Sunday, February 14, 2010

Wonder Boy

I hate to use this blog to air grievances but where else would I?

I got to work with a number of "interesting" people during my time at the C of E.

A number of years ago we had a new resident. He had come to medicine via a roundabout way obtaining degrees in Engineering and a PhD along the way. He was very interested in research which of course warmed the chairman's heart. I will call him Wonder Boy. If you read regional anaesthesia journals you should be able to figure out who he is.

One day I was working with him early in his R2 year. At that time I was interested in spinal cord stimulation and was doing trials of this with the neurosurgeons putting in the permanent leads. Wonder Boy asked me if I knew any practical way of stimulating the epidural space with a a goal of knowing where the epidural catheter is.

Knowing where the epidural catheter is seems to be of some importance. We have all been there. You do a case under epidural, after injecting 20 cc and then 10 more, there seems to be no block. You either have to switch to a GA or do a spinal and hope that the lake of local anaesthetic that might be in the epidural space doesn't leak thru your spinal hole. Or the patient with the post-op epidural where you are getting calls from the ward because it's not working; is it because it's not epidural or are there other reasons.

Now as I told Wonder Boy, the leads I used for epidural stimulation cost about $1000 which made them impractical. I then had a revelation.

During my residency one of our neurosurgeons for a certain procedure liked to have a central line placed in the atrium. When you actually want your CVP in the atrium, this is quite difficult so we used an atrial EKG. We put a attached a hollow metal lead to our CVP catheter, filled that catheter with saline which conduct electricity et voila when we got the humongous P wave we were in the atrium..

I told Wonder Boy this. I told him he should be able to introduce current to the epidural space thru a column of saline in the epidural catheter. I also pointed out that the equipment for this probably existed. Wonder Boy was not impressed. He said that what I had suggested simply would not work.

About a month later, Wonder Boy showed me his prototype which was a wire soldered to the metal coiling of a Arrow catheter. I wished him well.

I went to the resident's research day that year and WB presented his research. He actually had 3 presentations but he talked about his method of epidural stimulation. Or he sort of talked about it. He in fact didn't talk about it at all because as he told the audience he was patenting it and had been advised not to talk about it. Some of us rolled our eyes. He then went on to praise the two staff members who had helped him with his research neither named BH.

Fast forward to the 1998 ASRA Meeting in Seattle which I attended. Somebody told me the WB was presenting his research and I should be in audience for moral support. And so it was that I was in the audience while WB introduced to the world his method of epidural stimulation. Which was....attach a hollow metal lead to your epidural catheter, fill the catheter with saline and stimulate it. Which was of course what I had suggested several months ago. The method had by that time been patented and WB had modestly named it after himself.

Now quite frankly, I am better at suggesting things for other people to try than I am on trying them myself and I have to applaud him for all the time he spent trying out my idea on animals and humans even though he did most of it instead of the clinical work for which he was actually being paid.

Like all great researchers WB was able to create a research niche for himself by publishing multiple variations of trials with his epidural stimulation method. He has branched out to other things, is in demand at meetings and has co-authored a book. He is now on staff at the C of E (after taking two tries each to pass his written and oral exams).

Meanwhile I am just a bitter anaesthesiologist with a blog.


Blockit said...

Heres the thing, your blog has more reach than RAPM, keep blogging.

burnttoast said...

Those Masters of the Universe Types can generate some envy. But academics is a twisted game at best. Generate alot of crap papers to get tenure. Generate more, travel and give talks, and suck up on committees and to egomaniac surgeon/academics in the OR all in order to make Professor!! and the new department Head comes in and "Off with their heads!" All associated with prior Head are encouraged to leave, by assigning them to things unrelated to their interests and expertise. For example, famous neuro-anesthesiologist gets the ECT assignment. Forever. Seriously. Not to mention, the "whiz kids" (now faculty) who even the first year residents know can not provide competent care. If he is a doufus, everyone knows. They are respectful to his face, and eye-rolling be hind his back and avoiding him at parties. Guess you will have to be happy with your well-rounded life!

Bleeding Heart said...

An anaesthesiologist friend of mine came to the CofE from out of province for a surgery only available there.

I asked her later which anaes. and she told me it was Wonder Boy.

I have never told her how lucky she is to be alive!