i was not a thinker i was i can go not can go into internal medicine or pediatrics i needed to be a doer and so right on surgery. The end of medical school though. And there is time for some electives. So im looking at the electives going down the list. And well. Theres one. That actually pays. Of course sign me up. Im in it. We have an infant child at home. We were living in poverty level. I actually got back more than i paid in. I mustered up all of the wisdom that testosterone allows you to have. I zipped right over to united audio. I did listen to that music, i felt it. Something happened. Now im in surgical training and im having a little bit of disillusionment. I now had three kids a house and the dog. Ray and the surgery. Are you is an acronym acronym for the unknown. I was at a conference. It meant that people who are trying to go from writer to author get published you had trouble because the agent doesnt know you. Theyre not likely to take a chance on you. Either she didnt have the right or she does to care. Im using it tonight. And we will use it in a little bit different direction. And for example radiology show me a neurosurgeon before they come to the operating room. Lets jump up a couple more decades. I gain and a lot of different ways. I think it probably should be a roller coaster. Everybody wants greater heights. They want tighter turns and lots of spins. Quite frankly i have experienced some inconceivable depths of life. And gave me a whole lot of stories and it made life very interesting if the patient a woman 38 years old and right about the time i decided to go into medicine. And she was born with half a heart. And hopefully they were gathering a few more years of time. She managed to survive into her 30s and now shes coming because her heart is working helterskelter. The rhythm is all over the place. Not very good for longterm living. As we take the rhythm and converted to as normal as we can possibly convert it. When we start looking at the pressures of the heart. In the way the blood is flowing. And then she comes back one more time. I still time. I make her unable to move. I alter heart rate blood and Blood Pressure and breathing. And then i reverse these effects. I eliminate pain during the procedure and i prevent afterwards. I care for sick patients and six sick people but i am usually not the healer. Its rare that i would be. I do nearly all of my work behind double doors. The patient usually weve only met a few minutes before. They rarely remember my name when the procedure is completed. Only handful of times every year to patients or family members ask how my anesthesia actually works. The truth is theres is much about in a seizure that modern science cant explain. As it is a responsibility that is harrowing and its one i never take for granted. Lets step back for a second. That means every eight years and number equal to the population of the United States gets enough exercise. The most frequent medical healthcare procedure performed that entails risk. The anesthesiologist is ambiguous and largely invisible. And more people up to a hundred million every year complain of pain both acute and chronic as an anesthesiologist of over 30 years to come one come all University Health care system i have an exercise over 30,000 in my career. To newborn babies to kids to adults the primal life. To those who are potentially failed. I specialize in pediatric in the sea theology. Two morbidly obese teenagers. They dont keep regular hours. We are called upon and all times for middle of the day elective colonoscopies to middle of the night emergency trauma. This is a little bit scary to even myself when i put this into perspective. Day in and day out i spent most of the waking hours of my life behind the automatic double doors. It allows little of what was learned in medical school to be forgotten. Perhaps no other medical specialty is as inclusive as anesthesiology covering all the basic sciences. In a moment i have to admit there are those amongst you that believe that i probably not be in Psychiatric Care i should be receiving it. I interact with virtually every concedes bubble specialty in medicine that there is. From the time we meet in the pre in a seizure area after they evidence that they had been reunited with their loved ones i am the primary care dr. During my anesthesia care and become all of the doctors in one. That woman who has the aneurysm might be suffering the pain and deformities of arthritis. And when things take a turn for the worse and that operating room when the blot blood loss amounts its left to the indices yellow just to make life right. Over hundreds of years ago inhaling a gas was shown to produce insensibility and i do love that. Insensibility. Allowing for invasive medical procedures. The magnitude of this is obvious. There is a growing number of people receiving in a seizure. For what they considered the most significant article ever published in its lengthy and distinguished history. The article concerning the demonstration of inhaling ether to produce painless surgery. That paper published a mere few months of xray and imaging technology. And of antibiotics. Its pretty amazing. At that time was yet more than a century and half later when patients and families ask the most basic question in my specialty i am unable to answer. I have to head faith in my gas. Is an irony that patients place their faith in the anesthesiologist who places faith in the gas. Think about that for a minute because that in many ways makes me a faith healer. Its a timehonored tradition when they would introduce 50 or 60 years ago in the loss of consciousness was possible within a matter of seconds it was likely some anesthesiologists wanted to know the speed of induction and ask the patient to count backwards. The practice stuck. My practice i continue to ask them to count backwards. Another confession. When i size up a patient and i sense they had been practicing that there is some demons out there that are can speed count backwards i befuddle them in safe working account backwards by sevens. I cant ever remember hearing 86. My goal is that after my care every patient is better. And i hope that she have a very warm and bountiful thanksgiving. The strange aura. I will just experienced the most bizarre dream anybody has ever had. I think i have read enough of my book. So now, i hope for your enjoyment and that perhaps you might have a little bit more insight from my life and my career and for my specialty of in a seizure i present to you counting backwards. A couple of quick notes of gratitude. Michelle get out from behind there. Its absolutely stunning. Into cspan for some reason they found my book where they thats his filming in the back of the room. I think the film crew. I think cspan for inviting us into their office in tv. I hope you take a look at it. I dont like talking a whole lot but i would love to answer any questions. Open up and let them fly. Thank you. You honor me for coming tonight. Im only about two thirds done. And your warmth and humanity that come through remarkably i will say i was surprised to hear about the shelf with the guess its a very good thing but what motivated you to get your masters and to do the book. Can a start assert going deep. Why the book. First less lets address