Chapter Nineteen: Risks, Drugs, Upset at a University Residency

Chapter 19 Sub-sections

Wrong Way Drivers

On Saturday December 31, 1960, Pat and I had finished my four months at LA Children's Hospital and began the drive back non-stop to Denver. While driving in the right lane on a divided four lane highway in western New Mexico, as we reached the crest of a hill, a car flashed by, driving the wrong way in the left lane. We were lucky that we didn't have a head-on collision.

This near tragedy occurred once more in our lives, in 1968. We were in the army, in San Antonio, driving on a Sunday afternoon on Interstate 10 on the east side of town, in a van, with our four children. A car suddenly came over the crest of a small hill toward us, in the left lane, going the wrong way. It passed us almost before we realized it. In another mile or so, the driver swerved into an oncoming car, a head-on fatal collision, a suicide.

Tragic Drug Addictions

One University of Colorado anesthesia resident rotated at LA Children's after I did, but returned to Denver addicted to drugs – Demerol® and pentobarbital. At that time, I was at Denver General Hospital. During night call, he'd periodically come into the operating room suite. I saw him at least twice when I was doing cases in the late evening. We'd see him because the OR doors were kept open. He explained that his child was ill, and needed some sedation. Addictive drugs were freely accessible on the anesthesia carts. A week or so later, our chair, Dr. Virtue said at conference that addictive drugs were missing. Several residents remembered these visits, and he was caught. Despite rehabilitation, after residency, he was dead by fall 1962. He was found one morning in his car with an empty syringe by his side.

In 1986, I became Vice Chair in the Department of Anesthesiology at the University of California, Davis and Director of Research. My clinical work and night call were at the hospital in Sacramento. In late 1989, a senior resident and I were on call together on a Wednesday night. I covered the several busy operating rooms and he covered the out-of-the-operating room calls, e.g., obstetrics, problems in patient rooms, or critical events in the Emergency Room. He was capable and quite intelligent. We routinely had anesthesia parties at our home near Woodland and knew the residents. It was 7 miles from our home to my research lab in Davis, and another 13 to the hospital, on a bike path paralleling the freeway I 80 across the causeway to Sacramento. This resident and another once cycled from Sacramento to our home for an afternoon pool party.

He was a critical intellect, and a talented young anesthesiologist. He and several of our other residents were the greatest of friends. When we parted the morning after that Wednesday night call, we'd both been up all night. During the night, he had routinely described what he'd been covering. I could help residents on out-of-the-OR cases when necessary but he hadn't needed it.

Residents had the day off after call, this time a Thursday, to rest and recuperate. However he didn't come to the late afternoon regular anesthesia conference, which was an automatic, for his friends and he got together after conference. After this day's conference, several went to his apartment and found him dead. They all swore that it couldn't have been drug related, but autopsy confirmed that it was. Smart as he was, I concluded that he was accustomed to controlling doses. That casual confidence led to an overdose, a loss of consciousness before he realized it, and suppression of breathing to apnea. We were all stunned at this useless loss.

Almost a Barbiturate Suicide

In the 1960s, one Denver private practice anesthesiologist was found in his bathroom by his wife, while trying to make himself vomit. When queried, he admitted taking one hundred 100 mg pentobarbital (Seconal®) tablets. He had abruptly re-considered suicide and told her to bring him to an emergency room as soon as possible. When they arrived there some 15 minutes later, he was deeply cyanotic, a deep blue color, like a tank of nitrous oxide. His trachea was intubated, his lungs were mechanically ventilated, and he remained deeply comatose for about a week, as pentobarbital is not easily removed by dialysis.

After recovery, he seemed normal, and resumed practice in another state.

Cyclopropane Addiction

There was a Denver senior anesthesiologist in private practice who sneaked sniffs of cyclopropane, a potent volatile anesthetic. He'd sit on his anesthesia stool at the head of the operating table, behind the drapes, and open the popoff valve slightly for occasional repeated sniffs. Some had noted his bright red countenance during cases and wondered what was going on. Finally, during one case, he fell off the stool, obviously obtunded. He was rehabilitated into the public health arena.

Upset at Denver's Residency

Fifteen years after finishing my residency at the University of Colorado, I returned in February 1976 as a visiting professor, speaking on neuroanesthesia, MH, induced hypotension, and succinylcholine-induced hyperkalemia. It was quite a visit. The anesthesia chair, an intellect but not a strong administrator, had left for a Midwestern university at the end of 1975, with harsh feelings between him and the surgeons. As a ‘going away gift', he found new positions for most faculty and residents at other programs. The talented Carol Hirshman went to the University of Oregon (Wood, 2000).

In the turmoil, they had forgotten that I was arriving. There were two faculty and two residents remaining. One, a North Dakota native, who later moved to an eastern university, was the sole faculty at the VA Hospital, directly across 9th street to the north from the university hospital. The late wonderful Katie Wood, who literally saved the University of Colorado program over the next few years, managed academic anesthesia at Colorado General Hospital. Nurse anesthetists flew in from the adjacent plains states for a week at a time to bolster coverage. Recovery was slow, but the University of Colorado effectively did so and has done well.