The History of Mayo Clinic's Department of Anesthesiology and Perioperative Medicine
Welcome
Mayo Clinic’s Department of Anesthesiology and Perioperative Medicine was officially formed on April 1, 1924. In its first century, the department has played pivotal roles in a variety of important developments that have advanced the specialty of anesthesiology. These include:
- Dedicated nurses at Mayo Clinic who delivered anesthesia in the 1890s, starting the field of nurse anesthesia.
- Early trials that led to the use of sodium pentothal.
- Innovations such as the nation’s first blood bank and postoperative intensive care unit.
- Creation of the intravenous catheter.
- Training of “90-day wonders,” physicians trained in anesthesiology during World War II, many of whom became major leaders of the specialty.
- Co-founding and leadership of specialty organizations such as the American Society of Anesthesiologists and the American Board of Anesthesiology.
2024-2025 Centennial Celebration Events
During the centennial year of the Department of Anesthesiology and Perioperative Medicine from April 1, 2024, to April 1, 2025, there will be a variety of events and activities to celebrate the anniversary. Some of these events include:
- A department centennial anniversary gala on April 13, 2024.
- A special session on Mayo Clinic at the 2024 Anesthesia History Association’s annual meeting in Schaumburg, IL at the Wood Library Museum of Anesthesiology from April 25, 2024, to April 27, 2024.
- A series of visiting professors in Rochester, Jacksonville, and Scottsdale who will speak about the history of the department and its impact on the specialty.
- Two department-specific presentations in the series of dinners sponsored by Mayo Clinic’s Bruce Fye Center for History of Medicine.
- An exhibit installation, focusing on the history of Anesthesia at Mayo Clinic, at the International Museum of Surgical Sciences in Chicago, Illinois on August 15, 2024.
- Co-hosting the 2025 Anesthesia History Association’s annual meeting in Rochester.
Many more events and activities will be announced, and the events listed above will be given specific dates as the centennial approaches and the year progresses.
Anesthesia History Assocation 2025 Annual Meeting
In 2025, from April 25th to April 27th, the annual meeting of the Anesthesia History Association (AHA) will be held in Rochester, Minnesota at Mayo Clinic. It will be co-hosted by Mayo Clinic’s Department of Anesthesiology and Perioperative Medicine and the History of Anesthesia Society.
During the First International Symposium of Modern Anesthesia History in Rotterdam in 1982, a group of members of the American Society Anesthesiologists (ASA) who were in attendance discussed the organization of an anesthesia history society in the United States. Later that year a larger group of ASA members met and by January 1983, the name “Anesthesia History Association” was agreed upon. The “Inaugural Meeting” of the AHA was then held on October 9, 1983. Their annual meeting occurs in the spring. The History of Anaesthesia Society was founded in 1986. The purpose of the Society is to promote the study of the history of anaesthesia and related disciplines. Their annual conference is held each fall.
Centennial Celebration Weekly Updates
Through April 2025, the Centennial Project Team will have weekly updates that will contain very brief descriptions of articles or vignettes that highlight the department’s development, remarkable personnel across the spectrum of the department (e.g., respiratory therapists, nurse anesthetists, anesthesiologists, scientists, and administrators), and contributions to the specialty’s advances and recognition.
Mayo Clinic Anesthesiology Centennial Celebration Updates:
(Click Updates to Read More)
Please note that we will not have an Update on Thursday, August 1st. I will be traveling overseas at that time. We’ll pick back up on August 8th with Update #48.
The Mayo Clinic Department of Anesthesiology: Officers of Exceptional Rank
Mayo Clinic in general, and the Department of Anesthesiology specifically, has produced many leaders in the U.S. military. Notably, both Will and Charlie Mayo were promoted to Brigadier General rank in the U.S. Army Medical Reserve Corps in 1921. The institution has been a strong supporter of its staff members who have been involved in the various military branches, providing them special benefits when they are called to active duty. These benefits, including military salary augmentation, often exceed those provided by most academic medical centers.
There are two primary categories of military rank in the U.S. military branches. These are enlisted ranks and officer ranks. There also is a category of military rank for a unique group of personnel who have unique technical skills and knowledge. This category, warrant officers, is important but relatively small and more can be read about personnel in it online.
Enlisted Ranks
Typically, military personnel in enlisted ranks have not obtained the undergraduate degrees required of commissioned officers. They provide the great majority (82%) of military personnel overall. They are the soldiers, marines, sailors, and airmen who serve the country so well. Enlisted personnel are classified by rank type and a rank designation. These differ between various military branches. The rank designation is the letter “E” (for enlisted) and the levels rise from 1 through 9.
| Army, Marines, Air Force, and Space Force | Navy and Coast Guard |
| E-1: Private | E-1: Seaman recruit |
| E-2: Private 2nd class | E-2: Seaman apprentice |
| E-3: Private 3rd class | E-3: Seaman |
| E-4 Corporal | E-4: Petty officer 3rd class |
| E-5: Sergeant | E-5: Petty officer 2nd class |
| E-6: Staff Sergeant | E-6: Petty officer 1st class |
| E-7: Sergeant 1st class | E-7: Chief petter officer |
| E-8: Master Sergeant | E-8: Senior chief petty officer |
| E-9: Master Sergeant | E-9: Master chief petty officer |
Officer Ranks
Typically, military personnel who have earned undergraduate degrees and completed officer military training (e.g., at a U.S. military academy, in a Reserve Officer Training Corp – ROTC – in a university, or an Officer Candidate School) qualify for commissions in the various military branches. These commissions are approved by the President of the United States. Commissioned Officers comprise 18% of all military personnel. Officers also are classified by rank type and a rank designation. These differ between various military branches. The rank designation is the letter “O” (for enlisted) and the levels rise from 1 through 10 (although several branches have an 11th level during war).
| Army, Marines, Air Force, and Space Force | Navy, Coast Guard, and Public Health Service |
| O-1: 2nd Lieutenant | O-1: Ensign |
| O-2: 1st Lieutenant | O-2: Lieutenant junior grade (j.g.) |
| O-3: Captain | O-3: Lieutenant |
| O-4: Major | O-4: Lieutenant commander |
| O-5: Lieutenant colonel | O-5: Commander |
| O-6: Colonel | O-6: Captain |
| O-7: Brigadier general | O-7: Rear admiral lower half |
| O-8: Major general | O-8: Rear admiral upper |
| O-9: Lieutenant general | O-9: Vice-admiral |
| O-10: General | O-10: Admiral |
Our department has been represented in the military in both enlisted and officer ranks. Our enlisted personnel have served in many roles, including riflemen, communication specialists, and Navy corpsmen and Army medics. Please note that a number of military roles incorporate the term “man” but are gender neutral. Many of these individuals enter healthcare fields after completing their military service and then join our department as administrators, support staff, respiratory therapists, nurse anesthetists, and anesthesiologists. Our Officer personnel have attained undergraduate degrees, undergone officer training, and entered or re-entered the military through the draft, voluntary enrollment, or as a requirement of receiving undergraduate or graduate military scholarships.
As you might note in the lists above, advancing up the Officer ranks that run from levels 1 through 10 takes time, talent, and outstanding performances. Within the 10 Officer rank levels, there are two inflection points: (1) between the O-5 and O-6 levels and (2) between the O-6 and O-7 levels. These distinct points are characterized by the following (using Army and Navy examples):
- Advancing from an O-5 rank level (i.e., Lieutenant colonel or Commander) to an O-6 level (i.e., Colonel or Captain) requires approval by the President and confirmation by the U.S. Senate. At lower levels, the President of the United States has sole discretion of approving appointments and promotions. These promotions typically are based on recommendations from military promotion boards. Promotions to the O-6 rank level, however, require Presidential approval and confirmation by the U.S. Senate. In general, the U.S. Senate provides its Armed Service Committee with the primary authority to review these promotion requests.
- Advancing from an O-6 rank level (i.e., Colonel or Captain) to an O-7 level (Brigadier General or Rear Admiral lower half), like promotion to O-6 levels, require approval of both the President and the U.S. Senate. Unlike promotions to the O-6 level, however, promotions to the O-7 level undergo much more intense scrutiny by the U.S. Senate Armed Services Committee and, occasionally, the full Senate.
