Excerpt from Breathing for Two: Prologue

WHEN I was in medical school, I heard about a curious malady called Ondine’s curse. It was a breathing disorder, and the professor had casually mentioned it during a lecture on the mechanics of breathing—an afterthought, more or less.

“Who was Ondine?” someone asked.

The professor didn’t know.

Who coined the name?

It was an anesthesiologist who had observed it in patients with injuries to the respiratory center—the part of the brain that controls breathing.

“What’s the cure?” someone else said.

“There isn’t one.”

You hear about many disorders when you’re in medical school, of course. Some you think about a lot. Some you even begin to think you have, but usually you get over it.

Ondine’s curse is this: during sleep, the body forgets to breathe.

Ondine was a water nymph who fell in love with a man. It’s dangerous business for a nymph to get involved with a mortal, for if she has a child by him she loses her immortality. This happened to Ondine, who was content with her fate until she discovered her husband sleeping with another woman.

Ondine woke her unlucky spouse with her curse: You promised faithfulness with every breath. Let it be done. Should you ever fall asleep again, you shall not breathe.

Was ever revenge more poetically correct?

Fortunately, permanent ruin of the respiratory center is rare. I don’t have Ondine’s curse, and neither do you, probably, if you’re reading this. On the other hand, I encounter a temporary form of Ondine’s curse every day in surgery, where, as an anesthesiologist, I must routinely interrupt normal breathing in order to make surgery possible. An anesthesiologist, you might say, is the Ondine of the operating room.

Let me set the scene.

You’re an observer in a modern OR. Even though there are no windows, you know the sun hasn’t yet risen. A middle-aged woman lies awake on the table.

A nondescript but intense man in scrubs speaks intimately into her ear. The man isn’t acting as you imagine a surgeon would—he seems oblivious to the surgical paraphernalia in the room.

You see the man remove an empty syringe from an injection port and flick the intravenous line with the back of his hand. The woman’s eyes flutter and close. One hand, with which she’d been tapping a sort of rhythm on her thigh, goes limp. Her chest stops rising and falling.

One moment the woman was there, and now she’s gone. You’re not sure, exactly, what has just happened.
The nurses pay no attention, either to the woman or the man. Nothing noteworthy here, they seem to say. They go about their business, talking quietly, wheeling trays around, opening packs of instruments.

The man lifts a strange, plastic cone off the woman’s face—when did it get there? He pivots and retrieves a bizarre flashlight from an adjacent cart, and begins looking in the woman’s mouth. You notice the gas machine at the man’s side, a cascade of glass columns, porcelain knobs and metal conduits too complex to fathom. The machine makes a rushing sound and the woman’s chest rises and falls.

The machine is breathing for her.

The man tapes the woman’s eyes closed, picks up the chart, and starts writing. The woman is inert, insensible. Her transformation into surgical tissue has taken less than a minute.


It took me many thousands of hours to become the man in that vignette. I’m still becoming him.

It’s been said that anesthesiologists are the last clinical generalists. They need, apart from expertise in anesthesia, physiology, anatomy, and pharmacology, a working grasp of most other medical disciplines. Obstetrics, cardiology, pediatrics, radiology, neurology, pulmonology, endocrinology—the list, including the surgical specialties, goes on.

All that is true, and a lot of learning it is. But that isn’t the heart of it. The warp and woof of anesthesia is something strange, an essence different from other fields of medicine, the realization of which has come to me slowly over time, obvious only in retrospect.

In all other clinical specialties, surgical and medical, the doctor’s object is to prevent illness when possible; if not to prevent, then to cure; if not to cure, then to alleviate.

But in anesthesia, the object is to incapacitate.

Incapacitate, incapacitated. As in no thought, no awareness, no memory, no response, no movement, no breath. The anesthetist prevents no disorder, cures no affliction, and makes better no illness. His peculiar occupation is to turn a living soul into tissue.

I’ve been coming to grips with this strangeness in my profession for many years. I’ve groped for metaphors to express it. My favorite is the night sea journey. It goes like this:

I’m a boatman sailing across a body of water, and the patient is my sleeping passenger. It’s night. If we make it to the other side, a change in the patient, a change that involves healing, takes place. But I don’t directly participate in that. My job is to keep the boat moving.

Crossing the dark water poses many dangers: storms and headwinds, rocks and whirlpools, even dragons. When the boat leaks, I undertake repairs. When it veers off course, I must find the way again. None of this is much fun. A lot of it is harrowing. Hours of boredom, moments of panic, as they say.

The boatman’s journey is a romantic metaphor I like telling. I think of myself as the custodian of that craft and its precious cargo, sustaining a ritual of healing. But uppermost in my mind is the harrowing part of being a boatman.

Of all the dangers in an operating room, the most harrowing involves Ondine’s curse (I mentioned before that the anesthesiologist routinely must interrupt normal breathing). The anesthesiologist therefore routinely faces a harrowing question: what do you do with a body that can’t breathe?

The strangeness an anesthetist can experience—the strangeness I experience—comes from this: from being both Ondine’s instrument and antidote; from the need both to steal breath from my patient and then to restore it. This adds a subtle wrinkle to the metaphor of the boatman: the dangers of the journey come not only from outside, but from the boatman himself.

In my own case, enacting this little drama has taken a toll over time. To be sure, the journey changes the patient. But it also changes me.

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