that. There is a shelf that is above the in a seizure machine and that is where some of my colleagues are saying he is always telling us to load that shelf. If anybody in the room says that its good to go right to that shelf. You need it. It goes right to that. Thats my secret. Not anymore unfortunately. Thank you. That is a deep one. My wife suffered and in years and when she is pregnant with my daughter. She for survived something she should not have survived. A cause a brain injury. And it slowly eight away her life. I was looking for something for two purposes. I was trying to rationalize the irrational. We had been to dozens and dozens of psychiatrists. Trying to figure out what exactly was going on with my wife that if they could help they were can help me. So i turned to that. Thats when i decided what i was going to write. This pie can be good to do it. I finally said okay lets jump in. Lets get a masters in fine arts. Now, to go on to that one minor stage more if any of you listen to the fresh air interview you heard it when i got there i was writing about sandy thats that the pieces that i turned in. And all of the mentors and professors they looked at me and they had tears in their eyes and they were saying you write with such incredible passion. Thats very true. They said we want you here or glad youre here. Now pics of the pick Something Different to write about. I hate to admit this and hopefully the camera wont be on. I immediately went for the lowlying fruit which is my career because it was all around me. It was a sure thing. Thats why counting backwards was born. [indiscernible] at 600 it introduced me to the profession. And a lot of different parts of medicine you just dont think about. Thats when you start realizing there is no specialty that second to second is using all the basic sciences and applying directly to those in front of you. The bills were mounting and i wont lie to you that was a significant emphasis. It comes out in this book. And i havent thought about it until you ask this question. I tend to have a problem which was dme to surgeons. And apologize it i care too much for my patients. And you have to had to be able to separate. And in anesthesia im able to separate a little bit except for angel erin and you will hear about that one. You have to have some questions about something. Dont be embarrassed. Through all of these years of you practicing in a seizure and for your fellows here the words of wisdom you can give us. And loving what you do. Keep a journal. If you kept a journal when you start getting down you just open up that journal. You will find some spectacular patients. Day in and day out. One of the things i tend to do especially with the older patients they are having an intravenous injection and just before i start pushing the drug its time to go to your happy face. I have a patient do give a happy place get ready to go. The patients that i do and they say where is the happy place. I want to find that patient afterwards to explain that i met at that particular point youre not going i dont know after. So keep those stories. Youve heard all of my stories. Anybody else . What was the worst case you ever had. Worse in terms of difficulty or outcome . With one of my colleagues here of a child with a pathetic issue was also bleeding. One of the things that you get the sense about you. That you know something bad is happening. First thing in the morning here is the add on. This person was as close to death as you possibly get. I went to the radiation out sweet. Where the problems with the liver were coming. And before anything happened i just heard to that nurses in the radiation sweet and i said bad that thing is can happen. That case how many units of blood do we get. We got created in doing that. That was several hours of on your toes. Every time it just wild up welled up with the blood. I just said stop right now. Step back from the table. Go away. And he did. It allowed me half an hour to gain my wits and get the patient under control. And then said come back in. He did. We did okay. That was tough and that was one of those and get get out of there go away. That was memorable. I really think that is what helped that patient survived. Otherwise i wouldve discontinued and continued. Obviously near and dear to my heart are ruptured our ruptured blood vessels in the brain. Im getting to melodramatic there. Every patient that youve lost there is a vault and my brain. It has the image of every single one of them. The only help you can get better. Im sorry i went morbid on you. Will you continue writing . Part of that depends on tonight. Counting backwards might move into still counting absolutely stunning how may people have connected with me in the last week to two weeks telling their own stories of problems and one of the things that has really struck me deep this a the number of people including michelle i ask of you read the book and she said yes and then she said did it make you cry. The women who interviewed me from london made her cry four times. Im thinking to myself we got a problem here. The editor wanted to take out the truly sad chapter i think they were appropriate and saying you insane you can put this in the first book. The second book i could probably get away with it. So i have and i dont want to embarrass you too much susan. I took care of her son when he was ten months old that little ten month old boy taught we were about life than any other patient has. Right now it is being received quite well. And i hope it stays that way. [indiscernible] anybody else have any questions. I frequently tried to contact in a seizure to find out what the best form of anesthesia was for a patient. As more of a patient advocate. I would like to also put that out there. Be friendly with your internist. Theyre wonderful people and keep in touch with them. When a patient leaves the Recovery Room you want that patient to go to somebody that is really invested. Its a wonderful point. I will put a little twist on something you said there. You talked about anesthesiologists Holding Hands with surgeons. But every day in my practice im caring for more patients from procedures and those procedures are the interventional radiologist liturgy replacing valves. Is moving moreover to the non surgical side. And we are dealing why are best with it. We are getting closer to you one way or another. I cant leave you on a down and out. So, i was taking care of a patient and the patient was a chronic patient multiple procedures and when they have multiple procedures they tend to lose all of their veins to be able to induce these patients. People are putting on the monitors and i take a look at the left arm. I look at the patient. Up to this point. I tried making connections on everything. On what the favorite color was and i cannot get anything. Absolutely zero connections. Im looking at this arm and im thinking and finally i said okay ill bite i say i said what are you bad at for the first time spends a i said you spelled it wrong. That idea never went into quicker and within seconds that patient was asleep. Thank you guys. I hope you enjoy the book. Book tv is on twitter and facebook and we want to hear from you. Or post a comment on her facebook page. [applause]. Good evening everyone. Im thrilled to welcome you