Portal de Periódicos da CAPES

Eelco Wijdicks: a neurocritical appraisal

2012; Elsevier BV; Volume: 11; Issue: 5 Linguagem: Inglês

10.1016/s1474-4422(12)70087-x

1474-4465

David R. Holmes,

Palliative Care and End-of-Life Issues

“Eelco Wijdicks is the academic neurologist who has contributed the most to the field of critical care over the last three decades” says Alejandro Rabinstein, who has worked with Wijdicks for the past few years in the Neurological Neurosurgical Intensive Care Unit of Saint Marys Hospital in Rochester (MN, USA). “Brain death, coma, subarachnoid haemorrhage, hemispheric ischaemic brain infarctions, massive intracerebral haemorrhage, neuromuscular respiratory failure, and complications after organ transplantations are just a few of the topics we understand more and better thanks to his work”, explains Rabinstein. And to that list can now be added the prediction of potential for organ donation in patients with non-survivable brain injury—a subject that Rabinstein and Wijdicks explore in this issue of The Lancet Neurology. “Neurointensivists need to improve the outcome of critically ill neurologic patients, but they also have the obligation to find the best possible closure, and in some patients this includes organ donation”, says Wijdicks, explaining the rationale for their latest study. Organ donation is just one of the emotive issues that neurocritical care brings to the fore, many of which can take an emotional toll. “Some days are very rough and the clinical course is hopeless”, says Wijdicks, all of which has to be dealt with through the filter of sleep deprivation while on call. But Wijdicks, Rabinstein explains, “always manages to stay faithful to his principles; not only taking good care of patients, but also maintaining research and teaching as much a priority as always”. The caring part of the equation, at least, comes naturally. Wijdicks was born in 1954, in Leiden, the Netherlands, where his father “was a deeply caring primary care physician”, he recalls. “Our life at home—with patients going in and out—totally adjusted to his practice. He taught me one critical medical principle: that when a patient calls, they need help.” But fitting in the research and the teaching comes down to what Rabinstein calls Wijdicks' “iron discipline”. “When I was starting my fellowship, I asked him how was he capable of producing so much”, Rabinstein recounts. “I was hoping for a clue, a trick, a shortcut. I got an answer that admitted no further questions: ‘Work, work, work’”. “He is indefatigable” says Allan Ropper, one of three trailblazers in neurocritical care—along with Raymond Adams and C Miller Fisher—who made a lasting impression on Wijdicks during his time with them at the Massachusetts General Hospital in Boston (MA, USA). He arrived there in 1988, fresh from Erasmus University Medical Center in Rotterdam, the Netherlands, where an “extraordinarily talented mentor”—Rien Vermeulen—had taught Wijdicks how to see “both sides to a clinical situation and effectively play the Devil's advocate, and to constantly ask ‘show me the data’”. The Subarachnoid Hemorrhage Study Group of Hans van Crevel, Jan van Gijn, Rien Vermeulen, and Albert Hijdra at Rotterdam brought the subtleties of neurology back into care of patients with subarachnoid haemorrhage, Wijdicks explains, and it was there that he developed his interest in acute neurology. At Boston, Wijdicks enthuses, he had never seen “so much dedication to patient care and clinical research in one place”. Ropper, he says, “taught me everything I know, showed me how to write effectively and how to say it clearly, and to look out for the things you see in the intensive care unit—they might be new observations”. His inquisitiveness and rigour undoubtedly endeared him to the faculty at Boston, qualities that have played no small part in his becoming, in Ropper's view, “by far the most prolific and interesting person in the field of critical care neurology”. But perhaps equally important was the fact that he was such “terrific fun to have as a fellow” says Ropper. For Wijdicks, living with his wife and two children next to a turkey farm in the suburbs of Boston and driving a “rusty stalling station wagon that looked like something from National Lampoon's Vacation”, it was a transformative time; he recalls blissful days driving through “amber waves of grain” and under “spacious skies”. In 1992, he took up the challenge of setting up the Neurocritical Care programme at the Mayo Clinic, becoming Chair of the Division of Critical Care Neurology in 2003. “Mayo Clinic has guided me to put my life into the care of patients” says Wijdicks; “there were spectacular opportunities to finally come to grips with the neurology of critical illness, critical care neurology, how to manage the golden hour in the emergency department, and to develop a programme”. Wijdicks also likes to take the opportunity, when one presents itself, to share with his colleagues his passion outside medicine: the movies. “He could have been a movie critic in another life” says Rabinstein. “Unfailingly he invites trainees after each rotation for dinner and movies at his house.” Perhaps, says Ropper, it is because “he is rarely critical of other people in the way many academics can be”, or perhaps, as his clinical fellow Jennifer Fugate says, it's because his “constant curiosity and scepticism create a fantastic learning environment”, but Wijdicks inspires a rare and genuine warmth of feeling in his colleagues. “Above everything else I can say about him”, says Rabinstein, “he is a wonderful person. As a colleague and friend you can always, and I mean always, count on him”. Prediction of potential for organ donation after cardiac death in patients in neurocritical state: a prospective observational studyThe DCD-N score can be used to predict potential candidates for DCD in patients with non-survivable brain injury. However, this score needs to be tested specifically in a cohort of potential donors participating in DCD protocols. Full-Text PDF