• DOI:10.1097/00000542-200505000-00025
• Corpus ID: 45865000

Assessing the Past and Shaping the Future of Anesthesiology: The 43rd Rovenstine Lecture

@article{Modell2005AssessingTP,
  title={Assessing the Past and Shaping the Future of Anesthesiology: The 43rd Rovenstine Lecture},
  author={Jerome H. Modell},
  journal={Anesthesiology},
  year={2005},
  volume={102},
  pages={1050-1057}
}

• J. Modell
• Published 1 May 2005
• Medicine
• Anesthesiology

PRESIDENT Litwiller, officers of the American Society of Anesthesiologists (ASA), guests, friends, and colleagues. Forty-seven years ago, the United States Navy sent me to New York City to begin my postgraduate training. I met Dr. Emery Rovenstine at that time, but I did not appreciate the enormous impact that he had on anesthesiology. The list of his residents and those of his teacher, Dr. Ralph Waters, is a “Who’s Who” of the leaders of anesthesiology for their generation and the next. I subsequently met and interacted with many of Rovey’s residents, who have had a profound impact on my life. I never dreamed that I would stand before you today to deliver a lecture in Dr. Rovenstine’s honor. Of the 41 persons who have delivered this lecture from 1962 to 2003 (List of Rovenstine Lecturers: 1962– 2003; Patrick Sim, Librarian, ASA Wood Library, Chicago, Illinois, written communication, January 2004), 16 of them, and especially Emanuel M. (Manny) Papper, one of Rovey’s residents, in one way or another, were mentors to me. They were never too busy to answer questions, give advice, or recommend me for once-in-a-lifetime appointments. Both Drs. Waters and Rovenstine instilled the qualities of and responsibility for mentorship in their students and colleagues like no one else past or present. It is critical that today we all remain dedicated, involved, and unselfish in mentoring others. Another of Rovey’s residents, Dr. Louis Wright, for whom there is also a lecture named at this meeting, taught me how to administer open drop ether anesthesia. We sat on two stools as he held my hand, and we dropped ether onto a mask he held on his knee. Several times he reminded me that to be successful with this technique, it was called open drop—not open pour. The next task was to find a suitable patient. As fate would have it, a 230-pound muscular marine sergeant, who was deathly afraid of needles, insisted on ether for his herniorrhaphy. I obliged and, much to my surprise, this was one of the smoothest anesthetics I had administered. That day I learned the importance of patience, kindness, and compassion in administering anesthesia. And, yes, there is not only a science to administering a successful anesthetic but also an art. My goal today is to recount some of the many contributions made to medicine and society by anesthesiologists and to express concern that, perhaps, we are becoming complacent. We must continue to explore the field of anesthesiology in the broadest sense and be sure that our contributions are understood and appreciated not just by the medical community but by the public in general. Anesthesiologists long have questioned their proper place in the House of Medicine. I remember, as a resident, talking to Dr. Louis Orkin, another of Rovey’s former residents, as he and others interviewed medical students and residents to determine why anesthesiology was not a more popular career choice. The ASA Preceptorship Program was an outgrowth of those interviews. At that time, even though few people over the age of 60 yr were operated on and complex procedures, like openheart surgery, were seldom performed, the death rate attributable to anesthesia was approximately 1 in 2,500 patients. We monitored our patients by listening to their hearts with stethoscopes, feeling a pulse, manually inflating blood pressure cuffs, watching their color and, if one were extremely fortunate and arrived in the operating room very early, you could grab the one electrocardiograph machine in the operating suite for your patient. Yet, some at that time, but, fortunately, not all, were satisfied with the status quo except, perhaps, to find an anesthetic agent that would not explode, as did ether and cyclopropane, so that surgeons could use cautery rather than having to rely solely on sutures to control bleeding. My American Board of Anesthesiology (ABA) certificate was granted in 1964; it is number 3218. At that time, many believed it was best for the patient when a physician personally administered their anesthetic. Others believed that certified registered nurse anesthetists (CRNAs) could safely administer anesthesia if they were supervised by an anesthesiologist. Many CRNAs, however, felt they should be able to administer anesthetics independent of physician supervision, as anesthesiologists were not always available in all institutions. In those cases, the surgeon was the * Professor Emeritus of Anesthesiology.