Officers who advance to the O-6 rank level (Colonel or Captain) or higher, especially in the Army, Air Force, and Navy Medical Corps, represent a very small, unique group of outstanding military and medical leaders. In our first 100 years as a department, at least 10 remarkable individuals have achieve the O-6 rank level. One, Dr. Robert L. Lennon, has served at an O-7 rank level (Army Brigadier General). Bob is one of only a very small number of anesthesiologists or nurse anesthetists overall to attain this lofty rank in the nation’s history.
These outstanding individuals, listed alphabetically, are:
- Eric L. Bloomfield, M.D., Colonel, U.S. Air Force
- Edward P. (Paul) Didier, M.D., Colonel, U.S. Army
- Robert L. Lennon, D.O., Brigadier General, U.S. Army
- Brian P. McGlinch, M.D., Colonel, U.S. Army
- Paul D. Mongan, M.D., Colonel, U.S. Army
- Michael J. Murray, M.D., Ph.D., Colonel, U.S. Army
- Steven R. Rettke, M.D., Captain, U.S. Navy
- Benjamin W. Riley, CRNA, DNAP, Colonel, U.S. Army
- Frank J. Villamaria, M.D., Captain, U.S. Navy
- Francis (Fran) X. Whalen, Jr., M.D., Colonel, U.S. Army
You may read more about each of these exemplary leaders on our department’s history website at Mayo Clinic | Anesthesiology | Mayo Clinic Military Anesthesia Statistics. Clicking on the photo of each will provide you with background information on each. This website currently contains information on 35 department members who have served in the military. However, we believe that as many or more than 100 past and current members have served in the military. Dr. Steve Rettke and I are forming site-specific military advisory groups who we hope will be able to identify colleagues, past and present, who have served. We will then follow up with communications to encourage them to add their information to the department military webpage.
Mystery Photos
Last week’s Mystery Photos were Steven R. Rettke, M.D. and David O. Warner, M.D.
Steven Rettke, M.D. was born in Marinette, Wisconsin on October 22, 1946. He attended Western Michigan University in Kalamazoo, Michigan, earning a B.S. degree in Aviation Engineering in 1969. We believe he may be the only consultant in our institution’s history to hold an Airframe and Powerplant mechanic’s license. Steve also received a B.S. degree in biology from Jacksonville University (Florida) in 1975. He subsequently earned his M.D. degree in 1979 from the University of Wisconsin, Madison. He did his residency in anesthesiology at Mayo Clinic Rochester and joined our staff in 1982. His classmates in that entering 1979 residency class included Drs. Bob Chantigian, Mary Ellen Warner, and me. Our cumulative years on staff at Mayo Clinic now stand at 164.
Prior to completing his first college degree, Steve joined the U.S. Naval Reserve in February 1967 as an Aviation Reserve Officer Candidate (AVROC). He entered active duty in 1969 after receiving his initial officer commission. Steve then earned his wings as a Naval Aviator on October 16, 1970. His class was the last to fly the TF-9J Cougar. He qualified to fly onto and off of aircraft carriers aboard the U.S.S. Lexington (CV-16). He went on to fly the A-7 Corsair and was attached to Attack Squadron 87 (VA-87). A photo of Steve in his Corsair may be viewed below. He was deployed from February 1972 to December 1972 aboard the U.S.S. Franklin D. Roosevelt (CVA-42) to the western and eastern Mediterranean area of operations. He transferred to the U.S. Navy Medical Corps after medical school and spent a total of 27 years of active and reserve duty before retiring as a Captain.
Steve was a leader in our Rochester department throughout his career. He was Section Head of Rochester Methodist Hospital North Anesthesia from 1986 to 1988. He then was Division Chair of Multispecialty Anesthesia from 1988 to 1991. From 1992 to 2000 he was Division Chair of Rochester Methodist North Anesthesia.
Our department has been asked to provide anesthesia care for several U.S. presidents and their family members over the years. I’m not violating any HIPAA regulations when sharing this publicly available information with you that Presidents Lyndon B. Johnson, Ronald Reagan, and George H. W. Bush received perioperative care led by Mayo anesthesiologists (in Washington, D.C.) or by our Mayo anesthesia care teams across the institution. For example, Dr. Paul Didier provided care for Presidents Johnson and Reagan. Steve was our leader in caring for Presidents Reagan and Bush. Dr Roy Cucchiara led the care for President Reagan. Dr. Jim Hebl was involved in the care of President Bush. Our institution-wide department is fortunate to be asked to provide care for many U.S. and international leaders. Special kudos for those who have provided this care and for treating each of these leaders well, just as we do for all patients.
Steve was our lead anesthesiologist in the initial establishment of the Mayo Clinic liver transplant program, working closely with colleagues such as gastroenterologists Drs. Roland (Rollie) Dickson and Russell (Russ) Weisner and transplant surgeon Dr. Ruud Krom. As our department’s Liver Transplant Program Coordinator from 1984 to 1998, he was responsible for setting up protocols and working with other Institutional specialties. This involved designing and, with Mayo Engineering, building the Mayo rapid infusion pump since there were no commercially available rapid infusion pumps at the time. The original engineering drawing for the first version of the Mayo rapid infusion pump can be found below. Nationally, Steve was the anesthesia specialty’s representative to the United Network for Organ Sharing (UNOS). In addition, he was the inaugural chair of the ASA’s Committee on Transplant Anesthesia.
In December 2014, Steve retired as Professor of Anesthesiology. He and his wife Mary have two sons and reside in Rochester.
David O. Warner, M.D. was born in Columbus, Ohio on May 31, 1957. For those aware that David is my first cousin, his parents, Drs. E. Jackson (Jack) Warner and Louise Oman (Omie) Warner were pediatric anesthesiologists at Children’s Hospital in Columbus (now Nationwide Children’s Hospital). David obtained his undergraduate degree and his M.D. from the Ohio State University in 1979 and 1983, respectively. According to Dr. Peter Southorn in his summary about David in our department’s Art to Science text about our history (published in 2000), “He (David) was lured to Rochester by his cousin . . . “ I’m not sure “lured” is the correct term, but Mary Ellen and I were able to interest David and his wife, Julie, into visiting Rochester, a trip that may have been one of the best things Mary Ellen and I have done for Mayo Clinic and our department. Regardless of how he got to Rochester, David completed his five-year residency program in 1988. It included two years as a research fellow under the mentorship of Dr. Kai Rehder.
While David’s clinical career was predominantly focused on the care of children, his research interests varied over his 35 years as a consultant in our department. He was, and remains, a remarkable and innovative researcher. His research falls into six primary categories.
- Respiratory physiology: David’s early work with Drs. Kai Rehder and Bob Hyatt was focused on pulmonary mechanics and respiratory muscle physiology. His work led to our current understanding that volatile anesthetics relax smooth muscle both by impairing neural reflexes and by direct effects on airway smooth muscle. The ability of volatile anesthetics to relax even maximally stimulated airway smooth muscle is unique (e.g., not shared by beta-adrenergic agonists) and is the foundation for ongoing drug discovery efforts seeking novel bronchodilators.
- Perioperative tobacco control: David had a longstanding desire to improve perioperative lung health. His studies on the impact of tobacco smoke on lungs during and after anesthesia and surgery, as well as the potential to use the perioperative period to get patients to stop smoking, have led to major reductions in perioperative pulmonary complications as well as increased rates of smoking cessation in surgical populations. He founded the ASA’s Smoking Cessation Task Force in 2008 and influenced the Centers for Medicare & Medicaid Services (CMS) to pay anesthesia professionals for smoking cessation counseling of patients.
- Neurodevelopment following anesthesia and surgery in children: Based on preclinical studies suggesting that anesthesia may be associated with neurotoxicity in the developing brain, David organized a departmental team to investigate this issue in children undergoing anesthesia and surgery. The team’s first studies providing evidence that neurotoxicity from anesthetics may occur in children, showing that anesthetic exposure within the first three years of life is associated with a doubling of the risk for the later development of learning disabilities. Ongoing research is aimed at understanding whether anesthesia and surgery is causative or simply confounding in behavior changes and diminished fine motor skills in children and later in their lives, especially in those with multiple exposures to anesthesia and surgery.
- Cognition after anesthesia and surgery in the elderly. Similar to the findings that anesthesia may cause neurotoxicity in developing brains, there is some evidence that this impact may also be found in elderly brains. David assembled a Mayo team and found that although surgery with anesthesia is not associated with an increased risk of clinical diagnoses of long-term cognitive impairment, it is associated with a modest acceleration of cognitive decline. These results are reassuring from the standpoint of anesthesia exposure but highlight the continued need to address perioperative brain health as his team also found that postoperative delirium is associated with subsequent cognitive impairment.
