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Every day at 5 a.m. he drove downtown to his county Pantheon. There he scrubbed up with the other gods before he took patients for swims in the River Styx. When the surgeon gods finished, he'd carry the patients' languid bodies back to the sunlight. Only able to see the sutures, they hugged the surgeons, never knowing that my dad was the one who'd been their keeper. If that ever bothered him, he never said so.

My dad used to be an anesthesiologist -- the guy who puts you to sleep. Maybe he wasn't a god, but he was the doctor who made sure you woke up. When a patient goes under general anesthesia, "slumber" is a nice way to put it. When you sleep, you can breathe without a respirator. You can detect when you need more oxygen, and react on your own. You can even wake up on your own.

Questions To Ask Your Doctor Before You Have Surgery, Click here.

Not when you go under.

When you go under general anesthesia, the anesthesiologist suspends you between life and death. This may seem a little dramatic, especially since you may only meet these doctors once before surgery, when they come to check your chart, and then again when you're in the O.R. and the last words you hear are "take long deep breaths." Perhaps if "ER" were called "OR," they'd get more P.R. Dr. John Neeld, an Atlanta anesthesiologist and president of the American Society of Anesthesiologists, likened anesthesia to the work of commercial air pilots, where "99 percent of the work is routine -- then every now and then it's terror."

When I asked my father if he ever felt terror, he said that profound apprehension was just part of the job: "With every patient, no matter how healthy or sick, you always think bad things can happen. It's because of the unknown."

Anesthesiologists are there to ensure optimum operating conditions no matter how many unknowns there are. And they must do so for both patient and surgeon. Sometimes a local or regional block will do the trick; only part of the body is anesthetized and the patient doesn't need to be unconscious. But for more serious or complicated procedures, when there's no other choice than general anesthesia. the anesthesiologist must do much to keep both you and the surgeons comfortable.

At first he'll give you a sedative just to relax you. Once you're in the O.R. and surgery is about to start, the anesthesiologist will give you drugs that facilitate both amnesia and pain-relief. He also administers muscle relaxants to induce paralysis, so the surgeons can do their intricate repairs without fear of limbs moving. To get the general anesthesia started you are given an anesthetic agent -- like sodium pentothal -- intravenously. (This is what used to be known as "truth serum" but has never been proven to have that special power.) Then the anesthesiologist add inhalation agents like nitrous oxide and Forane to keep you under. And to relieve your anxiety, you're given sedatives like Versed or Valium.

But anesthesiologists get paid their big bucks for what they do once you're under: They make sure you don't die. They connect you to monitors that track your heart rate, blood pressure, oxygen saturation of the blood and carbon dioxide output. (And they know how to fix those machines if one goes kaput mid-surgery.) And they control your airway; they make sure your tongue, once relaxed, doesn't block your throat. A clear airway can be tricky to maintain during trauma cases when blood from mouth injuries or regurgitated stomach contents threaten to drip down the trachea. Then you're usually intubated -- yes, that scene they have on every episode of "ER" when they stick the plastic tube down the throat and there's always some anxiety about being "in." This is because if they accidentally stick it down your esophagus, oxygen pumped to your stomach isn't going to reach your lungs. Once successfully intubated, you're connected to a respirator.

Why do you need a machine to breathe for you, especially for a relatively simple procedure? The drugs used to keep you ignorant and numb are incredibly potent and tend to depress the respiratory system. If our body senses we aren't getting enough oxygen, we take quicker breaths. But some drugs alter that system, and the body is unable to respond to insufficient oxygen levels. And sometimes the surgery itself calls for paralysis of the diaphragm. If the procedure takes place nearby, the muscle will never relax enough on its own not to be a threat to the procedure. The anesthesiologist will use a neuromuscular blocking agent to keep the diaphragm relaxed. So, once you're under the general anesthetic, if for some reason the respirator malfunctions or the oxygen tank runs low and nobody notices, it's a problem.

When it comes to oxygen intake, there's little room for error -- it only takes five minutes before your brain will die, though other organs can go a little longer without oxygen. So if you're entering hour five of a seven-hour surgery, and the surgeon is engrossed in his cutting and sewing, and the nurses are busy sucking up blood, and the anesthesiologist is distracted, it's easy to see how five minutes could slip away before someone notices that the oxygen tank has run low or the respirator has malfunctioned. Luckily, the monitoring technology is now so highly developed that these "oops" scenarios are exceedingly rare.

Next page | A real fear is waking up mid-surgery