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Careers in Anesthesiology, Vol. VI

2002; Lippincott Williams & Wilkins; Volume: 95; Issue: 1 Linguagem: Inglês

10.1097/00000539-200207000-00069

1526-7598

Paul Barash,

Cardiac, Anesthesia and Surgical Outcomes

Careers in Anesthesiology, Vol. VI K. E. McGoldrick, MD. Park Ridge, Illinois: Wood Library-Museum of Anesthesiology, 2001. ISBN 1-889595-07-1 189 pp. $45.00. Will this book help you administer a better epidural anesthetic or acquire superior transesophageal echocardiographic images? The answer is a resounding no! Should this publication be read by all anesthesiologists, particularly our younger colleagues? Yes! This project, originally spearheaded by Dr. Raymond Fink for the Wood-Anesthesiology Library, is a gift to our specialty. Previous volumes have contained autobiographies of luminaries in our profession. Volume VI is an exception in that for the first time in the series a community practitioner, Dr. Thomas T. McGranahan, is a contributor. Rounding out the volume are Drs. B. Raymond Fink, Luke M. Kitahata, and J. Roger Maltby, who have each written revealing accounts of their lives in academic anesthesiology. Each author spends a significant amount of their chapter on the relationship with their spouses. Interestingly, this relationship was pivotal to their success. Also, shared in common was a major life-altering event, which led them into a career in anesthesiology. Idealism and persistence round out the common themes. Finally, each author offers, in essence, a mini-tutorial with insight into his unique area of competency. Fink’s autobiography was completed posthumously by his wife Peggy and their daughters. Married during World War II, the Finks returned to South Africa following training in Great Britain. Fink accepted a job as a Medical Superintendent at the Moraka Methodist Mission where he was the only physician and his wife the only nurse. During the course of his work, he performed a tonsillectomy on the niece of the chief dietitian. Later that day he visited the children’s ward to find it deserted, the student nurse having left the ward unattended to have a cup of tea. He found Mrs. Motshumi’s niece dead from asphyxiation. He states that upon giving her the news (she) …“uttered an unearthly shriek of terror and disbelief…To this day that scream remains graven in the fiber of my being.” This episode plus his hatred of apartheid led to his seeking a career in anesthesiology in the United States. This event also led to his pivotal research focusing on the mechanics of the larynx. In the latter part of the chapter he takes the reader through the intricacies of laryngospasm as he relates it to vertebrate consciousness and development of the forebrain. The chapter entitled, “Career as a Calling: A Life’s Course in Compassion” by Dr. Luke Kitahata was of special interest to me. He was my teacher, my Chair, and a close friend. After the countless hours we spent in clinical care and personal conversation, what could I learn? A lot. For example, he details how I was chosen to be his successor as Chair of the Anesthesiology Department at Yale! More importantly was the beautiful story of how an individual from a traditional Japanese family met and fell in love with a woman, Carolyn Massey, with deep family roots in North Carolina. Here again the importance of spousal relationships is exemplified by their shared common values in religion, education, and the arts. Trained as a neurosurgeon in the United States, he returned to Japan to Chair a Department of Surgery. He was concerned about the unacceptably high anesthesia complication rate at his hospital. He then took the unusual step of returning to the United States to train in anesthesiology so that he could again return to Japan with skills that would allow his hospital to lower its complication rate. However after residency, he joined the faculty at Yale where among his pivotal discoveries was the importance of the spinal cord in modulating and suppressing pain. These seminal studies are a significant part of the foundation of the management of pain, in particular acute postoperative pain. This section, which should be mandatory reading for every young faculty member beginning the sojourn into a career in research, vividly demonstrates the attributes of creativity, confidence and persistence in scientific investigation. He concludes his autobiography by uniquely stating that compassion must be instilled into a career in anesthesiology. In contrast to Fink and Kitahata, Maltby pains a picture of the “man for all seasons,” the type of individual known to all of us who trained or work in academic departments. Educated as general practitioner in England, he found that he required greater intellectual stimulation and thus trained as an anesthesiologist. A humorous vignette occurred on his first day in the OR. A senior consultant asked if he could remember the BBC? Maltby thought he knew the British Broadcasting Company. Rather, the attending continued, “That is all you really need to know about anesthesia. If the B ag, is moving, the B obbins (rotameters) are set right and the C olor is pink, everything is alright.” His intense desire to teach led him to a career in academics in Canada. Subsequently, he gives the reader insight into the development of the Bain circuit, the Williams Airway Intubator and the LMA. However, Maltby, best known for research in gastric physiology and NPO status, details the story behind his clinical studies. He and his wife Margaret share avocations of historical research, trekking and gardening and, interestingly, criminology. McGranahan’s chapter is unique in the entire series of publications as the first submitted by a private practitioner. Having graduated medical school with $700 of debt (an “overwhelming obligation”), he and his wife Ann, a nurse, went to Fitzsimons Army Hospital in Denver. During this internship, on the basis of his rotations in and OJT (on the job training), he decided on a career in anesthesiology. Following his residency, he took his first job in Wyoming. A revealing episode encapsulates the life of a practitioner of that era. After transferring a patient to the PACU, he noticed an obviously obstructed, cyanotic patient across the room. When he called this to the attention of the PACU nurse, she replied that the patient had a good airway. “She just can’t breathe very well.” He instructed the nurse to immediately call the surgeon’s office. Instead she got the nurse anesthetist who had cared for the patient. The CRNA stated that if the anesthesiologist so much as touched the patient he would be sued! “Of course the patient is blue, she was blue all through the procedure; therefore there is nothing to be alarmed about.” As he left the PACU, after increasing the face mask oxygen flow, he overhead the PACU nurse asking a pathologist who had an office adjacent to the PACU, if he could help. He looked at the patient and said “Not yet.” The support of his wife through these vicissitudes was the key to surmounting these challenges to professionalism. These and other anecdotes graphically portray the life of an anesthesiologist when our specialty was not as respected or established as it is today. I do not believe that it was accident that the life stories of these found individuals found their way into one same volume. Dr. Kathryn McGoldrick, the Editor, is to be congratulated on organizing and adaptly editing these four autobiographies. It is currently axiomatic to challenge people to “think outside the box.” These are four individuals who spent their lives “outside the box!” Therefore, this volume is a must read for anesthesiologists of all generations.