- Innovation in postgraduate medical education and assessment. As a director of the American Board of Anesthesiology, David led its Research Committee and produced papers that documented the value of board certification as well as increased understanding of how anesthesia professionals process and retain new information. These studies led to his development of the ABA’s Maintenance of Certification in Anesthesiology (MOCA) continuing education assessment tool, the MOCA Minute. They also triggered the inclusion of a novel Objective Structured Clinical Exam (OSCE) into the ASA’s examination process.
- Research in education and mentorship. David recognized the need for improvements in our educational systems at Mayo Clinic and elsewhere. He founded the Mayo Clinic College of Medicine and Science’s Office for Applied Scholarship and Education Science (OASES). The OASES program brings the expertise of professional educators to our institution’s educational programs.
Administratively, David has served within our department as its Rochester vice-chair for research. He co-founded the Mayo Perioperative Outcomes Group in 1995 and followed that by founding the Anesthesia Clinical Research Unit in 1999. Within the institution’s research community, David has been Associate Dean for Clinical and Translational Research, director of Community Engaged Research, and co-director of the Office for Diversity in Clinical Research. He has been an editor of Anesthesiology and the Journal of Applied Physiology. He was the president of the ABA in 2022 and was recognized by the ASA with its Excellence in Research Award that same year.
David retired clinically in January 2023. He continues as a supplemental consultant, working with department members to write research grant applications and offering his advice and insights to our colleagues with research and career interests. David and his wife, Julie, reside in Rochester. They have three children.
Mystery Photo Contest Winner
Last week’s contest winner was Philip Boyle.
Here are this week’s Mystery Photos. Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.
Please email your response at warner.mark@mayo.edu within 3 days of this update. I will also need your name and contact information. All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card. Only one winner per individual over the 80 weeks of Mystery Photos. If you win a weekly drawing, however, please keep submitting your responses. An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.
Photograph 1: Aerial view of Mayo Clinic's Jacksonville campus, 1986. Photograph 2: Aerial view of Mayo Clinic's Scottsdale campus, 1987.
The Mayo Clinic Department of Anesthesiology: The Early Development of Departments in Jacksonville, Florida and Scottsdale, Arizona
The underlying issues that drove Mayo Clinic to expand to states far beyond the Upper Midwest U.S.:
Payment systems in the U.S. evolved dramatically from 1935 through the late 1980s. In 1935, President Franklin Roosevelt signed the Social Security Act in one of his first major “New Deal” objectives. This act served the nation’s poor well for its first three decades but stumbled in meeting its objectives of providing healthcare support for many Americans. By 1961, President John F. Kennedy set out to improve medical care for elderly U.S. citizens by establishing a Medicare Task Force. By 1965, the task force’s recommendations led to President Lyndon B. Johnson’s signing of the Social Security Amendment Act (Medicare and Medicaid Act). Healthcare coverage for elderly and poor Americans rose exponentially, as did the country’s overall healthcare spending.
By the late 1970s, it was clear that healthcare expenses were spiraling upwards and that there was a need as a nation to control the rate of growth of these expenses. Multiple attempts were made in the 1980s (and have continued to be made since), most with modest and variable impact on overall healthcare expenditures. As with many national healthcare policies then and now, there were unanticipated consequences of their implementation and many of the changes during that decade fell short on providing their projected financial savings. Examples include:
- The 1981 Omnibus Budget Reconciliation Act (OBRA 1981): This act expanded Medicare and Medicaid benefits to home health care and new Medicare Supplement (Medigap) coverage. Both were anticipated to lower overall Medicare and Medicaid expenses by providing funds to pay for out-of-hospital care. In general, and for both, the opposite financial outcome occurred.
- The 1982 Tax Equity and Fiscal Responsibility Act (TEFRA): This act expanded benefits to hospice care, introduced prospective payment plans for coverage of unique populations, and added oversight of proposed care (e.g., surgical procedures) by Peer Review Organizations (PROs).
- The 1989 Omnibus Budget Reconciliation Act (OBRA 1989): This act required healthcare providers to provide pre-service estimates of the costs of their planned care management and approval by PROs before the care was delivered or reimbursed.
Not surprisingly, the rising healthcare industry adapted to these new regulations . . . and costs continued to climb. As you can imagine, administrative costs associated with these expanded regulations grew rapidly. New models of care popped up quickly. Those of us who worked in the 1980s will recall abbreviations such as HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and IPAs (Individual Practice Associations). In general, all were attempts by individual physicians, small groups, and large healthcare systems to remain profitable or even viable during this tumultuous period of expanding healthcare coverage and restrictions on payments. A more detailed summary of these changes may be found here.
One key issue that concerned large groups and healthcare systems: there was a general movement to restrict movement of patients from any one region of the country (or from one state to another). The hope was that regionalization of healthcare would encourage early non-procedural interventions (e.g., increased medication use, improved lifestyle choices) and reduce the need for expensive care associated with advanced procedural care (e.g., coronary bypass surgery). This movement raised concerns of large group practices and healthcare systems such as Mayo Clinic. At the time, approximately 30% of our patients came to Rochester from outside of our Upper Midwest region.
Mayo Clinic leaders responded to this concern by planning for new sites in Florida and Arizona. Sites in Texas were also considered initially. The institution’s geographic diversification was into the two largest U.S. cities that did not have existing medical schools at the time and cities that appeared to be relatively underserved by academic medical institutions. In addition, both Jacksonville and Phoenix were experiencing rapid growth at the time. Excellent video summaries of the start and growth of the Florida and Arizona sites may be found at Mayo Clinic in Florida: 30th Anniversary | Mayo Clinic History & Heritage and Mayo Clinic in Arizona: 30th Anniversary | Mayo Clinic History & Heritage, respectively. Both webpages are part of the Mayo Clinic History and Heritage website. This website is available to the public as well as Mayo Clinic personnel. It is also the same website that hosts our Department of Anesthesiology’s history webpages (Anesthesiology Department | Mayo Clinic | History and Heritage).
The First Two Years of Our Department in Florida
In 1986, the institution completed construction of its first Jacksonville area building on land donated by Mr. James E. Davis. It was located in the middle of an expansive pine forest along the Atlantic Intracoastal Waterway. The new Davis Building and the community-based St. Luke’s Hospital (250 beds, 14 operating rooms, and 8 miles west of the Davis Building and new Mayo campus) was staffed initially by 35 Mayo faculty members. Dr. Alan D. Sessler, chair of our department in Rochester, oversaw the development of our new anesthesiology department. He recruited Drs. James V. Harper and Timothy S. J. Shine to provide anesthesia services. Jim and Tim subsequently recruited four Rochester nurse anesthetists. These were Linda Buck, Burdette (Bud) Polk, Alicia Casabar, and Phil Kleinschmidt.
The St. Luke’s Hospital anesthesia practice was a mixed model of Mayo Clinic staff who provided services for Mayo Clinic patients and a private group of anesthesiologists who provided services for the majority of non-Mayo Clinic patients. Surgical volumes grew dramatically in the first months of operation during 1986 and 1987 and additional anesthesiologists were recruited to join our Mayo staff. The first of these new recruits included Drs. Lisa J. Vucalcic, Jerry A. Dorsch, Neil G. Feinglass, and David Mackey. By 1988, Jim Harper was appointed chair of the new Department of Anesthesiology at Mayo Clinic Jacksonville (the site’s name changed to Mayo Clinic Florida later). That same year St. Luke’s Hospital became an affiliate of Mayo Clinic, with Mayo Clinic Jacksonville assuming St. Luke’s Hospital corporate assets and liabilities.
The First Two Years of our Department in Arizona
In 1987, the Mayo Clinic Building opened in Scottsdale. Forty physicians initially staffed:
- The new Mayo Clinic Building
- Scottsdale Memorial Hospital – Osborn
- Scottsdale Memorial Hospital – North
- The Piper Center, an ambulatory surgery center adjacent to and associated with Scottsdale Memorial Hospital – North
Dr. Sessler also oversaw development of our new anesthesiology department in Scottsdale. He recruited Drs. John C. McMichan and Jesse J. Muir from Rochester and Dr. Kent P. Weinmeister, a 1982 graduate of our Rochester residency program and in private practice in Illinois. John McMichan was appointed chair of the department. During 1988 and 1989, with expansion of operating rooms at Scottsdale Memorial Hospital – North, additional anesthesiologists were recruited. These included Drs. Kurt E. Springmann and Mark R. Matthews.
