The tone of President Lincoln’s Second Inaugural Address was somber—it was 1865 and hundreds of thousands of lives had been lost in the Civil War. Remarkably, his address is not remembered for its dismal tone, but for the message of healing and hope in its conclusion. His promise “to care for him who shall have borne the battle, and for his widow and his orphan” is recognized today as the mission statement for the Department of Veterans Affairs and serves as an inspiration to countless veterans and those who serve them at the Durham Veterans Affairs Medical Center (VAMC). Duke Anesthesiology is proud to have played a vital role in accomplishing this mission for more than 30 years.
Although united by a common Veterans Affairs (VA) mission, there is much to distinguish the Durham VAMC. Many attribute the success of the VA Anesthesiology Service to the historically strong emphasis on faculty recruitment, which began with Duke Anesthesiology’s first VAMC chief, Stanley W. Weitzner, MD. Even after the Duke Department of Anesthesiology was formed, anesthesia services at the VA remained under the Department of Surgery. Dr. Weitzner was given the formidable task of establishing a separate VAMC Anesthesiology Service. “This was a radical concept in 1978,” Dr. Weitzner reflects, “we were the fourth VAMC in the entire country to succeed in this endeavor.”
Those who succeeded Dr. Weitzner, including Philip Lumb, MBBS, Jake Freiberger, MD, and Robert Sladen, MB ChB, benefitted from his hard work and commitment to excellence. “Today, the Durham VAMC is a unique environment where faculty are provided with the support and freedom they need to excel,” says current division chief, Jonathan Mark, MD. The VAMC’s unique Short Stay Unit, directed by Dana Wiener, MD, is one such example. Dr. Wiener oversees a team of seven physician assistants and laboratory staff who perform preoperative assessment and testing for patients scheduled for surgery and other non-surgical procedures at the VAMC.
Anesthesiologists at the VAMC also provide hospital-wide diagnostic transesophageal echocardiography (TEE) services, a procedure traditionally performed by cardiologists. Cardiothoracic anesthesiology, including TEE, has always been one of this group’s clinical strengths, along with regional anesthesia and care of high-risk surgical patients. These high-risk patients are managed perioperatively by the VAMC Surgical Intensive Care Unit service, under the direction of Scott Brudney, MB ChB, FRCA and his colleagues, Atilio Barbeito, MD, Raquel Bartz, MD, and Andrew Shaw, MBBS, FRCA, FCCM.
In addition, the VAMC Anesthesiology Service has earned a reputation for excellence in research. Thomas Slaughter, MD, who studied perioperative coagulation abnormalities, led these efforts for a number of years. More recently, Dr. Bartz has focused on laboratory research and received funding from the National Institutes of Health for her work on mitochondrial function and oxygen radical injury in critical illness. Clinical research took on renewed emphasis at the VAMC with the arrival of Terri Monk, MD, MS, whose investigations in geriatric cognitive dysfunction and the role of anesthesia in operative mortality is changing the face of perioperative medicine.
The VAMC Anesthesiology Service is also known for excellence in chronic pain management. Recently, the pain group has focused on Veterans Injury Pain Research (VIPR), a new initiative that seeks to prevent the development of chronic pain following traumatic injury. A $1.5 million Department of Defense grant awarded to Dr. Shaw and his team in 2010 is a significant first step toward reaching this goal. As part of the VIPR initiative, Srinivas Pyati, MD, DA, FFARCSI, David Lindsay, MD, and Thomas Buchheit, MD, are exploring innovative methods to prevent chronic pain and have established new VAMC clinics for thoracotomy patients and amputees.
The Durham VAMC Patient Safety Center of Inquiry (PSCI) serves as another example of how the VAMC Anesthesiology Service is working to improve patient care throughout the medical center. This unique center, funded continuously since 2007 by the VA National Center for Patient Safety and led by Drs. Mark, Barbeito, and Rebecca Schroeder, MD, conducts a wide variety of research, educational, and quality improvement initiatives aimed at improving patient safety through better teamwork, communication, and standardization of clinical practices.
Furthermore, the VAMC Anesthesiology Service places a strong emphasis on education. More than 10 years ago, Joel Goldberg, MD, played a significant role in creating a VA-funded Pain Management Fellowship Program. Dr. Lindsay now serves as program director.
As Duke Anesthesiology celebrates its 40th anniversary, a tribute must be paid not only to those who have helped advance the specialty of anesthesia at Duke and abroad, but also to those like President Lincoln who have inspired these individuals to do their best. Just as the Durham VAMC is proud of the veterans it serves, we are extremely proud of our Veterans Affairs Anesthesiology Service. Together, we are working to ensure that the future of patient care at this facility will set the national standard of excellence.