Five Lessons from the Ether Dome

Tom Patterson, Nile Hawver, Greg Balla, Lee Sellars (seated), Richmond Hoxie, and Bill Kux in Elizabeth Egloff's provocative medical thriller ETHER DOME directed by Michael Wilson, playing Oct. 17 - Nov. 23, 2014 at the South End / Calderwood Pavilion at the BCA. Photo: Paul Marotta.

Tom Patterson, Nile Hawver, Greg Balla, Lee Sellars (seated), Richmond Hoxie, and Bill Kux in Elizabeth Egloff’s provocative medical thriller ETHER DOME directed by Michael Wilson, playing Oct. 17 – Nov. 23, 2014 at the South End Calderwood Pavilion at the BCA. Photo by Paul Marotta.

Ether Dome, a play written by Elizabeth Egloff and directed by Michael Wilson, is a “provocative medical thriller” about the discovery of the use of ether as an anesthetic for surgery. The title refers to a now-famous amphitheater in Mass General Hospital (MGH) that was used for surgical demonstrations back in the 1840s, when this play takes place. But the central drama of Ether Dome is not the actual discovery of pain relief in surgery—that’s a quick moment. Rather, it’s the battle over who gets credit for the discovery.

Although this drama took place more than 100 years ago, we learned some deeply important lessons that are still relevant to modern medical innovation. Here’s the scoop:

Lesson #1: The greatest idea can come from the humblest source.

Dr. Horace Wells, a dentist in Connecticut, is the first person to accidentally discover that laughing gas can numb the body to pain, too. In the play, Wells tries this anesthetic on his patients, many of whom scream and suffer through horrible tooth extractions. His assistant Morton then takes the idea to surgeons at MGH (“The General,” as it is pompously referred to throughout the play), but they scoff at the idea. “What could a dentist from Connecticut teach us?” they ask. They think it’s impossible that something as common as laughing gas could lead to extraordinary returns. But eventually, the MGH surgeons, skeptical as they were, see the power in what Wells and Morton are showing them. Their adoption of a game-changing innovation takes far longer than it could have if they hadn’t been blinded by hierarchy and prestige.

Lesson #2: If you want to get credit for something, you have to pay attention to media and marketing.

There are many cringe-worthy moments in the play when the brilliant ideas of various physicians are shamelessly borrowed and monetized by Morton, a savvy and sweet-talking student. Dr. Charles Jackson, a surgeon at MGH who serves as Morton’s condescending teacher, carelessly gives Morton liquid sulfuric ether for anesthesia, without thinking about explicitly laying his claim to the idea. Similarly, Wells tells Morton about the use of laughing gas but is hesitant to broadcast his findings until he is absolutely sure it works. Morton, at the other extreme, likes to promise things first and then prove them later. When he proves that anesthesia works in dentistry, he makes sure a reporter is there to document it. And when he uses it for the first time in surgery, he makes sure it’s on the main stage of MGH’s Ether Dome, and that a lawyer is there to represent him and his role in the whole thing. Morton understands, even in 1846, the power of the media in having the last word and cementing his legacy.

Lesson #3: Medical innovation means striking a balance of risk.

A big theme in the play is the risk that comes with using a known compound in a new way. Wells is willing to take on the risk in a controlled manner, for the sake of patients, but is crippled by a fear of failure when things don’t work out perfectly. Morton, on the other hand, is focused on the payoffs of what could happen if he is successful. He is over-confident and willing to take huge risks, and he makes promises lacking evidence in order to pull that off. The success of a new innovation lies somewhere in the balance of knowing what to risk, how much to risk, and for whom—and neither character strikes this balance perfectly in the play.

Lesson #4: Work with a team of people who are motivated by the same things as you are.

“Ether Dome is the story of men with tremendous hubris,” Egloff, the playwright, reminds her audience. And she’s right – Morton is motivated primarily by money and fame. Wells is motivated by finding relief for his patients and improving his practice of dentistry. Jackson is motivated by scientific progress. In the end, the disjointed actions of Morton, Wells, and Jackson did lead to implementation of an important discovery, but at the cost of immense suffering for each of them.

Lesson #5: In medicine, visibility is powerful.

The difference with ether, versus many other discoveries in medicine, is that its effects were immediately visible and useful. The patient no longer screamed when an incision was made: that was an indisputable change. The dome at Mass General was built for visible demonstrations of the power of medicine, and using ether was an innovation that fit this tall order. But, as Atul Gawande writes in his New Yorker column “Slow Ideas,” not all medical innovation is so visible. As a result, even simple things that could have equally drastic results—like hand-washing—are harder to adopt, because they address invisible problems. If you are a medical innovator, finding some way to create a visual demonstration of the effect of your discovery can lead to wide-spread adoption of the idea.

Ether Dome is a compelling tale of early medical innovation in Boston. See it at the Huntington Theatre Company in Boston until November 23rd.

Vidya Viswanathan

Vidya Viswanathan

    Vidya is the founder of Doctors Who Create (doctorswhocreate.com), which brings together people who want to change the culture of medicine to reward and encourage creativity. She is a first-year medical student at the University of Pennsylvania and is passionate about using the power of innovation and storytelling to improve clinical care.

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