Teaching Anesthesiology in Afghanistan

The article in the January 2007 NEWSLETTER by Elizabeth N. Javernick, M.D., on her anesthesiology experiences in Afghanistan with the U.S. Army, caused me to remember, with pleasure, my own experiences as an anesthesiologist in Kabul in 1972 under the auspices of Care-Medico.

Significant for me was the need to introduce and teach our 14 Afghan resident physicians a technique that did not require sophisticated and expensive equipment like that available to Dr. Javernick. With this in mind I taught [with my husband, Harold R. Brodman, M.D., a surgeon] and demonstrated the value of central venous pressure (CVP) monitoring, to the best of my knowledge, a modality used for the first time in Central Asia. The residents were bright, able and enthusiastic, a joy to me.

As a result of the use of CVP, we were able to administer significantly larger volumes of infusions than the Afghans had had the courage to use previously. This was at least partially responsible for our zero mortality rate, especially surgery for those catastrophic events like perforated typhoid ulcers and gangrene associated with volvulus of the sigmoid colon.
 
Elizabeth B. Brodman, M.D.
Scarsdale, New York

The Moores (RA¹ and DC) Being Presidents of ASA 50 Years Apart and ‘On the Same Track’ — A Financially Secure ASA!

Kudos to Roger A. Moore, M.D., as ASA’s past Treasurer and to the members of the Section on Fiscal Affairs “… that ASA’s assets and reserves are greater than ever before, that no dues increase is recommended for the foreseeable future, that we now have a rational travel and per-diem reimbursement policy and that the proposed budget for 2007 is balanced!” (ASA NEWSLETTER. 2006; 70(9):3.)

This comment made me reminisce to a half-century ago, ascending to the Presidency of ASA in 1959, and being Chairman of its Building Fund Committee whose members included L.V. Hand, M.D., F.E. Leffingwell, M.D., and J.E. Remlinger, M.D. (1960 through 1963). Furthermore, I wondered how many, if any, of ASA’s 41,884 members (1/30/07) are aware of all of the historical precursors of ASA’s present fiscal status which were orchestrated during those years.² They resulted in: 1) the ASA owning its Busse Highway headquarters property in Park Ridge and being debt free, 1959; 2) purchasing the two-plus-acres of land adjacent to that property (1962) on which the present headquarters was built, 1992; 3) a permanent home for the Wood Library-Museum (WLM) in 1962 which had led a nomad life from 1930-1961; and 4) no dues increase for eight years (1959-1966).

In 1958, ASA had: 1) 6,489 members; 2) deficit spending of approximately $50,000; 3) outgrown its unairconditioned leased space at 188 West Randolph, Chicago, Illinois; and 4) negotiated to terminate the lease as of February 1, 1960, agreeing to pay $4,350. To relocate in Chicago, a minimum of 4,500 sqare feet of undivided, unfurnished air conditioned space would cost a minimum $10 per sqare foot. Furthermore, of concern was that the WLM located in New York City was storing valuable historical artifacts rent-free in the unairconditioned Foregger Boathouse at Roslyn, Long Island, New York, making them subject to saltwater and weather deterioration.

All of these factors signaled it was prudent for ASA to: 1) stop renting, which is not shrewd for a non-profit organization; 2) leave the high-cost Chicago area; and 3) own property in a convenient, low-cost, developing area close to air transportation (unfolding O’Hare) and the proposed freeway to Chicago that would allow expansion as needed by a rapidly growing society.

At the Annual Meeting (November 21-22, 1958), the House of Delegate approved a $50 dues and empowered the Board of Directors to construct a headquarters of 6,000 sqare feet other than in Chicago provided the total cost didn’t exceed $225,000. Furthermore, it sanctioned numerous cost-containment items that: 1) did not alter the purpose of the Society; 2) would not impede its further growth; and 3) would avoid deficit spending, being in debt or exorbitant dues. The economizing measures were termed the “Austerity Program” by those who opposed them. Interestingly, the $225,000 had to be borrowed from Monarch Life Insurance Company because at the Board of Directors meeting (May 16, 1959), they were informed by a Vice-President of the Northern Trust (ASA’s bank) that the Society had been deficit spending and its credit was no good.

