Shirley Graves: Turn Around, the Future is Now

By Shirley Graves, MD, DSc(Hon)

Shirley Graves, MD, DSc(HON)Where does the time go? What changes as time moves on? You turn around and it’s tomorrow. Turn around, turn around, and it’s another year. Yes, the world we live in changes each day, each week, and each year. Certainly, many aspects of the world of medicine change. Anesthesiology has seen and produced many changes that have improved the safety of patient care. While today I write of some of the changes the digital era has made in our practice, the entire field of anesthesiology and our scope of practice have also changed and expanded. Critical care medicine, pain medicine, and other subspecialty areas have changed the face of our specialty — a discussion for another day.

My era was what I refer to as a transition phase in anesthesiology, as we moved from pen and paper into the digital era. The electronic automated record is but one example of our move into the arena of digitalization. However, it seems there is still a bit of pen and paper necessary for the complete anesthetic record when daylight savings time makes our computers hiccup.

I received open-drop diethyl ether as a child for a tonsillectomy but never used it in my daily practice. Some of the early anesthesia machines I used still had a copper kettle for diethyl ether but were replaced by flowmeters for agents such as halothane and the “champagne of anesthetics,” cyclopropane. Although cyclopropane produced a fast and easy induction, it was explosive — not a good thing. Halothane was widely used but its liver toxicity pushed it into obscurity as newer anesthetics were developed. Modern-day anesthetics like sevoflurane and propofol made their way onto the list of preferred agents that induce that wondrous state of unconsciousness as painful procedures are safely carried out on our patients. The evolution of anesthetics and drugs used daily by anesthesiologists is interesting but is also a topic for another day.

Over the past few decades, anesthesiology has changed as it has moved into the technological era. In the late 1960s, at my place of residency, there were only a few ECG monitors available: one for the “heart room” and another one or two that you rushed in to secure for your room if you had a complicated case. These monitors were not standard fare for each anesthesia machine. Today, our anesthesia machines display complex data: not only ECG, but oxygen saturation, carbon dioxide, and more information than we thought possible a half century ago when I came to UF. Another development is simulation, an advancement in learning that was one of the early innovations that began at UF. Many people other than anesthesiologists have benefited from this technology — firemen, first responders, nurses, the military, and others.

It was 1970 when I arrived at UF’s Department of Anesthesiology. Back then, our department was very different from the digital era that prevails today. It wasn’t just the anesthetic agents and the monitors, but the ways in which we communicated were different from today. Granted, even then, the days of overhead paging to find a doctor was a thing of the past. It was the “age of the beeper.” Early in the 1970s, beepers were upgraded to display a telephone number to call (not just an operator) — but this telephone was firmly attached to a cord we now call a landline. That generation of beepers subsequently gave way to the cell phone. Old “Ma Bell” was on the way out and mobile telephone conversations were born. Because early cell phones were so big and bulky, most of us continued our comfortable relationship with the beeper. The cell phone, as seen by this writer, was and is a convenience, maybe even a blessing, but sometimes I just wish I wasn’t always available. We can turn them off or just not respond, but most times, that’s just not something we feel is the proper thing to do. Texting has become a simple and friendly way of communicating that generally gives you a more immediate response than email, which is still, in 2018, a valuable means of communicating. Years ago, when email first surfaced as a popular way of communicating, the department chair at the time had his secretary type the email message and would then dictate a response for her to type back to the sender. Those were the days when we all had a designated secretary and a real person answered our office phone; there was no computer-generated menu telling you to “select 1, 2, 3…” and never being able to speak to a real person.

And so I come to the reason I share my thoughts with you as to what technology has brought to our department: Communication. I believe that one of the most significant changes over the past several years is in the way we communicate. It isn’t just our department, our hospital, our university, but all of society that has changed. We, and our children as well, depend on technology for many of the ways we communicate. Is this good? Well, it is certainly convenient and makes messages, questions, and decisions minute-to-minute events. Is there a downside to these forms of communication? I would say they raise questions as to what is good about this technological leap forward. Have we forgotten how to sit down beside each other and discuss problems, work as a team to develop solutions, and implement change for the better? There is the question as to whether this age of technology — texting, for example — has led to a generation of young people who have not learned to look each other in the eye to discuss issues. Is it important to look at each other as we speak and express our thoughts? In a text, we cannot see the emotion that is attached to the words, which I believe is important. Having said that, I also believe that ease of communication allows decisions to be made and conclusions brought to the front in a timely fashion. But somewhere in those messages, we must remember that we may be missing the heart and soul that is so important to arriving at those thoughts and decisions. Looking at one another eye to eye tells a lot about what we are saying, so it is important to remember that a typed message needs to be crafted and sent with care for its message and its consequences. I know I’m just a person from the “transition period,” not the high-powered digital era, but I do text every day — my grandkids dictate that I do so, although they know that a phone call, a handwritten note, or a sit-down conversation is still a priority from time to time.

The way we communicate is one of the greatest changes that I see in today’s world. When I visit my physician, there is my doctor, a computer, and me. Somehow, it takes a part of the human interaction away from that encounter. There can be a positive aspect to this, as the doctor can quickly access my medical history and it helps with making decisions for the current visit. I could write many pages discussing the good and bad of computerized doctor visits, texting, and even basic learning via the internet in the digital era. I shall not do so. I want us to remember that we are still just people taking care of each other.

Quite a few years ago, J.S. Gravenstein, MD, put together several videos about caring for our patients. I was involved with one about using our senses as we take care of our patients. Electronic monitors give us valuable information that improves the safety of administering an anesthetic, but there is no substitute for the importance of our eyes, ears, and touch in assessing the status of our patient as they place their lives in our hands. We must look, listen, touch, and know that someone important is depending on us — our patient. I leave you with my thoughts expressed in my poetry and it reads…



I am your patient,

See me thru my eyes,

For into your care I’m sent,

Your trust I must realize.


I am your patient,

Treat me like your own,

For into your care I’m sent,

My life is yours on loan.


I am your patient,

Gently mend my broken body,

For into your care I’m sent,

While I’m here take care of me.


Because I am your patient,

See me thru my eyes,

You’ll know I’m scared and bent,

Let these eyes see that on you I can rely.


— Shirley Graves, MD

And so, as a patient I say, “However you conduct the anesthetic, remember, technology is important but your touch, your attention, your personal best is what will keep me safe.”