Chapter Twenty-Five: Rewards of an Anesthesia Career

Chapter 25 Sub-sections

Anesthesia appealed because it involved ongoing manipulations of physiology and pharmacology, with adaptations according to disease factors. It stimulated thinking and creativity, even prior to my research career. It was always fun to administer anesthesia, whether general or regional. I missed some things I shouldn't have, some regarding patients, and some regarding research. I didn't recognize Bush's observation that burned patients are resistant to curare at the same time that they're sensitive to succinylcholine. He wrote this before hyperkalemia to succinylcholine was recognized; it would have advanced the field two decades sooner.

Over the years, I have erred at times in providing patient care, and regretted that I hadn't been more observant. And I was ineffective in continuing my research grant support after several renewals. Perhaps I had too weak an insight into what I could have done next. I didn't think so, but I've noticed that most researchers go through this waning of successful grant proposals. The late pioneer B. Raymond Fink, initially a neuroanesthesiologist at Columbia University, re-located to the University of Washington in Seattle, and didn't fade at all even into his 80s, with ongoing grant renewals. He and I discussed our two careers, and my attempts. I always admired his findings, respected his work, and would love to have been as successful.

A Special Emergency Case

After 45 years, I vividly remember this case, and how gratifying it was. It's helped to remember it. When I've been challenged with tough stressful problems, I try to focus an enormous effort into practical straightforward solutions without becoming overly obsessed. In private practice in Denver, about 1963, I needed to anesthetize a 15-month-old baby with a hand laceration. This could have been a challenging emergency, and I needed to waste no time in deciding the best anesthetic approach. An intravenous line was already in place, and I administered small doses of demerol and pentobarbital for light sedation. Then, instead of a general anesthetic (I always prepared for that possibility), I performed an axillary block. The skin wheal provoked only a slight wince and the baby slept thereafter. I placed the needle around the arteries without searching for paresthesias, and, with the baby's thin build, blockade of the nerves was easy, and the case went well. This was satisfying because of its simple successful approach.

Academia, a great choice

My dictum still holds: In anesthesia, we make possible tolerance of stressful situations, even though they may not be painful. And the motivation to find out or discover what's behind what's going on has led to satisfying experiences in a wonderful variety of places.

Academia was my choice after five years' private practice. I don't know if I would have switched if I hadn't been asked to join the Mayo Clinic, as I wasn't thinking of change. The combination of research and clinical care at Mayo and in the army was intoxicating. This was furthered at UC Davis.

Figure 22
Fig. 22. Daughter Gail on our cycling trip from Mâcon to Cluny, Autun, Vézelay, Auxerre, and Pontigny.

In time, I became a visiting professor at various universities, lectured at regional, national, and international meetings, and was an associate examiner for the oral board examinations of the American Board of Anesthesiology. These examinations provided the best anesthesia refresher course. You can scarcely match the breadth of knowledge of a well prepared candidate, for s/he covers wider aspects than any single person's specific and focused anesthesia knowledge. In general, all of these experiences have led to friends and contacts that I would not have otherwise known. I finish with a brief description of our 1985 cycling trip with Pat and our daughter Gail (Fig. 22) to several pilgrimage churches in France: Cluny, Autun, Vézelay, Auxerre. We had flown to Zurich with our bikes and traveled by train to Mâcon. We would not have attempted this if Gail hadn't been fluent in French. She used the formalities that the French prefer. For example, lunch in a village we were passing through: She'd enter the restaurant while Pat and I waited outside. In her proper French, and her open easy smile, she'd ask if the proprietor was there; then, are you serving lunch; then, may we partake with you? With her healthy appearance, red hair, and shorts, she made what could be difficult approaches for us wonderfully easy. The rural French meals were marvelous.

The church at Cluny, by 1150, had become the center of the universe of 300 monasteries, located across Europe, England, Scotland, Poland, and the Holy Land. Its abbot Odo had developed religious studies, traveled extensively, and organized beliefs. Pilgrims traveling to Santiago de Compestella in northwest Spain used the various pilgrimage churches as stopping points.

We didn't know where we'd stay each night, and we enjoyed simple wonderful meals. Pontigny, on a side trip east of Auxerre, was marvelous: it had a nondescript quiet cafe. Gail made the customary formal requests about lunch and we ordered in the bar area. We thought we'd eat in one of the booths, which were much like those in an American restaurant. Thank goodness for Gail's facility.

After fifteen minutes, two beers each, we were asked to come back and eat. We walked directly through the kitchen into a large dining room where they were serving about 25 customers – all working men. They shared rectangular tables that seated eight, in a room five tables wide, and six tables long, all this totally unexpected. The salad was, again, good, but mysterious, with finely meshed celery or sauerkraut in long strands, cucumber, and sausages. The main course was lean circular ham and thick short noodles that were very good. We had no cheese or dessert. The bottle of red table wine was good, simple, and smooth, no label, no cork. 210 ff ($25) for 3 meals, ½ bottle red wine, four beers, three cokes -- a wonderful meal. We have reminisced about that unique experience.

Figure 23
Fig. 23. Pascha, the Great Dane at L'Hotel de la Tête Noir in Autun. He owned the hotel.

Our trip prize was Pascha: in Autun, during its 2000th anniversary, we stayed at L'Hotel de la Tête Noir. It had this quiet Great Dane, Pascha, who patrolled the lobby, laid his chin on your table at breakfast --- he never tried to get food --- so of course you gave him a croissant. The lobby had his personal chair. Fig. 23.

There was much to be grateful for in my professional life: probes of questions, research, travel. I tried to work gently with a great deal of effort, to avoid stress or obsession, to work to a feeling of value, yet be satisfied with simple pleasures: Pascha underlined that.