May the Force Majeure Be With You
 n
contrast to Dr. Bacon’s opinion
(February “From the
Crow’s Nest), I fully understand
the anesthesiologists’ very realistic decision
to avoid publicly explaining their position (despite
my agreement with that position). As a student of military
history, Dr. Bacon surely is familiar with the difficulty
of taking on a force majeure [“greater
force”].
In the real world, the anesthesiologist who cancels
or refuses to do most any case, no matter how valid
his/her clinical or ethical reasons, faces a hostile
audience. In this case in particular, involving a popular
surgeon with a subsequent good result, the anesthesiologists
were up against way too much sentiment to try to defend
their unpopular decision, however valid it was.
Howard Schranz, M.D.
New York, New York
DeBakey
Anesthesiologist Fills in Blanks
read with great interest your February
2007 NEWSLETTER editorial
about Dr. DeBakey’s surgery. As “another
anesthesiologist from a nearby hospital,” I
would like to set the record straight.
I was the chief of cardiovascular anesthesia at the
Methodist Hospital in the past, and I maintained my
privileges there until now. I personally provided
anesthesia for Dr. DeBakey’s patients for 22
years. I also traveled abroad with him on numerous
occasions when an anesthesiologist was needed and,
with his help, wrote some of the landmark papers addressing
the topic of aortic aneurysm repair. (I also spoke
on this topic at last year’s ASA Annual Meeting.)
When Dr. DeBakey stopped doing surgery, I moved to
the VA Hospital to improve the service there. Our
VA has the best outcomes for cardiac surgical morbidity
and mortality among all VA hospitals and has earned
this distinction for the past six successive years.
I have been a faculty member of the Baylor College
of Medicine for over 25 years and am not just another
anesthesiologist from a nearby hospital.
The point that I would like to make is that as his
anesthesiologist, I personally reviewed Dr. DeBakey’s
medical record and there was no document stating that
Dr. DeBakey did not want surgery. Moreover, the hospital’s
ethics committee approved proceeding with the surgery.
In my opinion, refusing to anesthetize a patient after
the ethics committee has approved the surgery represents
patient abandonment, not heroic actions. So following
a call from Mrs. DeBakey, I provided anesthesia for
Dr. DeBakey as I have done in the past for all the
DeBakey family. These are some of the details and
facts that you did not know because you were not there.
It was disappointing that a three-page editorial would
be written about this episode based on an article
in the New York Times and without contacting
the individuals involved. I teach my children better.
If you are interested in the details, please do not
hesitate to call me.
Salwa A. Shenaq, M.D., F.A.C.C., M.B.A., C.P.E., C.H.C.Q.M.
Houston, Texas
Editor’s Note: We greatly
appreciate Dr. Shenaq setting the record straight.
In writing the editorial, I purposely did not seek
out any of the physicians involved. Rather, we were
trying to write from the perspective of a reader of
the New York Times.
— D.R.B.
Nurses
Pulling No Punches in Public Relations
have always felt disillusioned since I wanted to become
a physician and then an anesthesiologist. Maybe it
started with watching nurses (both RNs and LPNs) wearing
long, white coats looking rather “doctor like,”
compared to me in my short, white “medical student
coat.”
My concern intensified later in my career as a first-year
anesthesiology resident taking over the nurse anesthetist
cases at 3:30 p.m., because it was their time to go
home. Even at that stage in my training, there was
always something that bothered me about the anesthetic
management of the case before I had assumed care.
“Advanced Practice Nurses” providing anesthetic
care do not exist in my practice, yet correspondence
with colleagues has always painted a dire scenario
when discussing all the “near misses”
discovered during the course of a day supervising
nurse anesthetists.
My discontent with the American Association of Nurse
Anesthetists (AANA) is further fueled by recently
visiting their Web site section on “CRNAs at
a Glance.” I came across the following statement:
“Regardless of whether their educational background
is in nursing or medicine, all anesthesia professionals
give anesthesia the same way.”
If AANA promotes this, and society believes this …we
better get out of the corner and get our boxing gloves
on.
Keep the Faith,
Brett M. Sprtel, M.D.
Grayling, Michigan
Practicings
Make Perfect
read with great interest your April 2007 editorial,
“Changing
the Status Quo." I, like many
anesthesiologists, have a keen interest in the future
of our specialty and recognize the many current and
just-over the-horizon challenges we face. In the editorial,
you ask the question, “To whom should anesthesiology
turn to assess and perhaps change the status quo?”
and you correctly point to the ASA, ABA and the RRC.
However, I believe you overlooked the most important
group that, in my view, will be the most likely to initiate
change, determine what works and apply these solutions
to the practice of anesthesiology. As in the past, practicing
clinicians will be the key to change.
In the mid-1970s I was first introduced to anesthesia
by Bonnie M. Tompkins, M.D., my major professor’s
wife, at the University of Wisconsin. Our laboratory
was developing a very early automated record by recording
trends of physiologic parameters during neurosurgical
procedures. While I was not involved in this research,
I did have the opportunity to observe the prototype
in the operating room and talk to anesthesiologists,
some who predicted the imminent demise of the specialty.
These predictions, heard repeatedly over the next 30
years, have not become manifest. Instead, our specialty
has flourished in spite of the many challenges because
anesthesiologists have repeatedly reinvented themselves.
Anesthesiologists introduced the ICU and critical care
medicine. We were the first to systematically treat
chronic and then acute pain. The two years of general
training expanded to incorporate many subspecialty practices,
each started by clinicians with a particular interest
in a subset of our practice. What was once the parlance
of academic physicians in a handful of select medical
centers is now practiced in the average community hospital
(e.g., cardiac anesthesia). The vast majority of these
changes were initiated by practicing anesthesiologists,
and the various leadership groups then figured out how
to incorporate those changes into the specialty.
How will the medical specialty of anesthesiology metamorphose?
I honestly don’t know. Some of our futurists think
we will spend more, if not all, of our time as hospitalists
or in the ICU. In contrast, we could pursue a course
more consistent with our European colleagues and staff
emergency rooms, or we could displace echocardiologists
and pulmonologists as hospital-based bedside proceduralists.
New drugs and technologies could make procedural anesthesiology
care obsolete, or new, more invasive procedures on ever
sicker patients may make even greater demands on our
services. Whatever the future holds, it seems likely
that solutions will be formulated in the practical laboratory
of clinical practice. Practicing anesthesiologists will
figure out which clinical mix is achievable and sustainable.
As in the past, the before-mentioned troika of leadership
will then take these solutions and formalize them into
the legislative, regulatory, educational and certification
environments.
I have tremendous confidence in my colleagues and remain
very optimistic. I believe our future is so bright we
ought to wear shades (my apologies to the author).
J.P. Abenstein, M.S.E.E., M.D.
Vice-Speaker of the ASA House of Delegates
Oronoco, Minnesota
Reader
Sees Parallels in Search for Parity
have
been an ASA member for almost 25 years, having had to
retire in 2003 due to complications from HIV/AIDS. During
this time, the seemingly never-ending search for parity
of recognition with the rest of the medicine strikes
me as very similar to the same quest between American
gays and their straight counterparts. I cannot help
but draw a parallel between the pleas for comity that
appear in gay periodicals like The Advocate,
which is celebrating its 40 anniversary, and those in
the ASA NEWSLETTER. The most recent issues
of both made me aware of this connection, so I thought
I would write.
Hopefully some day both groups will not need to pursue
activities relating to equivalence and can therefore
devote their energies to more productive matters.
John K. DesMarteau, M.D., F.A.C.A.
Washington, D.C.
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
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to the Editor by letter or e-mail must be clearly
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