Would I Do It Again?

I am writing this “exposé” at the encouragement of several individuals, including ASA’s Chief Executive Officer, Brian Reilly.

Let’s roll back the clock to the early 1970s, when I was a dental student and discovered the importance of local anesthesia and, subsequently, general anesthesia for the care of dental patients who required reduction of mandibular fractures or orthognathic procedures. The anesthesiologists at Tufts were special people. They were Pied Pipers in the best sense of the word. They loved their specialty, and it was infectious. Bob Reynolds, Bibi Wunderlich, Dorcas Guest, and a young, part-time attending named Henry Rosenberg, were incredible teachers. (He would reappear in my career many times over the next 40 years!)

Years later, I became a resident in anesthesiology at Penn under a special NIH T-32 program to train dentists in anesthesia and pain control. I finished that program and realized that I would have to get a medical degree to practice to the full extent of the specialty. My mentors at Penn were Henry Rosenberg, Mehdi Keykah, Jack Neigh, Skip Ellison, Dave Jobes, Alan J. Schwartz, Steve Prevoznik, and, of course, the chair, Harry Wollman. During my rotation at Children’s Hospital of Philadelphia, my mentors were Jack Downes, Russ Raphaely, Pina Templeton, Gene Betts, and a quiet but amazing Bob Kettrick. Dr. Kettrick took me through my first night of pediatric anesthesia call. There were two patients whose aggregate weight was 1,200 grams. The first patient was a 550-gram, 24-week preemie with necrotizing enterocolitis, and the second patient was a 650-gram, 24-week preemie with a preductal coarctation of the aorta that required urgent correction. Despite my clinical and intellectual inexperience, Bob skillfully guided me through the care of each patient. The two patients survived. I did not make any trip to the bathroom, and Bob did not get any chest pain. I was hooked for life! I wanted to be a pediatric anesthesiologist, and how lucky was I to have trained with these incredible individuals? They were all mentors and not tormentors. All emphasized clinical excellence (there was a patient on the other side of that equation) as well as academia, and if you cared to pursue such a career clinical pathway, there was even bench or clinical research. The mentors excited me at every turn by realizing that I had the potential to excel.

Fast forward…I finished medical school and retrained in anesthesiology at Mt. Sinai Medical Center in New York. I decided on pursuing a surgical internship in a mostly every-other-night program during the era when every-other-night programs were considered missing “half of the good cases.” I felt like a kid locked in a toy store. There was so much to learn, and I was getting paid to learn! How wonderful was that opportunity? I finished the surgical internship at Mt. Sinai and remained there, retraining in anesthesiology under the tutelage of Joel Kaplan and James Eisenkraft. Joel prepared me for leadership, and James taught me how to publish and wade through medical statistics.

After four years in Manhattan, I had a choice between an incredible private practice opportunity in nearby New Jersey or the beginning of an academic career in Pittsburgh. I chose the latter, and to quote a line from “Indiana Jones and the Last Crusade” – “I chose wisely.” I joined the anesthesia staff at the Eye and Ear Hospital as part of the University of Pittsburgh Medical Center. It was the start of an amazing clinical, administrative, and academic career. Peter Winter, the chair of Anesthesiology at the University of Pittsburgh, gently and thoughtfully guided me through the trajectory. Other mentors included Nobel nominee Peter Safar, the inventor of CPR, Ake Grenvik, Jim Snyder, Jan Smith, and D. Ryan Cook. My partners at the Eye and Ear Hospital, especially Rene Gonzalez and Rob Krohner, helped to meld our careers together. There were many other colleagues on a stellar team, including John J. Schaefer (co-inventor of Sim Man). Peter Winter “let us loose,” and all we did was “produce.” We developed one of the first difficult airway carts, one of the first fiberoptic intubation carts, and one of the first video fiberoptic carts. On the surgical side, Eugene N. Myers, the Chair of Otolaryngology, was also an incredible mentor. Gene saw our potential in the management of complex head and neck anesthesia. We rewarded each other with great clinical care and academic opportunities, including the chance to help teach the nascent fiberoptic endoscopy course spearheaded by Jim Roberts from Mass General at the ASA annual meeting. I met so many new colleagues from Mass General, among other institutions. How lucky could one be?

