By: 12 November 2021
Book review:  If in Doubt: An Anaesthetist’s Story by Keith Wilkinson

Keith Wilkinson is a consultant anaesthetist, freshly retired, who spent the majority of his career working at Noble Hospital, Isle of Man.

Anaesthesia is one of the few specialties where one has to be a “Jack of all Trades” and willing to take on all-comers: and the Isle of Man is probably one of the few remaining places in the British Isles where this description is taken to extremes. The nearest specialty centres are overseas, the work-force is limited; and once a year they hold one of the world’s most dangerous races there. This memoir follows his medical career from student to retirement, detailing why he made an active decision from an early age to take head-on the challenges that working in such an unusual environment could bring.

The book is a slim 212 pages, but covers a lot of ground. There are 14 chapters with titles such as “Crossroads”, “Finals”, “Fear” and “Failure” covering different aspects of his student and medical experience, placing them in the context of the times in which he lived.

Wilkinson is just slightly older than myself, and many of the changes in practice that he details are ones that I myself remember and lived through. Anaesthetising patients for hours by holding on a face mask and without the benefit of oximetry and capnography was an all too familiar pastime (the resultant firm anaesthetist handshake is now confined to history thanks to the invention of the LMA); being called to theatre to let the consultant go home, and finding out that he has not written anything on the anaesthetic chart should also be a thing of the past. He also correctly emphasises the support that nurses could bring to a young house officer daunted by their first exposure to the real world, and the importance of gaining confidence by ‘doing’. He also describes the fear of making a mistake, and concerns about difficult ethical dilemmas that he has faced.

Wilkinson states that part of his purpose is to open the doors on what an anaesthetist does to the wider readership, and he achieves this goal very well, explaining complicated concepts with just the correct degree of detail to satisfy all types of readers. DNAR orders, Intensive care, life threatening complications, and legal conundrums are all covered in a series of suitably anonymised anecdotes which clearly illustrate not only the full breadth of an anaesthetists scope of practice, but the depth of feeling that can result from having to deal with terrible situations arising in the early hours.

The book was a good read, and will be of interest not only to anaesthetists like myself who want to recall their glory days when “proper” anaesthetics were given, or those younger ones who want to know how things were done in the dark ages, but also to social historians and the wider public who want to understand what life on the front line was really like.


Reviewed by consultant anaesthetist James Watts.


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