During the initial year, nurse anesthetists were not part of the model of care as this model was fairly novel for Arizona in general and in the Phoenix area, specifically, at the time. Within a year (in 1988), the team care model at Mayo Clinic Scottsdale (to be named Mayo Clinic Arizona later) was approved and Pauline C. Bisel, CRNA and John (Jack) D. Hostak, CRNA were recruited to Arizona from Rochester. During the first year, while awaiting hospital privileges at Scottsdale Memorial Hospital – North, Pauline and Jack performed preoperative evaluations and provided sedation for outpatient procedures performed in the Mayo Clinic Building. By 1989, they received privileges to practice in Scottsdale Memorial Hospital – North.
Photographs from left to right: Alan Sessler, Jim Harper, Tim Shine, Linda Buck, Burdette Polk, Alicia Casabar, John McMichan, Jesse Muir, Kent Weinmeister, Pauline Bisel, and Jack Hostak.
Mystery Photos
Last week’s Mystery Photos were William L. Lanier, M.D. and Bruce J. Leone, M.D.
William L. Lanier, M.D. was born on June 8, 1955, in Statesboro, Georgia. He grew up on a farm near Metter in southeast Georgia. He attended the University of Georgia, graduating in 1976. He subsequently matriculated to the Medical College of Georgia. Upon earning his M.D. in 1980, he served as a resident in anesthesiology at Wake Forest University from 1980 through 1983. He followed his residency with subspecialty training in neurosurgical anesthesiology at Mayo Clinic in Rochester and was appointed to the Mayo Clinic faculty in 1984. By 1995, Bill had risen to the rank of Professor of Anesthesiology.
Bill was actively engaged in both laboratory and clinical research throughout his career. For 10 years, he served on the research team of Dr. John (Jack) Michenfelder’s Cerebral Blood Flow and Metabolism Laboratory at St. Marys Hospital. From there, he moved to the Medical Science Building on the Rochester campus where he established and was medical director of the Neuroanesthesiology Research Laboratory for the next 13 years. His original research focused on neuroprotection, cerebral physiology, and clinical neuroanesthesiology. He also published and lectured extensively on quality of medical evidence, medical ethics, and professionalism. Two of his most clinically important lines of research involved (1) augmentation of ischemic brain injury by clinically relevant doses of intravenous glucose solutions or minor changes in blood glucose concentration and (2) modulation of ischemic brain injury by small (e.g., 1ºC) changes in temperature. Notably, the former research resulted in changes in default intravenous 5% glucose fluid usage in anesthesiology practice worldwide and the latter research resulted in changes to how we now manage patients with ischemic brain injuries.
Bill was president of the Society for Neuroscience in Anesthesia and Critical Care (SNACC) in 1994. In 2011, he was named SNACC’s Teacher of the Year and in 2014 was recognized with the SNACC Distinguished Service Award. He was an examiner for the American Board of Anesthesiology from 1994-2014. Additionally, he has been a scientific reviewer or consultant for approximately thirty-five indexed scientific journals. He was a founding section editor for the Journal of Neurosurgical Anesthesiology; a founding editorial board member for Disaster Medicine and Public Health Preparedness; and the senior editor overseeing the conceptualization, planning, and launch of Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
Bill’s many education accomplishments were highlighted in last week’s Centennial Update #45. Bill has been active his entire career and even now in retirement with mentoring high-school-, college-, and medical students, as well as resident physicians and early career faculty in anesthesiology and other fields. More than ten of his Mayo Clinic mentees have joined our departments across the institution and have spent their entire careers on the faculty. He has also mentored students seeking advanced academic degrees in the Mayo Clinic School of Nurse Anesthesia. He has been a strong advocate as well as mentor for trainees of all types during his career.
Bill remained active as a practicing physician until the time of his retirement in September 2021. However, from January 1999 to early-2017, he spent most of his professional effort serving as editor-in-chief of Mayo Clinic Proceedings, the world’s third largest circulation scholarly biomedical journal. At the time of his appointment, the Proceedings was a provincial publication, with authorship of articles overwhelmingly from Mayo Clinic physicians and scientists. During his time as editor-in-chief, and because of promotional efforts for a new Journal vision, authors from approximately sixty nations submitted manuscripts, and the journal’s Impact Factor increased from 2.0 to 7.2. He is the longest serving editor of the Mayo Clinic Proceedings.
Bill is an avid hunter and angler, having hunted and fished throughout North-, Central-, and South America. He has been active in introducing many young people to fishing. He and his wife, Mary, also enjoy gardening, travel, foods, and the arts. Bill and Mary have two children. In September 2023, they moved to their 1,000-acre Zedee Farms north of Metter, GA. The farms have been in the Lanier family for more than 2 centuries. They now actively manage their farms for commercial timber production and wildlife habitat.
Bruce J. Leone, M.D. was born in Boston, Massachusetts on November 23, 1957. He attended undergraduate school at Harvard University and graduated in 1978. After Harvard, Bruce matriculated to the University of Florida College of Medicine, graduating in the class of 1982. He completed his rotating Internal Medicine internship at Baylor University Medical Center at Dallas, Texas in 1983 and his anesthesiology residency at the University of Texas Southwestern Medical Center (Parkland Hospital) in 1985. Bruce then did a research fellowship in Cardiac Anesthesiology at Parkland Hospital, completing this in 1986, followed by two years as a Senior Registrar at the Nuffield Department of Anaesthetics at Oxford University, UK. He became an Assistant Professor of Anesthesiology at Duke University Medical Center in 1987 and completed a second cardiac anesthesiology fellowship at Duke University Medical Center in 1988.
After a decade at Duke University, Bruce joined our Mayo Clinic Florida faculty in 1998 and helped establish the cardiac and pulmonary transplant programs, working alongside cardiac surgeon, John Odell, M.D. Bruce served as Vice-Chair of the department in Research and Academic Affairs, as well as the general Vice Chair of the department. He also served as Program Director of the anesthesiology residency program from 2013 through 2015. In his education role, he was a long-serving member of our Jacksonville’s Surgery and Surgical Specialties education committee within the Mayo Clinical School of Graduate Medical Education. He was a member of the cardiac anesthesia team at Mayo Florida from 1998 through 2008, when he then transitioned to neuroanesthesia, serving as Chief of Neuroanesthesia Division from 2009 through 2014.
Bruce was active in national organizations such as the ASA. He served on ASA committees related to clinical as well as experimental circulation and equipment and facilities. He was a reviewer for the NIH’s Surgery, Anesthesia, and Trauma Study Section. Bruce was a member of the editorial boards of the Journal of Cardiothoracic and Vascular Anesthesia and the journal Anestesia en Mexico.
Bruce retired in October 2023 as a Professor of Anesthesiology. He now spends his time traveling between his homes in North Carolina and Florida with his wife Christine and their pets.
Mystery Photo Contest Winner
Here are this week’s Mystery Photos. Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.
Please email your response at warner.mark@mayo.edu within 3 days of this update. I will also need your name and contact information. All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card. Only one winner per individual over the 80 weeks of Mystery Photos. If you win a weekly drawing, however, please keep submitting your responses. An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.
Photograph: Alan D. Sessler, M.D., undated
The Mayo Clinic Department of Anesthesiology: Educators Internally, Leaders in Education Everywhere
The Department of Anesthesiology has played a major role within the institution in the Education Shield as well as in extramural education societies, on anesthesia-related boards, and in education regulatory organizations. In this early summer series of four Updates, I will describe the history and development of our department’s education programs and the contributions of our department members to institutional and national leadership in anesthesia and respiratory care education. Specifically,
- In the initial week we highlighted the Rochester education programs in nurse anesthesia and respiratory care.
- In the second week we focused on the LaCrosse, Wisconsin nurse anesthesia program and the anesthesiology residency and fellowship programs in Florida and Arizona.
- In the third week we described the Rochester anesthesiology residency and fellowship programs.
- In this final week we will showcase department members who have played major education leadership roles within the institution and nationally.
