The anesthetist visits the patient preop-eratively. In a casual but personally conversational fashion he/she addresses the patient. He communicates those understandings and attitudes that he/she knows as an experienced anesthetist will be of most value in effecting within the patient that state of well-being most conducive to successful surgery and a favorable postoperative course. This communication is made slowly, thoughtfully, with pauses of varying length to meet the patient's needs in understanding. These pauses are indicated in the following material by the indicated spacing in the words employed.
I am Dr. Smith. . . .1 am going to give you an anesthetic tomorrow I wanted to meet you. I wanted to check ... a few simple things . . . myself ... to make sure . . . everything goes smoothly .. . tomorrow morning.
The anesthetist then examines the patient exactly as he/she would under other circumstances, continuing the remarks:
Everything is fine. ... I suppose everybody ... is a little apprehensive . . . before an operation. . . . But you need not be. . . . You are in very good condition ... for an operation . . . and you have an excellent surgeon. . . . You could not be in better hands . . . and, of course I'll be there too. ... I promise I'll look after you . . . very carefully. . . . Everything, you will find . . . will go very smoothly. .. . Tonight the nurse will give you a sedative ... to make sure you will relax . . . and have a good sleep ... it always helps, doesn't it ... to just relax . . . and not to worry unnecessarily? . . . Actually ... it is much easier to relax . . . than most people ever realize. . . . Here ... let me show you something . . . useful . . . and very pleasant. . . . Just close your eyes ... for a moment . . . take a deep breath . . . and make yourself more comfortable . . . That's very good. . . . Now open your eyes . . . and let me place your hand . . . like this . . . [demonstrating] in front of your face. . . . Is that comfortable? . . . Good . . . now all you have to do ... is to choose some spot . . . upon your hand . . . like that furrow there . . . and deliberately concentrate ... on that spot . . . and just let your hand ... do what it wants to do. . . . That's very good. . . . Notice how the fingers separate . . . how light appears between the fingers . . . how the fingers spread . . . spread far apart . . . just like a fan. . . . That's very good. . . . See how the hand itself . . . has now begun to move . . . towards your face. . . . Just let it. . . . As the hand comes closer ... to your face . . . how comfortable . . . you begin to feel. . . . And actually, when the hand does touch your face . . . several pleasant things will happen. . . . Your hand will feel very comfortable . . . against your face ... it will feel . . . as if it is stuck . . . with glue . . . very comfortable. . . . And your eyes will be so tired . . . you will find it very pleasant ... as they close . . . and you take a deep, deep breath . . . and begin to relax all over. . . . That's very good ... so pleasant ... so comfortable . . . Just for a moment now . . . notice how pleasant it really is . . . when I touch you gently ... on your shoulder . . . like this . . . [demonstrating]. Now the gentle pressure ... of my hand . . . makes it so very easy ... to take another deep, deep breath . . . and begin to let eoperating room . . . and you recognize my voice . . . and especially when you feel my hand . . . upon your shoulder . . . just like this . . . [demonstrating] . . . you will be surprised . . . how very easy it will be . . . to recall how comfortable . . . you are now. . . . And you will be inclined ... if you will allow yourself ... to take a deep, deep breath . . . and become most comfortable . . . and very content ... to leave everything to me. ... It is pleasant, isn't it ... to just lie there and relax . . . with your eyes closed . . . feeling warm and comfortable . . . and very safe . . . just letting yourself relax? . . . Just be indolent and lazy. ... I will leave you . . . for a few minutes now. ... I have to see another patient. . . . But I will be back . . . very soon. . . . While I'm gone ... be comfortable . . . very comfortable . . . and just relax all over.
The anesthetist then leaves the room in accord with his statement to the patient. When he returns:
I'm back. . . . I'm glad to see . . . you were able ... to relax so well. ... It is very pleasant, isn't it?. ... I just wanted to remind you . . . that everything is well in hand ... for tomorrow morning. . . . You have an excellent doctor. ... He is very good ... as you already know . . . and you're very fit for the surgery. . . . And don't forget. . . .1 will be there myself ... to give your anesthetic . . . and to make sure . . . that everything . . . goes smoothly. . . . After the operation . . . you'll be pleasantly surprised ... to find how well you'll really be. . . . You'll be able to breathe easily. . . . You will be able to pass your water. . . . You will be able to be remarkably relaxed . . . and very pleased to find it is all over. . . . Operations today . . . are very different . . . from what they used to be . . . I'm going to awaken you now. . . . Remember . . . when we meet in the operating room . . . and you recognize my voice . . . and especially . . . when I touch you on your shoulder . . . just like this . . . [demonstrating] . . . you will find it very easy . . . if you wish ... to take a deep, deep breath . . . and be very comfortable. . . . I will count to 3. . . .When
1 do . . . you will awake. . . .completely awake and rested . . . very relaxed. . . . And when the nurse . . . tonight . . . brings you your sedative . . . you will take it . . . and find it very easy ... to drift off to sleep . . . and sleep a very restful sleep. . . .1 . . .
2 . . . 3 . . . That's excellent. . . . Good night. . . . I'll see you in the morning.
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