Douglas R. Bacon, M.D., Editor

We All Need Heroes: A Tale of Two Richards and John

We have survived six months together. Through the editorials in each NEWSLETTER, I have tried to bring forward issues and items that are thought-provoking and of concern to every anesthesiologist. Yet there is another side to our specialty, perhaps best defined under the rubric of professionalism, that is important but may not get enough credit — the role models who taught us, and oftentimes continue to teach us, how to practice anesthesiology. I am not talking about the mechanics of practice — for example, the art of matching the anesthetic to the patient — but the nuances of being an anesthesiologist, caring for the patient, anesthesiology staff, the surgeon and operating room personnel. I have been richly rewarded, both as a resident and as an attending, in working with physicians, nurse anesthetists, anesthesia technologists, surgeons and operating room staff whom I feel are of the highest professional order, my heroes. Today I will tell you about three of them from my time in anesthesiology, and I encourage the readership to send in stories of their heroes for possible publication in future NEWSLETTERs.

Richard Ament, M.D. (1919-1998)
I was a medical student, having just completed my second year when, as part of the ASA Preceptorship Program, I entered the operating rooms at Buffalo General Hospital for eight weeks of clinical experience in anesthesiology. My “official” preceptor was the formidable Richard Ament, M.D., who had been ASA President six years before. Despite my lack of clinical experience, I was treated as any other medical student during those weeks. I learned to set up the anesthesia equipment for multiple procedures, participated in the Wednesday morning conferences and fell in love with the specialty of anesthesiology. Three years later, when I began my residency, Dr. Ament gave the first lecture on the history and scope of anesthesiology practice. Throughout my first year, he was a presence in the operating room and beyond, for he functioned as the program director as well. A trip to his office was not usually in the resident’s best interest!

During my second year of residency, Dr. Ament retired from clinical practice to spend more time with his ailing wife. He remained the vice-chair for education, and as one of the two chief residents, I interacted with him frequently. The intimidating former ASA President had transformed into a firm but guiding hand as we explored what training this new third year of residency would encompass. After residency I stayed on faculty at the State University of New York at Buffalo and worked closely with Dick over the next nine years, sharing a Wood Library-Museum Fellowship and a publication. I learned from Dick Ament about the importance of teaching bright, young anesthesiologists to bring the field forward. As Dr. Ament’s mentor, Emery A. Rovenstine, M.D., for whom the annual lecture is named, would say, “A bad surgeon needs a good anesthesiologist; a good surgeon deserves one!” From Dr. Ament, I learned about teaching, administering a residency training program and the importance of supporting organized anesthesiology. When Dick died, I knew I had lost a mentor, but during his memorial service, the profound loss of a dear friend hit me hard.

Richard N. Terry, M.D.
The summer of 1983 was auspicious because I met another hero shortly after meeting Dr. Ament. Richard N. Terry, M.D., also was an attending at Buffalo General Hospital, who often sought me out to teach and demonstrate anesthetic techniques. He was a patient soul who helped me to learn basic anesthetic skills such as intubation and intravenous line placement. I was an “all thumbs” medical student. He had the unique ability to arrive just as his help was needed, yet he never gave the impression that he had done anything. Three years later, as a junior resident, I vividly remember his sending me to bed one night on call while he did the case! (With his impeccable logic, he told me he had slept all afternoon, now it was my turn.) I had spent the evening seeing preoperative and postoperative patients in an effort to leave a little early the next morning, and I must have looked exhausted.

Unfortunately for us residents, Dr. Terry retired during my second year. Just before he left clinical medicine, he assumed responsibility for yet another first-year resident. There was a code blue some six floors above the operating rooms, and Dr. Terry decided that he (in his early 70s) and the resident would take the stairs to the code. Barely winded at the end of the climb, there was cause for concern that the resident might be the next person in need of intubation! But Dr. Terry did not come back to the operating room and brag about beating someone half his age up the stairs; instead he issued genuine concern for my colleague’s well-being. Dick’s favorite story was about a surgeon for whom he adjusted the operating room light to better illuminate the wound. The surgeon told him what a great anesthetic he had given! From Dick Terry, I learned about how to teach residents not just technical anesthesia but to care for every person who surrounds us daily. At the State University of New York-Buffalo department of anesthesiology, there is no doubt why the annual graduation day academic exercise, where the residents present their original research projects, is named “Dr. Terry’s Teaching Day”! Alive and well in his 80s, Dick Terry remains an inspiration as a physician, anesthesiologist, teacher and friend.

John I. Lauria, M.D.
On my desk sits a letter to which I have not responded. I have yet to find the right words to tell my former chair what he has meant to my career and me. I first met my residency chair during my first rotation at “his” hospital. As a county hospital, it was the level 1 trauma center and, as such, the surgery schedule was subject to change — fast. But John I. Lauria, M.D., went about the operating rooms as unperturbed as possible. One Sunday call, I had a young man with a fractured femur for rodding. My attending had brought in two units of blood, and since I did not need to transfuse, I let the blood sit on the anesthesia cart. The case finished, the units were warm and unused. I had to return it to the blood bank where it was destroyed. I knew I was in trouble. I approached “the chief” and told him of my error, fully expecting a reprimand and perhaps some disciplinary action. He laughed and said, “Is that all?” I have never forgotten how that felt. I was reassured and felt valued. Later that year, when I became engaged to my wife of 17 years, John took us out to dinner at his country club. It was a memorable night, ingrained along with the picture I have of him throwing rice at my wife and me as we left the church on our wedding day.

The years passed, and John left academic medicine for private practice. He asked me to join him, and I was tempted. But I wanted to continue to be an academic anesthesiologist and ultimately turned down his offer. When I left Buffalo four years ago, he arrived, unknown to me, at the send-off party and gave me a very special gift — a pen he had made. It rests in a place of honor on my desk. Yet the most important things that John gave me are the clinical lessons I share almost daily with residents and others I train. “Beta blockade is not a substitute for anesthesia” often rings in my head as I decide if the patient’s hypertension is caused by intrinsic disease versus light anesthesia. “MAC is harder to do correctly than general anesthesia” was another of his aphorisms that I still use. “The happiness of the resident and junior attending staff is often reflected in the birth rate on any given year” is another observation that holds a lot of truth. Clinical medicine aside, John Lauria taught me that caring for your colleagues goes beyond the confines of the hospital.

I believe that Tina Turner is wrong — we do need another hero. I see mine every day. They are my contemporaries who keep me humble by reminding me that I need cheese with that whine, some who swap pediatric cases for my love of geriatric cases, others who create the master schedule and the daily schedule and quietly and calmly absorb the inevitable complaints that go with the job.
Look around you and you will see colleagues at the medical staff meeting ensuring that the interests of anesthesiology are eloquently articulated. Others are coaching youth soccer, baseball, hockey and other sports, giving back perhaps more than they have been given. Please send me their stories.

— D.R.B.

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