The Department of Anesthesiology and Educational Programs: Leaders in the Mayo Clinic College of Medicine and Science and In Education Nationally
There are many opportunities to provide leadership in education within Mayo Clinic and in our specialty. In previous Centennial Updates I have highlighted colleagues in the past century who have served as directors of the American Board of Anesthesiology, earned Mayo Clinic’s Distinguished Educator Awards, and been recognized in the Mayo Clinic Fellows Association’s Teacher Hall of Fame. In this issue, I will highlight our anesthesiologists who have served as leaders of the schools within the Mayo Clinic College of Medicine and Science, as well as those who have been officers or chairs of major anesthesia education organizations or regulatory bodies. I have listed their primary education leadership role at Mayo Clinic in parentheses.
- Alan D. Sessler, M.D. (Dean, Mayo Clinic School of Graduate Medical Education). Alan was a life-long advocate for high quality education. In addition to being a Director of the ABA from 1977 through 1989 and its President in 1988, Alan served as an ASA Vice-President of Scientific Affairs. In this latter position, he oversaw the educational programs within the ASA. Alan was the Executive Secretary of the Foundation for Anesthesia Education and Research from 1995 through 2011. In that role, he founded the FAER Academy of Research Mentors and started the FAER Medical Student Anesthesia Research Fellowship program. He served as a member of the ACGME’s Residency Review Committee for Anesthesiology. Within Mayo Clinic, Alan was the Dean, Mayo Clinic School of Graduate Medical Education from 1988-1995. Memories of Alan’s dedication and advocacy for education may be found at two tributes, one written by Dr. Doug Bacon and the other by Dr. Mark Warner.
- Michael J. Murray, M.D. Dean, Mayo Clinic School of Health Sciences). Mike has been an advocate for education in many forums and positions. As a major leader in the evolution of Critical Care Medicine, he served on numerous education-related committees and provide oversight to programs and meetings. He played a key role in the development of our anesthesiology residency program when he was chair of the department in Jacksonville, encouraging Dr. Marie De Ruyter to apply for an accredited program. Mike served as editor of one of the Faust Anesthesiology Review books and has been a co-editor of many other books. He was a long-serving ABA oral examiner and member of the ABA’s Critical Care Medicine Examination Committee. In 2000, he was appointed as Dean, Mayo Clinic School of Health Sciences. Although only in the role for a little over a year as he moved to Jacksonville to chair our Mayo Clinic Florida Department of Anesthesiology, he made several major changes that improved a number of the health sciences training programs.
- William L. Lanier, M.D. (Editor-in-Chief, Mayo Clinic Proceedings). Bill has been a leading educator at Mayo Clinic and outside the institution. Within the department, he chaired the 1988 Task Force on Master’s Degrees in Nurse Anesthesia. He led our department’s institution-wide Academic Appointments & Promotions Committee for 20 years. For a decade, he organized our Rochester Grand Rounds and Visiting Professor programs, instituting exchange visiting professor programs with Duke University, the University of Pennsylvania, and Wake Forest University. Within Mayo Clinic, Bill has been the longest-serving and remarkably successful Editor-in-Chief of the Mayo Clinic Proceedings. During his 18 years of leadership, the Proceedings evolved from a parochial medical journal to the third largest circulation of biomedical journals. In his editor role, he also created Mayo Clinic Proceedings: Innovations, Quality and Outcomes. With that editor role, he was a major contributor to the success of the Mayo Clinic College of Medicine and Science and served on its Education Finance Committee. Outside of Mayo Clinic, Bill was an ABA oral examiner for 20 years, a member of several additional scientific editorial boards, and chair of the Society for Neurosurgical Anesthesia and Critical Care’s (SNACC’s) Education Committee. He was recognized in 2014 by SNACC as its Teacher of the Year. For 6 years, he led the short course for new journal editors for the prestigious Council of Scientific Editors.
- Mark A. Warner, M.D. (Dean, Mayo Clinic School of Graduate Medical Education and Executive Dean, Mayo Clinic College of Medicine and Science). Mark worked closely with Mayo medical students soon after joining staff and was recognized in 1988 with one of the school’s two annual Golden Apple Teaching Awards. He joined Dr. Duane Rorie as the only other Rochester department member to receive this award. His advocacy for medical education expanded from that fortunate start, culminating in 2005 with his selection to serve as Dean, Mayo Clinic School of Graduate Medical Education. His 7-year term as dean was successful primarily because of the efforts and vision of our own Dr. Steve Rose, Vice-Dean of the school. In 2012, Mark advanced to the Executive Dean role of the Mayo Clinic College of Medicine and Science, with oversight of all five Mayo Clinic schools and all education-related activities across the institution. He continued in that role until 2016. He was recognized by Mayo Clinic with one of its Distinguished Education Awards in 2017. Outside of Mayo Clinic, he served 12 years as a Director of the ABA and was its President in 2009. He was a member of the ACGME’s Residency Review Committee for Anesthesiology during a 6-year period and was its Chair from 2006 through 2008. He was also Chair of the ASA’s Section on Education and Research from 2004 through 2008.
- Steven H. Rose, M.D. (Dean, Mayo Clinic School of Graduate Medical Education). Steve has played a major role in our department educational programs throughout his career and is our department’s most highly awarded educator. From 1994 through 2007, Steve was our Rochester department’s residency program director. He also served as our department Vice-Chair for Education from 1994 through 2009. In 2003, he became Associate Dean of the Mayo Clinic School of Graduate Medical Education (MCSGME). He remained in that role through 2009. He also became the Vice-Dean of MCSGME in 2007, working closely with Dr. Mark Warner who was Dean. Steve carried the title of Designated Institutional Official by ACGME from 2007 through 2022, making him the primary contact for the ACGME in one of the country’s largest and finest graduate medical education schools. Steve succeeded Mark as Dean of MCSGME in 2011 and remained in that role through 2021. Like Mark, Steve was recognized by Mayo Clinic with one of its Distinguished Education Awards in 2022. He also has received the ASA’s Excellence in Education Award (2022), the ACGME’s Parker J. Palmer “Courage to Lead” Award (2016), and the Mayo Fellows Association’s Humanitarian Award (2021). He was inducted into the FAER Academy of Research Mentors (Education) in 2012 and the Association of American Medical Colleges Arnold Gold Humanitarian Honor Society in 2016.
- Timothy R. Long, M.D. (Senior Associate Dean for Surgery and Surgical Specialties, Mayo Clinic School of Graduate Medical Education). Tim has followed in the footsteps of Dr. Steve Rose, rising sequentially from our Rochester department’s residency leader to a senior authority in the Mayo Clinic School of Graduate Medical Education (MCSGME) and to a leader in anesthesiology education nationally. Tim became our Rochester program director in 2007 and remained in that role through 2023. He has been our Rochester department’s Vice-Chair for Education since 2009. He was appointed as an Associate Dean of MCSGME in 2019 and rose to Senior Associate Dean in that school in 2022. Outside of Mayo Clinic, Tim has been an oral examiner of the ABA since 2015. He is an editor of the Journal of Education in Perioperative Medicine. From 2021 through 2023, Tim served as the President of the Association of Anesthesiology Core Program Directors. He also is the representative of the Organization of Program Directors Association to the influential Council of Medical Specialties Society. Tim was recognized for his contributions to education by the Mayo Fellows Association with its Teacher of the Year Award and, in 2023, he received the ACGME’s Parker J. Palmer “Courage to Lead” Award.
- David O. Warner, M.D. (Associate Dean for Faculty Affairs, Mayo Clinic Alix School of Medicine). Although primarily recognized nationally for his pulmonary, smoking, and anesthesia epidemiology research expertise and leadership, David has also played a significant role in education. Throughout his career, he has received numerous Mayo Clinic Alix School of Medicine (MCASOM) Excellence in Teaching Recognition awards. In 2009, in recognition of his outstanding research mentorship of many early career clinician investigators from around the world, David was inducted into the FAER Academy of Research Mentors. He became the inaugural Director of the Mayo Clinic’s Office of Applied Scholarship and Education Science in 2014. Outside of Mayo Clinic, David served as a Director of the ABA from 2010 through 2022 and was its President in 2022. He was appointed as Associate Dean for Faculty Affairs of MCASOM in 2017 and served in that role through 2022.
