IZINDABA
BOOK REVIEW

Waking Up Safer? An Anesthesiologist's Record

By Berend Mets. Bristol, UK: SilverWood Books, 2018. ISBN: 978-1-78132-749-4 (book), 978-1-78132-801-9 (ebook)

The unique and exciting life story of Berend Mets is the backdrop to a book that gives us an unusual insight into anaesthesia. Sometimes underappreciated, this highly scientific medical specialty enabled the phenomenal advances of surgery over the past 150 years. The book provides the historical background to a discipline that was closely linked to the unprecedented technological and scientific advances of the nineteenth century. The tour through the emergence of anaesthesia could not better contrast it with that of its sister discipline, surgery. While the urge to cut open an infection or amputate a crushed limb has been around for millennia, the controlled management of pain and the resultant ability to perform major operations had to await the innovative medical discoveries of the nineteenth century. Mets recounts the history of the pioneers of anaesthesia with the ease and skill of a seasoned writer. He shows that a daring pioneering spirit was needed to open the door to painless surgery, but argues that meticulous attention to detail and continued improvement of algorithms of care are the modern-day trademarks that allow us to wake up safely after an operation. He uses numbers to illustrate the astounding evolution of this discipline, with mortality rates decreasing from 1 in 1 500 in 1954 to 1 in 140 000 in 2014. Mets maintains that this is still far from the safety record of air transportation, with one fatal incident in 2 300 000 flights. As such, he proposes that aviation protocols should guide us in the even more rigorous implementation of safety measures for yet better outcomes in anaesthesia.

The author's unusual talent to embed his well-structured factual scientific message in his own captivating narrative makes this book easy reading, even for non-medics. Seeing the development of anaesthesia through the author's eyes, the reader is barely aware of being taken into the depths of physics and physiology that form the solid foundation of modern anaesthesia. At the same time, the book is also essential reading for surgeons, as it will inevitably deepen respect for a closely affiliated discipline that many of them take for granted.

Through his personal anecdotes, the author also shows the boundaries of modern medicine. He contrasts his experience of being thrown into his first night on call at one of the biggest African rural hospitals with the sophisticated cutting-edge research laboratories with which he was involved. The latter include both laboratories at the University of Cape Town, where he conducted the research for his PhD, and those that he headed for some years at Columbia University in New York.

It is evident that the author's life trajectory, primed by the medical background of his parents, was shaped by his own unusual passage through Indonesia, Singapore, England, Holland, the West Indies and eventually South Africa. His mother's frightening experience of the nearby launch of the German V2 rockets in her native Holland and the circumstances of World War II made her choose nursing and an early career in Dutch Indonesia. His father, a medical doctor who had been born in Java, was as a young man during the Japanese occupation smuggled through enemy lines with ammunition and weapons on a bicycle, and eventually ended up in a prisoner of war concentration camp in the Indonesian jungle for years.

The context of this personal background never gets lost in the book. While the 'front line' stories epitomise what can be done with a minimum of infrastructure and modern support systems, other stories demonstrate scholarly enquiry and the systematic translation of scientific discoveries into the academic front lines of modern medicine.

Throughout, Mets never loses his gifted ability to tell stories. He completed a significant part of his training at Groote Schuur Hospital in Cape Town, where the first heart transplant took place, making cardiac anaesthesia a natural context for examples and tales in the book to highlight the past journey towards greater safety in the field. The actual story of the anaesthesia of the first heart transplant is just one example of the way he manages to enliven a highly scientific topic for the lay reader.

The book is a rare first-book publication from an author who has the philosophical wisdom of the widely travelled, the scientific and clinical insight gained through long years of an exciting and colourful career, and a great gift for telling stories.

Peter Zilla, Johan Brink

Christiaan Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa peter.zilla@uct.ac.za

Justiaan Swanevelder

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa