Career Reflections–By Joannes Karis, MD

My medical career began shortly after the conclusion of WWII when I entered medical school at the University of Utrecht. The influx of a large number of medical students at the end of the war resulted in a significant backlog in available clinical rotations in Holland, forcing me to pursue an internship in the United States. I chose a rotating internship at New York City Hospital at the recommendation of one of my professors, who had visited Cornell University’s City Hospital of New York and encouraged me to pursue that option.

When I arrived in New York, I found that New York City Hospital was, in fact, an understaffed indigent care hospital, not the City Hospital of New York that my professor had mistakenly recommended. I made the best of a very difficult rotating internship and then did a year of general surgery training at Kings County Hospital in Brooklyn.

After my initial training in New York, I returned to Holland to fulfill my mandatory military service and complete the Dutch medical license process through the University of Leiden. I returned to Kings County Hospital in 1957 to complete my residency in anesthesiology. Afterward, I joined the faculty at Columbia Presbyterian Hospital in Manhattan, where I spent a total of 15 years. During this time, I became the director of one of the world’s first surgical intensive care units and pursued basic science research to understand the underlying physiologic mechanisms of neuromuscular blockade agents.

In 1975, my close friend and mentor whom I had first met at Kings County Hospital, Dr. Merel H. Harmel, recruited me to Duke, where I spent the final 18 years of my career doing cardiac anesthesia. I loved the sense of university community that Duke engendered, and I developed a particular pride and affection for this phase of my life. I became involved with the development of physiologic monitoring for the operating rooms and was able to collaborate in the development of the Duke Automated Monitoring Equipment (DAME).

While at Duke, I worked with a stellar team of operating room colleagues. One of my most interesting clinical cases was in 1978 when Dr. Edmond Bloch and I successfully separated 10-day-old thoracic conjoined twins. The case had two anesthesia teams, one led by me and color coded with yellow tape, and the other team, led by Dr. Bloch, that was color-coded blue. Each twin started with 14 color-coded lines and additional lines were added during the course of the case. Another interesting case occurred when I was in the OR hallway, and there was a “Code Blue” called for an operating room across the hall. The patient was being operated upon in the prone position and had been accidentally extubated during the case. A junior anesthesia attending who was covering the case was struggling to get the patient reintubated. I entered the room to help and proceeded with the most unusual intubation of my career—replacing the endotracheal tube while upside down and under the table!

Duke University also afforded me the opportunity to create an exhibit entitled “Triumph Over Pain” at The 1982 World’s Fair in Knoxville, Tennessee. I worked with anesthesia equipment manufacturers and Dr. William Sudduth of the North Carolina Museum of Life and Science to illustrate the history of anesthesia from the first anesthesia delivered by Drs. Crawford Long and Horace Wells through the development of state-of-the-art gas machines and monitoring equipment. During my final years at Duke, I represented the university as a volunteer with Project Hope to help develop cardiac anesthesia at university hospitals in Krakow, Poland, and Hangzhou, China.

I now reside in Phoenix, Arizona, with Martha, my spouse of 55 years. We have two children, both of whom pursued teaching careers in medicine. My daughter Margaret is an attending in infectious diseases at Yale University, and my son John is a neuroradiologist at the Barrow Neurological Institute in Phoenix, Arizona. My wife and I hope that our sponsorship of an endowed chair within the Duke University Department of Anesthesiology will help to build on the phenomenal level of research, teamwork, patient care, and physician education with which I am honored and proud to be affiliated.

Chris KeithCareer Reflections–By Joannes Karis, MD