- Renee E. Caswell, M.D. (Associate Dean for Surgery and Surgical Specialties, Mayo Clinic School of Graduate Medical Education). Renee was the longest serving Chair of the Education Committee in our Mayo Clinic Arizona Department of Anesthesiology, with her term lasting from 1997 through 2017. From 1997 through 2005, she was the coordinator for residency training at the Scottsdale and Phoenix campuses. In 2005, she became the Associate Program Director for the Arizona department’s residency program and wrote the accreditation application for it. In 2009, she advanced to the Program Director role and served in that capacity until 2017. Easly in her career, she also was the Director of the department’s Continuing Medical Education program. She was appointed Associate Dean for Surgery and Surgical Specialties within the Mayo Clinic School of Graduate Medical Education (MCSGME) in 2003 and remained in that role through 2008. In addition, Renee chaired the Mayo Clinic Arizona Simulation Subcommittee from 2005 through 2007. She was recognized by Mayo Clinic with its Distinguished Educator Award in 2015.
- Pamela A. Mergens, M.D. (Associate Dean for Admissions, Mayo Clinic Alix School of Medicine): Pam has been involved in medical student and resident education for her career at Mayo Clinic. From 2005 through 2012, she led Grand Rounds in our Mayo Clinic Arizona department. She was the chair of our Arizona residency program’s Clinical Competency Committee from 2007 through 2014. In 2016, she was appointed as Associate Dean for Admissions in the new Arizona campus of the Mayo Clinic Alix School of Medicine. She continued in that role until 2023.
- Susan M. Moeschler, M.D. (Assistant Dean for Faculty Development, Mayo Clinic School of Graduate Medical Education). Susie has made many contributions to education at Mayo Clinic and outside of the institution. In 2015, she was one of the inaugural recipients of an Education Science Career Development Award from Mayo Clinic’s Office of Applied Scholarship and Education Science. In 2016, she received the Course Director of the Year Award from the Mayo Clinic School of Continuing Professional Development for the Mayo Clinic Opioid Conference. Since 2015 she has been the Program Director of our Rochester Pain Medicine Fellowship. She earned recognition in 2023 as the Mayo Clinic College of Medicine and Science’s Outstanding Emerging Educator. She was also appointed as Assistant Dean for Faculty Development by the Mayo Clinic School of Graduate Medical Education in 2023. Outside of the institution, Susie is the President-Elect of the Association of Pain Program Directors. She was recognized in 2019 by the American Society of Pain and Neuroscience with its Excellence in Education Award.
- Lopa M. Misra, D.O. (Associate Dean for Admissions, Mayo Clinic Alix School of Medicine). Lopa has served as a leader of medical student and resident education on our Arizona for nearly 20 years. She led our anesthesiology medical student clerkships and rotations in Arizona from 2008 through 2018. She also has been a member of our Arizona department’s Simulation Committee since 2011 and our Arizona residency program’s Clinical Competency Committee since 2010. She joined the Arizona-based Mayo Clinic Alix School of Medicine’s Admissions Committee in 2021 and was appointed Associate Dean for Admissions in 2023, succeeding Dr. Pam Mergens.
Mystery Photos
Last week’s Mystery Photos were Lee A. Nauss, M.D. and David P. Martin, M.D., Ph.D.
Lee A. Nauss, M.D. was born in Estherville, Iowa on March 28, 1932. After graduating high school in 1950, he spent two years in the U.S. Army Medical Corps as a corpsman. Upon discharge from the Army in 1952 and working for two years as a trucker in Estherville, Lee met a beautiful young candy striper in the Estherville Hospital while visiting his grandfather. Maria and her family had immigrated to Estherville from the Ukraine during a period of political upheaval. Upon meeting, Lee learned that Maria was interested in nursing school. He drove her to several potential schools. At Allen Memorial Hospital in Waterloo, Iowa, the program director enticed both to join the nursing school. They both graduated in 1956 and moved to Rochester, with Maria working as a nurse and Lee as a student in our Nurse Anesthesia program.
Lee completed our nurse anesthesia program in 1958. He and Maria moved to Juneau, Alaska where he organized a department of anesthesia at St. Anne Hospital. He worked there for 7 years. At the urging of several Juneau physicians, Lee and Maria moved In 1965 to Riverside, California where he could take undergraduate pre-medicine classes at La Sierra University in preparation for medical school at Loma Linda University. However, that opportunity at Loma Linda feel through as he was now more than 30 years old, an age discrimination that seems exception in today’s world. Therefore, in 1966 they moved to Little Rock, Arkansas where the University of Arkansas, Little Rock School of Medicine agreed that he would qualify for entry once he was established for a year as a resident of the state. To become a resident of the state, Lee took courses at the University of Little Rock on Monday, Wednesday, and Friday and worked as a nurse at Children’s Hospital in Little Rock on Tuesday, Thursday, and Saturday. It all paid off as he matriculated to the University of Arkansas, Little Rock Medical School in 1967.
Lee earned his M.D. in 1971. His post-graduate training included an internship in Little Rock and a year of anesthesia residency training at Virginia Mason Hospital in Seattle. He and Maria had planned on his completing his anesthesia training at Virginal Mason and then moving to Alaska. However, there was an epic battle between the state of Alaska and its state board of medical practice at the time and the board essentially dissolved and would not consider applications for new medical licenses. Stuck in a Catch-22 situation, Lee decided to finish his residency training at Mayo Clinic in Rochester.
Lee and Maria arrived in Rochester with their U-Haul trailer in late June 1973 on a Saturday morning. He contacted the anesthesia office and was told that he was on call at St. Marys Hospital that evening. Welcome to Rochester, Lee! His first night on call and in town, he was covering obstetrics at SMH and decided to use an epidural anesthetic for a laboring patient. It wasn’t the first epidural used in obstetrics at Mayo Clinic but it triggered quite a discussion as the obstetricians had previously determined that none of their patients would receive epidurals. To Lee, it was natural as he was trained to use epidural analgesia at Virginia Mason. Ultimately, both Drs. Dick Theye (chair of Anesthesiology) and George Malkassian (chair of OB/GYN) agreed that epidurals were acceptable as long as Lee taught all of the residents to place them.
Upon graduation from residency training, Lee joined the department staff and organized a program for the treatment of chronic pain at Methodist Hospital. He was joined in the effort by the return of former Mayo Clinic anesthesia resident, Dr. Joe Wang (class of 1968). Together they built what is now the Pain Clinic. They were joined in that effort in 1982 with the return of Dr. Peter Wilson from Australia. Peter was a post-doctoral fellow (Fulbright Scholar) at Mayo Clinic in 1976, working on understanding the mechanism of action of opioids and non-opioid neurochemicals (e.g., baclofen) when injected intrathecally.
Lee and Joe were intrigued by the potential of using intrathecal or epidural opioids for the treatment of acute and chronic pain. Mayo Clinic had several key scientists involved in the study of spinal opioids, specifically Drs. Frederic Kerr and Tony Yaksh. At Tony’s urging, in 1977 Lee used epidural morphine in a lung cancer patient who got complete pain relief. It was the first use of intrathecal opioids in a human. After organizing a small study of 7 additional patients who had intractable cancer pain and recruiting Dr. Juergen Thomas of the Department of Neurology to assist, Joe, Lee, and Juergen published the world’s first report of the use of intrathecal morphine in humans. Our own Peter Southorn, Lee’s residency classmate, wrote about this remarkable advance in medicine in a department newsletter.
Lee received multiple Teacher of the Year Awards from the Mayo Clinic Fellows Association in recognition of his exemplary education of anesthesiology residents. He was a gifted clinician, amazing storyteller, and extraordinarily humble and gracious colleague. Lee retired from the department in 1997.
Maria passed away on February 24, 2006. Lee subsequently met and married his current wife, Geri, on January 1, 2009. In a bit of a fairy tale ending, Geri and Lee were introduced together by a couple with whom Lee and Maria had shared a cabin in Alaska, just south of Denali. Lee and Geri currently reside in Rochester.
David P. Martin, M.D., Ph.D. was born in Cincinnati, Ohio on April 28, 1964. The family moved to Kokomo, Indiana when he was 6 years of age. He completed undergraduate studies at Indiana University in 1985 and earned his M.D. and a Ph.D. in Neuroscience at Washington University in St. Louis in 1992. After an internship in St. Louis, he moved to Rochester as a resident in anesthesiology, graduating in 1996. Colleagues in his 1996 class who have served as members of our department include Roxann Pike, Todd Kor, and Brian McGlinch. Following residency, he did a fellowship in pain medicine combined with postdoctoral research in the Neurology laboratory of Dr. Phillip Low. Investigations related to that research later contributed to the creation of a high-frequency spinal cord stimulation device that is still used clinically today.
