When Barry Glazer gave me the President’s medallion last year, I was excited about the prospect of accomplishing our goals, which included:

• Support research and encourage more appreciation of our science among clinicians

• Build better ties between the ASA, academic anesthesiology and anesthesiologists in private practice

• Build better bridges with other specialty physician organizations and with international groups, and

• Increase our efforts to educate Americans and their legislators about what we do to safeguard their lives.

Part of appreciating where we are and where we might be headed comes from knowing how we got here — and who sent us. Names like Erdmann, Rovenstine, Apgar, Waters, Lundy and Bonica come to mind. I want to begin my remarks today by praising three anesthesiologists and one lawyer who joined our noble ancestry since we met last year in Orlando, Florida.

Frank McKechnie, M.D., pioneered recovery room care in the 1950s. Today we take this critical link between the O.R. and the hospital floor for granted, but I hate to think how high anesthesia-related mortality would have been in the 1960s and 1970s had it not been for Frank McKechnie.

Peter Safar, M.D., the “Father” of CPR, did for critical care and emergency medical transport what McKechnie did for the recovery room. As put by the Pittsburgh Post, “ …Peter Safar’s life was dedicated to cheating death.” He was nominated for the Nobel Prize three times. Those people in Stockholm missed their chance. My guess is that some of them would not have had the chance to miss their chance, were it not for the contributions of Peter Safar.

In addition to Safar and McKechnie, we have the legacy of Manny Papper, M.D., to build upon. By being first in the right place at the right time, he trained more anesthesiology chairs than any other mentor to date. The publisher of the Miami Herald captured Manny Papper best when he wrote, “No one who experienced his gentlemanly manner would have guessed at the force of his will.”

The lawyer I mentioned is Jack Lansdale. To us he is known as the ASA’s wise counsel for almost 30 years, but to history he is known as the Lieutenant Colonel who led American forces to Germany’s atomic bomb project before the Red Army could reach it, capturing Werner Heisenberg and Otto Hahn, among others, at the end of World War II.

How should we spend this inheritance … the legacy of our heroes? Papper, McKechnie and Safar would advise us to invest in our most fundamental asset — the SCIENCE of anesthesiology. The drugs and the tools and the knowledge that enable us to make a living …come from research … and just doing everything that we already know how to do is not an option. We need to do all of those things better, and we need to learn to do things that have never been done before.

So how do we, the ASA, encourage and support research in anesthesiology? This meeting is a great example with “Research Taking Center Stage at Our Annual Meeting.” Tomorrow Terri G. Monk, M.D., will present the Emery A. Rovenstine Memorial Lecture on “Postoperative Cognitive Dysfunction: The Next Challenge in Geriatric Anesthesia,” (if not anesthesia in general!). After her lecture, our highest award for research, the Award for Excellence in Research will be presented to Mervyn Maze, M.B., Ch.B. Our Distinguished Service Award will be presented to Bernard V. Wetchler, M.D., a pioneer in establishing ambulatory surgery. Then, in its first appearance, I will have the pleasure of initiating the Annual Presidential Scholar Award to Peter J. Pronovost, M.D., for his groundbreaking work on the systematization of patient safety. Dr. Pronovost has devised and tested measures of performance in the ICU. For the sake of our patients, our organization and our profession, we need to promote Dr. Pronovost’s ideas. The connection between what we do as an organization and the implementation of such breakthroughs is direct and solid and very important.

Equally solid and important is the financial underpinning that pays for our support — the funding that we get from government, the grants that we get from industry and, ultimately, the money that we get paid to do our jobs (which I’m sure most of you are less interested in [laughter from audience]). Let me bore you with just one example of how ASA pursues such matters.

Documents and arguments and correspondence play their part, but if you really want to get something done, for instance about Medicare reimbursement, you have to talk to Tom Scully, Administrator of the Centers for Medicare & Medicaid Services. That’s easier said than done, because several thousand people from several hundred organizations want to bend Mr. Scully’s ear about Medicare reimbursement, and as far as most of them know, the line forms at the end, and most appointments run about 10 minutes.

