Belmont, Massachusetts (Winter 2018)
|The ether dome today. Author photo.|
On October 16, 1846, dentist William Morton successfully demonstrated the use of ether as an anesthetic inside Massachusetts General Hospital’s Bulfinch Pavilion. That day, now passed down to us as “Ether Day,” is often seen as a turning point for surgery both in the United States and around the world. Although Morton cannot be credited with the discovery of anesthesia, his name is often associated with the beginning of modern surgical anesthesia because of what happened in the lecture hall covered by the structure now known as the “Ether Dome,” which has come to lend its name by extension to the hall itself.
The Ether Dome today is a brightly lit sanctuary at the heart of MGH. From the top of the surgical amphitheater, as it was once generically known, the view is vertiginous. Seats are arranged in steep semicircular rows around the main floor where surgeons of ages past demonstrated their expertise and lecturers today pass on their knowledge to rising generations of physicians. Leaning forward from one of the higher seats, one feels almost at risk of being pulled into a terrifying fall toward the podium below. There are fewer rows today than there were in 1846, spaced slightly farther apart vertically, and the room has been modernized, but its layout has been largely preserved. Imagining the room filled with students and faculty from a bygone age is both easy and thrilling.
Here William Morton – by all accounts a lying, self-aggrandizing schemer – arrived at 10:25 a.m. on Ether Day, explaining he had been delayed by last minute adjustments to a custom-made apparatus he was carrying. He poured ether into the glass globe of the apparatus and used the contraption to administer the anesthetic to patient Edward Gilbert Abbott. After a few minutes of deep inhalation, Abbott fell asleep. The silent anticipation in the room must have been electric; even just waiting for Morton’s arrival, one medical student had found “the stillness oppressive.”1 Renowned surgeon John Collins Warren, first dean of Harvard Medical School, picked up a scalpel and held it to Abbott’s neck. There had to have been at least a few people in that audience holding their breath and able to feel their hearts beating in their chests as they watched this moment unfold. Warren made a three-inch incision in Abbott’s neck, dissected down to a mass in the area, and removed it. After it was all over, he turned to the riveted audience and said, famously, “Gentlemen – this is no humbug.”2
Most authors have interpreted this statement as a reference to an earlier demonstration that had been something of a disaster. In late January of the previous year, dentist Horace Wells had attempted to demonstrate the anesthetic use of nitrous oxide for dental extraction to some medical students in a hall on Washington Street in Boston, likely near the medical school’s Mason Street location.3 When the patient moaned in pain at one point, the students began to jeer at Wells and echo the patient’s cry. Wells was humiliated, writing later, “As several expressed their opinion that it was a humbug affair (which in fact was all the thanks I got for this gratuitous service), I accordingly left the next morning for home.”4 He also wrote that as a result of the “excitement” of his Boston “adventure,” he suffered an illness from which he “did not recover for many months.”5
This public failure marked something of a turning point for Wells. His career unraveled. He dabbled in ornithology, inventions (he tried to market a hand-pumped shower), and art auctioning, then moved to New York to restart his dental practice. He developed an addiction to chloroform, attacked two prostitutes with sulfuric acid, and committed suicide in jail in late January of 1848, almost exactly three years after his humiliation in Boston – just missing the news that the Academy of Sciences in Paris had in the end recognized his contribution as the originator of inhalation anesthesia.
To my mind, the wonder and glory of Ether Day have always been tempered by the sadness and injustice of Washington Street. Certainly Horace Wells did not end his own life simply because of the medical students’ mockery; but those students helped set mechanisms of despair in motion that they had the power to combat or perhaps even prevent entirely. In fact, as protectors of the intrinsic dignity of other human beings, which all physicians are called to be, they had a duty to respond with support, even if they had criticisms, rather than with contempt, cruelty, and arrogance – but they failed.
Today when physicians hold “Morbidity and Mortality” conferences, called “M&M” for short, the main goal is root cause analysis of adverse medical events in order to prevent their recurrence. The salient questions are always, “Why did this happen,” “What should we have done differently,” and “What can we all learn from this?” I have often gone back to that cold January day in 1845 and tried to “M&M” it in my mind. The patient actually reported afterward that he remembered experiencing only a little pain; the outcome, technically, was acceptable. But what could Wells have done differently? By his own analysis, he withdrew the anesthetic too soon, which might have accounted for its inadequate effect. One could also speculate that the preparation of nitrous oxide was somehow deficient or different from what he ordinarily used, or that the equipment he had on hand was unfamiliar or defective in some way.
What might have happened if the medical students had engaged in some real-time debriefing, discussing these very issues, and even helping Wells to understand and overcome them? What if they had gotten up to assist instead of remaining in their seats to jeer? In other words, what if empathy and kindness, the very virtues required of them in their profession, had dictated their behavior rather than the Schadenfreude of their imagined superiority over the humble dentist from Hartford?
The scene is so different in my mind when this more evolved “re-do” unfolds. I see young men conferring in a collaborative way, one or two perhaps helping Wells out with the apparatus, one making sure the patient was being reassured, and a much more reverent and collegial atmosphere pervading the event. One can almost feel a spirit of good will hovering as if in benediction over these imaginary groups of people – like Gerard Manley Hopkins’ “Holy Ghost over the bent World…with ah! bright wings.” This is the holy ground we can create in our teaching hospitals when the teaching and learning are done with mutual respect.
The anesthesia department at Massachusetts General Hospital celebrates Ether Day every year. When I look around at the historic descendants of those early pioneering doctors and nurses, I see clinicians who epitomize much more the virtues and values of my fantasy version of Wells’ demonstration rather than the disappointing viciousness of what actually happened. It is a department that believes that empathy lies at the heart of good teaching, that colleagues must respect and support colleagues, and that all of us, from our seasoned intensivists to our students who are just beginning, always have more to learn from each other.
In a world where empathy seems ever-scarce, and divisions exert menacing, mighty forces that can create fault lines among us, the lessons of the Ether Dome, and all the stories that have made it the sacred space it is, have become increasingly important. It is easy to point the finger at medical students in 1845 and say, “They should have been asking, ‘How can we get the best result here?’ instead of lying in wait to point out the worst in another, or to laugh at him.” What is not easy is to keep learning and relearning the empathy that is as essential to our humanity as our reason. In the end the question that might save us, the one that should have been asked 173 years ago in that Boston lecture hall, is a simple one that belongs to both the best teachers and the best learners: “What can I do to help?” When educators and their students, writers, scholars, doctors, nurses, research scientists, public servants, and the people they serve see themselves as the guardians of each other’s dignity and progress, united in the common goal of dispelling ignorance and lack of understanding, the full meaning of Ether Day becomes clearer, and we have real reason for hope.
- Julie M. Fenster, Ether Day (New York: HarperCollins, 2001), 19.
- Fenster, Ether Day, 77-79.
- Rajesh P. Haridas, “Horace Wells’ Demonstration of Nitrous Oxide in Boston,” Anesthesiology 119, no. 5 (November 2013): 1014-22.
- Fenster, Ether Day, 64.
ISABEL LEGARDA, MD, completed her undergraduate studies in English and American literature and language before pursuing a career in medicine. She is a part-time faculty member at the Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital. She has written for The Establishment and for NPR’s This I Believe series.