Dave chaired the Division of Pain Medicine from 1999-2001. During an era where it became increasingly challenging to excel in both the operating rooms and Pain Clinic, he chose to switch entirely to the operating rooms, specializing in orthopedic anesthesia and liver transplant. He served as departmental Vice Chair for Safety and Quality from 2010 to 2023 and implemented Safety & Quality Grand Rounds, our Near Miss program, and the SAFE-CAER event review. His roles also included serving as the medical director for the moderate sedation practice for all Mayo Clinic enterprise procedural sites.
Outside of Mayo Clinic, Dave has been an extraordinarily active member of multiple organizations. Within the Minnesota Society of Anesthesiologists (MSA), he has held every office in that society, concluding his time as an officer when he was elected President in 2015. He was awarded the MSA Distinguished Service Award in 2022 for his dedicated effort to sustain and grow the society. He has been very engaged in both committee and editorial board work in the American Society of Anesthesiologists (ASA). Highlights include becoming the founding editor-in-chief of Patient Safety CME Editorial Board, Section Chair for Education and Research, and Director. He was elected ASA Vice President for Scientific Affairs in 2022, an office he holds today. Recently, Dave joined the board of directors of the Foundation for Anesthesia Education and Research (FAER). He also is the current President of the Academy of Anesthesiology. The Academy was formerly the Anesthesia Travel Club first started by Dr. John Lundy in 1929.
Dave’s steady hand, tenacity, and vision for the specialty have made him invaluable to our department, the Mayo Clinic, and the ASA and other specialty organizations. Dave and his wife, Laura, have 2 adult children and 3 grandchildren.
Mystery Photo Contest Winner
Last week’s contest winner was Bob Chantigian.
Here are this week’s Mystery Photos. Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.
Please email your response at warner.mark@mayo.edu within 3 days of this update. I will also need your name and contact information. All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card. Only one winner per individual over the 80 weeks of Mystery Photos. If you win a weekly drawing, however, please keep submitting your responses. An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.
Thank you for your readership and welcome to Update #44.
Happy July 4th to everyone, with special emphasis on those who have served our military over the years.
During this past month we have highlighted our department’s remarkable education programs. I had intended to focus this issue on our colleagues who have played major roles in education within the institution or outside of the organization.
However, since this Update landed on July 4th, I thought it would be fitting to focus on our colleagues who have served nobly in our U.S. military forces.
The Mayo Clinic and the Military
In a very real sense, Mayo Clinic was located in Rochester, Minnesota because of the military.
The Civil War and Dakota War of 1862: How They Impacted Mayo Clinic’s Location in Rochester.
As background, the Civil War was sparked on April 12, 1861, with the Battle of Fort Sumter. Minnesota’s governor, Alexander Ramsay, fortuitously was in Washington, D.C. on that day. On April 14th, he volunteered to supply the newly announced Union Army with 1,000 Minnesota volunteers. With the establishment of the 1st Minnesota Regiment, Minnesota became the first state to respond to President Lincoln’s request to raise a Union Army of 75,000 troops. During the war, the “1st Minnesota” became one of the most distinguished regiments in the Union Army. The regiment fought bravely at the 1st Battle of Bull Run, Antietam, Fredericksburg, and in 1863 in its final major battle, Gettysburg. It was at this final battle that the regiment suffered immense losses but held the wavering line at Cemetery Ridge against 1,200 charging Confederate soldiers and saved the Union Army from defeat.
While many able-bodied men from Minnesota were pulled eastward in the 1st Minnesota Regiment, changes were occurring back in the state that triggered the Dakota War on 1862 (Dakota War of 1862 - Wikipedia). In that year, Dr. William Worrell Mayo was living in Le Sueur, Minnesota along the Minnesota River. On August 19th, word of the start of what was to become the Dakota War reached Le Sueur. The 900-person town of New Ulm was under siege by members of the Dakota nation, specifically the Santee Sioux. A volunteer militia from Le Sueur and nearby St. Peter headed to New Ulm, arriving late on August 20th after the first day of the battle. Dr. Mayo and two other physicians were part of that volunteer group. They quickly opened two hospitals in the town and cared for the 5 settlers who were wounded in the opening skirmish of the preceding day. Over the next two days, the town swelled with settlers from the surrounding region. There were approximately 2,500 settlers and military/militia members in the town on August 23rd. The battle resumed on that day. The military reported 16 of its own killed and 24 wounded but there were many settlers also killed and wounded. Contemporary estimates for the killed or wounded, including members of the Dakota nation, range from 300 to 800. Dr. Mayo and his two physician colleagues served admirably. Surviving military participants escorted the remaining 2,000 settlers as they retreated east 20 miles for the safety of Mankato, evacuating New Ulm on August 25th.
After the New Ulm battle, it was determined that the safety of the recruitment office in Mankato for the 1st Minnesota Volunteer Army was in jeopardy and it was moved east 90 miles to Rochester. Dr. Mayo was asked to serve as the examining physician of the 1st Minnesota’s draft board. Dr. Mayo agreed and moved his family, including 2-year-old son Will, to Rochester. He started his position on April 24, 1863. Charlie was born in Rochester in 1865. Welcome to Rochester, Mayo family!
The World War I Impact on the Mayo Brothers and Mayo Clinic
The Mayo Brothers played a major role in World War I by developing field hospitals for the American Expeditionary Forces, vetting specialists to serve in the Army, and improving the quality of care provided by members of the U.S. Army Medical Reserve Corps. Of these tasks, perhaps the most important was that they worked for the Surgeon General of the U.S. Army as consultants to ensure that the volunteer surgical specialists were qualified. An excellent, comprehensive summary of their efforts and those of other Mayo Clinic personnel during WWI was written in 1994 by Dr. Oliver H. Beahrs, one of Mayo Clinic’s most famous surgeons.
The brothers took turns working in Washington, D.C. during the war, with one always in Washington and the other working back in Rochester. It was a very busy time for them, and they expended not only their time but a portion of their fortune to support their work, extensive travel back-and-forth, and expenses of Mayo physicians and nurses who cared for wounded troops in France. The brothers were recognized for their expertise and contributions, with each being promoted to Brigadier General in 1921.
The World War II Impact on the Mayo Clinic
Mayo Clinic responded to the call for medical assistance with a large number of its staff serving in the military during WW II. The clinic also provided “short course” training for many physicians, nurses, nurse anesthetists, and physical therapists in Rochester. Anesthesiology was one of the important specialties chosen for the short course training. The most notable of the Mayo Clinic efforts in WW II include:
- The Mayo Clinic field hospital in New Guinea.
- The Mayo Aero Medical Research Unit.
- The short-course training in several key specialties, including anesthesiology.
Mayo librarian Clark Nelson provided a short summary of Mayo Clinic’s WWII contributions.
For anesthesiology specifically, Lt. Colonel Ed Tuohy introduced continuous epidural/intrathecal administration of local anesthetics during the war. In addition, the previous advocacy for the use of pentothal and storage of cold blood by Dr. John Lundy and colleagues proved crucial to the survival of our wounded military members.
The Mayo Clinic, Our Military, and the Department of Anesthesiology
Many of our department members have served in the military. I would highly recommend that you go to Mayo Clinic | Anesthesiology | Mayo Clinic Military Anesthesia Statistics and view the contributions of many of our colleagues. The military webpage in our departmental historical website is not complete. In the coming year, we hope to populate it more completely. We will form a Mayo Anesthesiology Military History Work Group under the leadership of Dr. Steve Rettke and seek volunteers who can help grow the webpage. We have many past and current department members who are not currently represented on the webpage, especially those from our Florida and Arizona departments.
That said, we currently have many outstanding colleagues represented on the site. I hope that you take a few moments to open the webpage and learn more about their contributions.
Thank you from the Department: Celebrating the Centennial
Challenge coins are an iconic symbol in the military. You may read more about this history and symbolism at Challenge coin - Wikipedia. Historically, these coins are given as a token of appreciation, recognition, and pride for service members who have gone above and beyond their duty.
In this spirit, all 2,100+ staff members across the institution will be receiving Department of Anesthesiology and Perioperative Medicine centennial coins this coming week or two. These coins are designed to commemorate our first 100 years and recognize the remarkable contributes of founders such as Alice Magaw and Dr. John Lundy.