There is, however, an alternate path. If you know a prominent U.S. Senator who can get Tom Scully’s attention, and if you can get that person to write or call Mr. Scully, you can then round-up Roberta Hines, M.D., Michael Scott, J.D., Karin Bierstein, J.D., and Alexander A. Hannenberg, M.D., for a nice long sit-down with Mr. Scully. We did just that for a very engaging hour and five minutes last July 22. On our way out, Mike Scott turned to me in amazement and exclaimed, “You’re the luckiest man in the world!”

Mike was right. I have been lucky enough to become the President of ASA, and I have been lucky enough to have the help of ASA professionals like Ronald A. Bruns, Denise M. Jones, Jill A. Formeister, Janice L. Plack, Susan M. Rogowski, Philip S. Weintraub, Manuel Bonilla, S. Diane Turpin, J.D., Karin Bierstein, J.D., Sharon Merrick, Lisa Percy, and yes, Mike Scott, our own Director of Governmental and Legal Affairs — a genius, in my opinion, who has worked with us for the past 28 years of his life helping advance our specialty’s interests. Mike is retiring at the end of next year. How lucky was I to get one of his last full years of service? [looking over at Dr. Litwiller] And Roger, how lucky are you to get his last full year and his 30th?

Please let me draw your attention to one more ASA stalwart — our portrait photographer, Chad Evans Wyatt — whether capturing a renowned Czech artist, a famous newscaster or an ASA President, Chad Wyatt makes our images shine. Thank you, Chad, for making ASA Officers look good for the past 14 years.
Let me close with a message about our collective image — the image of anesthesiologists. The October 2003 ASA NEWSLETTER has an article by Robert E. Johnstone, M.D., about the many anesthesiologists serving in Iraq and Afghanistan and about colleagues like Scott M. Croll, M.D., who administered anesthesia to frontline troops and Iraqi civilians during the siege of Baghdad.

Fortunately, Dr. Croll is with us today, as is Col. John Chiles, 25th Chief of Army Anesthesiology. Dr. Croll, Dr. Chiles, Dr. Johnstone, please stand, and let us express our gratitude for what you have done for our troops, for the people of Iraq and for the image of our specialty [standing ovation].

In contrast to Dr. Johnstone’s article, a long article in The New York Times, which has a somewhat larger circulation than the ASA NEWSLETTER [laughs from audience], shows pictures of anesthesiologists in action in Iraq but only surgeons are interviewed. The article discusses the things that we do, right down to airway management, but the words “anesthesiology” and “anesthesiologist” are never mentioned.

It’s not that we have a negative public image, but we do have an inadequate image. Too many people, including too many people who should know better, think that we just put patients to sleep. I got that message loud and clear one day when I was waiting outside my office while medical students gathered inside for an introduction to our field. I overheard one student ask, “What do anesthesiologists do?” The answer came back, “They put people to sleep.”

I walked in, introduced myself and asked them to imagine the following: “You’re lying face up on a cold steel table, covered only by a sheet. People in disposable gowns appear at your side. One of them pulls off your sheet and cuts the skin over your sternum with a razor blade — right down to the bone. Then he saws through your chest, inserts a crank and winds you open until he can grab your heart. After hooking you up to a pump, he cuts a valve out of your heart and sews in a valve from a pig, then he puts your parts back in place and staples you back together.

How many of you could sleep through that?”

They got the message.

We need to get the truth out in the open. We need to shine by telling people who we are and what we do. Anesthesiologists are doctors who make surgery possible. We keep patients alive while surgeons do things that would otherwise kill them. Everybody needs to know that, and we need to tell them.

So we have a lot on our plate — clinical care, research, teaching, professional society organization, government lobbying and even public relations. As Gertrude Stein once said, long before the Internet and even before television, “Everybody gets so much information all day long that they lose their common sense.” We all know that feeling, but we all need to do as much as we can and still do everything well, because, like Alice in Wonderland, you have to run as fast as you can just to stay in the same place!

Thank you for letting me run, and thank you for letting me serve as the President of this wonderful organization.

James E. Cottrell, M.D., is Professor and Chair, Department of Anesthesiology, and Senior Associate Dean for Clinical Practice, State University of New York Health Sciences Center at Brooklyn, New York.