Not too many years later, and with the appropriate mentoring, I was promoted to Associate Professor. I became Acting Director of Resident Education in the Department of Anesthesiology, and Associate Chief of Service. At this point, I had an opportunity to plan a sabbatical, which was focused on noninvasive therapies for TMJ pain. I had always wanted to understand why certain therapies worked and others did not with respect to temporomandibular dysfunction. I was mentored through that process by Tom Rudy and Dennis Turk. Unbelievably, I grabbed the brass ring on the first attempt! I became a co-principal investigator on an R-01 grant that produced great clinical research and many papers.

For family reasons, we relocated back to Philadelphia after a brief stop in New Haven. In Philadelphia, I had the chance to team up with Liz Drum (ASA’s international “diplomat”) at Temple Children’s and Shriners Hospital. We were enthusiastic, producing both clinically and academically. At this point, I became ASA’s Liaison to the American Dental Association and the American Association of Oral and Maxillofacial Surgeons. This position opened vistas to dental colleagues and helped move the dial in patient safety by promoting pulse oximetry and capnography and reducing the use of black box warning medications in dental patients. During my stint in Philadelphia, I had the good fortune to become Associate Chief Medical Officer at Temple Children’s Hospital. It was during that time that the events of 9/11 occurred. Nobody prepares you for that type of crisis management. We learned on the job. Temple Children’s Hospital was the closest pediatric burn center to ground zero. Fortunately, we did not see any casualties, but we were prepared.

Several years later, we returned to Pittsburgh when I assumed the Chief position at the Mercy Hospital of Pittsburgh. I was mentored in that position by a former ASA President and Chief, Rick Siker. Rick and his colleagues were a great guiding light. Shortly after my return to Pittsburgh, Mercy joined the University of Pittsburgh Medical Center. It enabled a great academic step forward and an opportunity to utilize resources that were only available at the University of Pittsburgh. After eight years as Chief, I was invited to assume the position of Vice Chair for Faculty Development at the university. I eagerly jumped at the opportunity, thanks to Chair John Williams. He was a great mentor and proved that even mentors need mentors themselves. By 2018, I decided to retire. After many years of departmental service, I was humbly rewarded with the position of Professor Emeritus in the School of Medicine. Retirement was not completely satisfying for me. I volunteered to anesthetize challenged children and adults at the School of Dental Medicine who required dental care. I finally realized that my time had come to truly retire from clinical activities and fully retired from clinical work in January 2024. I still give lectures to residents in the School of Medicine, but I am mostly retired.

My career included another aspect that I have not described so far. Although I have been a member of ASA throughout my career, I knew that volunteerism and advocacy were very important. Aside from liaison positions to the American Dental Association, American Association of Oral and Maxillofacial Surgeons, and the American Dental Society of Anesthesiology, I became very active in ASA committees, including the Committee on Ambulatory Surgical Care and the new Committee on Late Career and Retired Members, on which I serve as vice chair. I have served ASA as a liaison to the World Federation of Societies of Anaesthesiologists and for many years as a member of the House of Delegates. On the state level, I was extremely fortunate to have served in every officer position, including president of the Pennsylvania Society of Anesthesiologists in 2015. In all these committees and positions, I have been most fortunate to meet incredibly nice people who were or are very active. I have known many members of the ASA Executive Committee for over 25 years. All it took was the willingness to give back!

In summation, would I do all this again? The answer is an emphatic YES! For me, the better way to ask it would be, do I have any regrets? The answer to that is an emphatic NO! Thank you, to the ASA, my family, friends, and colleagues who enabled me to be the best I could have been. It has been a wonderful life!