In May 1959, one acre of a 3-plus-acre plot was purchased on Busse Highway in Park Ridge for $40,000 (the maximum budgeted amount of the $225,000), leaving the remaining two-plus-acres in abeyance.

In September 1959, construction started, and in February 1960, ASA took occupancy. By May 1960, due to cost-containment, the ASA’s assets were well over $500,000.

In August 1960, the WLM was informed that the Foregger boathouse had been sold and materials stored in it must be removed immediately. Therefore, they were moved to the basement of the headquarters building.

In 1962, the 2-plus-acres of the ajacent property on which the present headquarters building resides and which ASA could not afford initially became available for $115,000, and with foresight it was bought. Furthermore, the WLM addition connected to the Busse Highway headquarters was begun at an estimated cost of $286,769. Unlike in 1959, when ASA had to borrow money, these were “cash purchases” from the “General and Reserve Funds” of ASA. Construction of the WLM was completed July 19, 1963, and dedicated November 3, 1963, unfortunately six months after the death of its namesake, Paul M. Wood, M.D.

Daniel C. Moore, M.D.
Seattle, Washington

References:
1. Roger A. Moore, M.D., in line for ASA’s presidency in 2009 (as taken from the masthead of Anesthesiology. 2007; Volume 1.)
2. Moore DC. The accidental anesthesiologist. In: Caton D, McGoldrick KE, eds. Careers in Anesthesiology: Autobiographical Memoirs. Volume VII. Park Ridge, IL: Wood Library-Museum of Anesthesiology; 2002:234-268.

Shadowy Issue Brought to Light by February Editorial

While it is not my place to critique your editorials and I do not wish to be inappropriate as I comment on your February 2007 editorial, I must comment. Your “Shadow Warriors,” in my humble opinion, is one of the best and most important commentaries that has been written in many years. It is insightful, extremely well written and addresses one of anesthesiology’s most important issues, which we have only referred to with trepidation over the years. I commend you and can only hope that the ASA leadership will follow your lead to keep the fact that accepting a lesser role in surgical medicine is unacceptable.

I know that we may disagree on the issue of physician-administered anesthesia, but the two do go hand in hand. I must admit that I had to reflect on your opening paragraph to find what I believe was your subtle lead-in to the meat of your editorial. As one who recently experienced a cardiac catheterization and insisted that my cardiologist respect my wish for a DNR and no bypass procedure should an unlikely life-threatening emergency occur, I can respect the wishes of Dr. DeBakey and greatly respect those anesthesiologists who took a moral, ethical and principled stand at their own personal professional risk.

It is a shame that when push comes to shove, our surgical colleagues, in many cases, abandon us. I keep hoping that that does not represent a true underlying philosophy of many surgeons. Forgive my digression.

Again I commend you, although you do not require it, on an exceptional editorial, which I believe will be a very significant and thought-provoking writing that should be taken note of by our ASA leadership. My sincere congratulations!

Wilson C. Wilhite, Jr., M.D.
Daphne, Alabama
(ASA President, 1994)

Residents Tackling Topics of Substance

I’m writing to commend Christian Miller Reiter, M.D., on her well-written piece “A Substance Abuse Story” in the March 2007 ASA NEWSLETTER. As a previous “Residents’ Review” Editor of this NEWSLETTER, I’m glad to see a resident take a stand and address a topic crucially important to her and other anesthesiology residents.

Too often we get bogged down in the political process of ASA and forget to speak for the emotional side of the anesthesiology resident. We need to address these sad, hurt, scared and confused emotions and make sure that we have strategies to balance our lives and protect ourselves from danger.
 
Michael F. Aziz, M.D.
Portland, Oregon

The views and opinions expressed in the “Letters to the Editor” are those of the authors and do not necessarily reflect the views of ASA or the NEWSLETTER Editorial Board. Letters submitted for consideration should not exceed 300 words in length. The Editor has the authority to accept or reject any letter submitted for publication. Personal correspondence to the Editor by letter or e-mail must be clearly indicated as “Not for Publication” by the sender. Letters must be signed (although name may be withheld on request) and are subject to editing and abridgment.