Douglas R. Bacon, M.D., Editor

Zamboni Dreams

or those who have not spent their lives around hockey and figure skating arenas, a Zamboni is the funny-looking truck that is driven over the ice to resurface it. In the heat of a Minnesota summer, with temperature in the 90s and high humidity, going ice skating is a great way to cool off. A dear friend of mine since freshman year of college, Douglas Catalano, who had experienced subzero winter weather at my home, was amazed that I would take the family ice skating in the middle of summer rather than staying outside enjoying the heat. His comment was the same as always, “You ain’t right.”

This summer, ice has taken on a new meaning. Within the anesthesiology department, two of my partners, Jack L. Wilson, M.D., and Hugh M. Smith, M.D., have helped to organize a group of department members and friends who have children who play hockey. With ice time cheaper in the summer months, we have banded together on Sunday night to play the game with our offspring. Splitting the cost of renting the ice, we have become a cooperative — the only goal we share is to have fun. Skill level varies among the adults, from a couple of the parents who have played at the college level to novices who are on the ice for the first time. The children vary in age from 5 to 16. We laugh together, encourage each other and watch as the skills of our children continue to amaze us.

These Sunday nights have become important to my sons and me. My 9-year-old insists that I am by far the worst defense man in the history of ice hockey, and in conjunction with his 15-year-old brother, both goaltenders, they have nicknamed me “Zamboni.” This is due to the fact that I spend considerable time on the surface of the ice, usually prone, but occasionally supine. Hard as it is to admit, both boys are far more skilled than I will ever be. Yet to play the game with them, however informal, has meant the fulfillment of a dream — to play ice hockey. And having my sons with me has made it so much sweeter. Growing up there was no youth hockey in my suburban town despite the proximity of a National Hockey League team, and I never had the opportunity to fully engage the sport. My friends and I played street hockey until it became too dark to see, yet I had always dreamed of flying across the ice, picking up the perfect pass and burying the puck in the net behind the goaltender. But as an old and inexperienced player, my friend Doug has expressed concern that I may well injure myself. Reassuring him that I was wearing full gear with the latest safety innovations, I got the time-honored response,“You ain’t right.”

But what are the “Zamboni Dreams” for anesthesiology? Over the past several years, we have tried to imagine what the specialty will become in the next 20 years; in essence, we have asked the dreamers to elucidate their vision. The recent emphasis on intensive care medicine has been one result of the mid-21st century view of hospital-based anesthesiology — intensive care becoming the majority of what the hospital does some 40 years into the future. The 2000 strategic plan is currently being revisited and updated to fit the changing circumstances in anesthesiology.

At ASA headquarters in Park Ridge, Illinois, the manner in which the Society is administered is undergoing modification. In the end, this will strengthen our Society, while in the short term it has meant additional work for staff already giving superior effort. Yet effort on this scale is what is necessary to make dreams come true.

The Society for Obstetric Anesthesia and Perinatology (SOAP) update on page 31 of this issue holds an intriguing vision that may be applicable to the future of anesthesiology. SOAP was created on the premise that perinatologists, obstetricians and anesthesiologists need to have a forum where issues germane to pregnancy can be discussed — and the impact of these issues on each specialty discerned. SOAP President Gurinder M. Vasdev, M.D., makes an interesting point that as anesthesiologists we have become too focused on our own concerns and have not created enough opportunities to interact with other disciplines outside of patient care.

At a recent lecture I attended, a simulation video of a catastrophic obstetrical case was shown. In the first scene, no discussion of resource management had been done, and responsibilities were not assigned. The result was an unventilated, asystolic patient for more than four minutes. A second scene, done after discussions about resource management and team building, demonstrated a well-run code and a patient who now had the best chance at long-term survival. Innovation in medical education takes time and persistence, but this “dream” may well be worth pursuing for it will benefit our patients in the long run.

At the moment, anesthesiology enjoys a very positive reputation among medical students, and our residencies are filled with bright physicians eager to learn all that the specialty has to offer. These residents are our future. We need to ensure that they learn the skills to be an anesthesiologist, but we must also teach them the values we hold near and dear. Professionalism, one of the Accreditation Council for Graduate Medical Education general essential requirements, should be imbued from day-one of training — by example of those who teach. As a society, ensuring the financial and educational stability of residency education is a must. The “teaching rule” has to be reversed to guarantee a bright future. For without resources, our dreams will remain that — dreams.

Financial stability for all anesthesiologists is critical. At the moment, the Centers for Medicare & Medicaid Services (CMS) has proposed a substantial and long overdue increase in the reimbursement for each anesthesia unit. The comment period ends August 31, 2007 — and as you read these words, time will be running out. It is incumbent upon each of us to comment. Keeping current with all governmental affairs and third-party payers is essential to our future. If we do not have the resources to attract and retain people, the specialty will never move forward.

Leadership is critical. The oft-heard complaint that “nobody does anything about the future” is not true. Changes made today may take years to effect. For example, any discussion with the American College of Surgeons in an effort to coordinate annual meeting weeks, even if it were agreed upon today, would take almost a decade to effect as the meeting dates and reservations are made that far in advance. The initiative that has changed the administration of the Society will have effects decades into the future, and the bold leadership of our senior officers will affect not only our Society but the specialty well into the future. Without the encouragement of Jack and Hugh, both skilled players, our group would not have come together, and the dream would just be that. Leadership is key to molding the future, and encouragement to fulfill visions is a must if innovation in the specialty is to occur.

Eighteen months short of turning 50, I have begun to live a small dream of mine. I pay the price the day after, with sore muscles and occasionally a bone-deep fatigue — a cost gladly paid. As anesthesiologists, if we are to live our dream for the specialty, no matter how small, we must be engaged on many levels. First and foremost, we need to care for our patients with the highest possible standards. Second, we need to be a presence in the operating room and the hospital. This means working on committees, occasionally doing an “extra” case and truly being citizens of the medical center. Third, we need to make an effort locally and within our states both with the legislature and with average citizens. Talking to the scouts about anesthesiology or participating in career day at the local high school may take precious “off” hours, but the reward, of inspiring someone into our specialty, is well worth the effort.

Finally, we need to be engaged on a national level. The struggles with CMS are the things of legend, yet this year, CMS has listened, to the betterment of our practices. We still need to fix the teaching rule to ensure some financial stability to residency training. Our representatives need to know who we are and what we stand for — or little of our dream can be realized. Participation takes time, and occasionally money, but the reward, leaving the specialty better and stronger than when we joined, is worth it. Please write your letter to CMS, support the candidate of your choice, and become involved in local, state or national anesthesia organizations. (See page 4 for information on how to send a comment letter to CMS.) We can no longer afford to be the nameless person at the head of the table. Through hard work, skill and community, dreams can come true. I am learning to play hockey. Together we can fulfill the “Zamboni Dreams” for anesthesiology and perhaps prove my friend Mr. Catalano wrong.

— D.R.B.

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