Post a Lookout: Patient Safety and the Anesthetist as a Watchman.

As I assisted a surgeon during my third year of medical school, my proximity to a patient's hope for health and the possibility of her death revealed the great power and privilege of the operating room (OR). Although patient safety has improved over the last century, few actions in the OR are harmless. Vigilance, and its role in harm prevention, is reflected in quality improvement literature and the lighthouse logo of the American Society of Anesthesiologists. I propose a related framework that builds on the themes of vigilance and patient safety: The work of the anesthetist can be understood by biblical reference to the close surveillance of a watchman who announces what he sees (Isaiah 21:6). In the Bible, the term watchman recognizes whoever is overseeing from a watchtower, whether a military sentinel, an agricultural caretaker, or a prophet. This essay extends this analogy for anesthetists who are like watchmen of the OR. Like these lookouts of scripture who warn of chariots and swords, safeguard fields and vineyards, and announce the sun's rising, anesthetists are guardians of the patient's body and mind in the night of the OR and welcome the patient to a new day after a "deep sleep" (Genesis 2:21). Anesthetists as watchmen have significant responsibility in their vigilance and duty to respond to threats, and their attentive work contributes to the interdependent goal of restored health for the patient. Through this scriptural analogy to watchmen, anesthesia practitioners might have a theological framework for integrating their work of vigilance and advocacy for patient safety with that of God's prophets and Israel's forebearers.