Thank you for your contributions that lead us to being one of the world’s leading anesthesiology departments.
Mystery Photos
Last week’s Mystery Photos were Charles F. McCuskey, M.D. and Daniel R. Brown, M.D.
Charles F. McCuskey, M.D. was born November 26, 1893 in Marshall County, West Virginia alongside the Ohio River 30 miles south of Wheeling. After college at Fairmont State College and West Virginia University, he attended medical school at the University of Tennessee, graduating in 1918. He subsequently served in the U.S. Navy Medical Corps in Charleston, South Carolina. After four years in general private practice in Tennessee, West Virginia, and Washington, D.C., he moved to Rochester and started his residency training on January 1, 1925. He was the first trainee of Dr. John Lundy to complete the residency and joined the Mayo staff on July 1, 1926.
Dr. McCuskey remained on the Mayo Clinic staff until 1933. At that time he moved to Los Angeles and joined the staff of the College of Medical Evangelists (now Loma Linda University’s School of Medicine). By 1938, he had a growing reputation in anesthesiology and was recruited to chair the newly formed department of anesthesiology at the University of Southern California (USC). He served as chair of that department from 1939 through 1961. In his first year at USC, he also served as the first president of the Pacific Coast Association of Anesthetists (to become the California Society of Anesthesiologists). His early years at USC were interrupted by WWII. From December 1941 through February 1946, he was an active leader in the U.S. Army’s Medical Corps. He ended his distinguished military career as consultant to the Pacific Ocean Area and the Central Pacific Area. He received a Bronze Star and retired as a lieutenant colonel, one of the few anesthesiologists to serve in both world wars.
He was one of just a handful of anesthesiologists in the U.S. to serve as president of his state society (1939), the American Society of Anesthesiologists (1948), the American Board of Anesthesiology (1948) and the Academy of Anesthesiology (1957). He also chaired the Section on Anesthesia of the American Medical Association in 1949. He received the ASA’s Distinguished Service Award in 1953 for his organization of state component societies and hosting the first ASA House of Delegates meeting while he was ASA president.
An excellent summary of his life was published in Anesthesia & Analgesia in 1968. Dr. McCuskey and his spouse, Gertrude, had two children. He died on January 24, 1980.
Daniel R. Brown, M.D., Ph.D. was born on May 2, 1964 in St. Paul, Minnesota. He grew up on a sheep farm in Woodbury, Minnesota. After graduating from Hamline University in St. Paul, he obtained his Ph.D. and M.D. degrees from the Medical College of Wisconsin. His Ph.D. in Respiratory Physiology formed the basis from which he learned anesthesia and critical care at Johns Hopkins University.
In 1998, wanting to get back to the Midwest, Dr. Brown joined the Mayo Clinic in Rochester. A strong proponent of critical care medicine, he played a lead role in expanding our department’s footprint in that crucial subspecialty across the institution. It was not easy. Dan led a dedicated group of 10 anesthesiologist intensivists in the early 2000s when he first became chair of the department’s Division of Intensive Care and Respiratory Care in 2001. These individuals spent the majority of their time and an immense number of hours providing care to critically ill patients in an increasing number of ICU units across the Rochester campus. During that period, Dan successfully recruited like-minded, dedicated anesthesiologist intensivists and grew the number of division members during his time as division chair (2001-2021) from 10 to more than 50 intensivists. The critical care anesthesiology group in Rochester is now the largest institutional critical care group in the country, with our department caring for the great majority of the most acutely ill patients in Rochester. Dan and Dr. Francis (Fran) X. Whalen, Jr. began the rapid response team (RRT) in Rochester, with both personally covering this practice until it became a stand-alone service under critical care. It is impossible to overstate the remarkable leadership skills and abilities that Dan brought to advancing Mayo Clinic’s critical care services during the first two decades of this century.
Dan’s efforts were recognized by the institution when he was selected to chair the Independent Multidisciplinary Group in Critical Care in Rochester. This group coordinates all Rochester ICU care. In that role, he also led the institution’s Critical Care Specialty Council. Dan has gone on to lead the institution’s Midwest Hospital Practice Subcommittee, charged with coordination and oversight of the Mayo hospitals in the upper Midwest of the U.S.
Dan is an outstanding clinician and teacher. He has received multiple Teacher of the Year and Clinician of the Year awards in the department and critical care medicine. An excellent educator, Dan is also a long-serving oral examiner of the American Board of Anesthesiology. The institution and a grateful patient’s family honored him by designating a named professorship on his behalf. The Walter and Lenore Annenberg Professor of Anesthesiology in Honor of Daniel R. Brown, M.D. is held by Dr. Mark A. Warner. It is the first named professorship honoring a Mayo Clinic anesthesiologist.
His outstanding professional and leadership efforts have been recognized nationally. Dan served 11 years as a member of the FDA’s Anesthesia and Respiratory Devices Panel. He was on the Board of the American Society of Critical Care Anesthesiologists, a society that evolved into today’s Society of Critical Care Anesthesiologists (SOCCA). He has been a representative to the AMA’s Relative Value Scale Update Committee (RUC), a group that advises Medicare on how to value a physician’s work. He was president of SOCCA from 2018 through 2020, leading the organization through the early days of the COVID pandemic. In 2023, SOCCA recognized Dan with its Lifetime Achievement Award. In 2016, the Hamline College of Liberal Arts named Dan its Outstanding Alumnus.
Dan and his spouse, Heidi, live on a farm in Chatfield where he can be found gardening, tending bees, and pursuing outdoor activities. They have three children.
Mystery Photo Contest Winner
Last week’s contest winner was Tanner Hill.
Here are this week’s Mystery Photos. Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.
Please email your response at warner.mark@mayo.edu within 3 days of this update. I will also need your name and contact information. All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card. Only one winner per individual over the 80 weeks of Mystery Photos. If you win a weekly drawing, however, please keep submitting your responses. An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.
The Mayo Clinic Department of Anesthesiology: Educators Internally, Leaders in Education Everywhere
The Department of Anesthesiology has played a major role within the institution in the Education Shield as well as in extramural education societies, on anesthesia-related boards, and in education regulatory organizations. In this early summer series of four Updates, I will describe the history and development of our department’s education programs and the contributions of our department members to institutional and national leadership in anesthesia and respiratory care education. Specifically,
- In the initial week we highlighted the Rochester education programs in nurse anesthesia and respiratory care.
- This past week we focused on the LaCrosse, Wisconsin nurse anesthesia program and the anesthesiology residency and fellowship programs in Florida and Arizona.
- This third week we will describe the Rochester anesthesiology residency and fellowship programs.
- In the final week we will showcase department members who have played major education leadership roles within the institution and nationally.
The Department of Anesthesiology and Educational Programs: The Residency and Fellowship Programs in Rochester
Mayo Clinic was one of the first U.S. medical centers to have a residency program in anesthesiology. Although “informal” anesthesia training of young physicians occurred at Mayo Clinic before 1924 (e.g., Drs. Gaston Labat and Bill Meeker trained surgical residents in the use of regional anesthesia in the early 1920s), it wasn’t until the arrival of Dr. John Lundy in 1924 that an effort was started to introduce a formal education program in anesthesiology for physicians. Dr. Charles F. McCuskey began his training in 1925 and was the first to complete his anesthesia training in Dr. Lundy’s new program.
An interesting scenario occurred in 1926 when Dr. Ralph Waters moved from his private practice of primarily anesthesia in Sioux City, Iowa to Madison, Wisconsin to establish in 1927 at the University of Wisconsin what was to become known as the country’s first official residency program in anesthesia. As part of Dr. Waters’ 1926 move, he stopped in Rochester for 3 months to work as an assistant with Dr. Lundy and learn regional anesthesia. While in Rochester, he was enrolled in the nascent Mayo Clinic School of Graduate Medical Education and was graded by Dr. Lundy for his 3 months of efforts. His grade card is still retained by the school.
By the late 1920s, Dr. Lundy developed a 3-year training curriculum in anesthesia that included 15 months of experience in clinical anesthesia, 3 months in anatomy, and 18 months in research. Although never fully implemented and the idea of 3 years of training in anesthesia did not become the norm in the specialty until 1985, many of the program’s early trainees did, indeed, spend 3 years in training. Eleven of the 24 residents from 1925 through 1941 earned Master of Science degrees from the University of Minnesota.
Program directors for the more than 850 anesthesiologists who have completed their residency training in Rochester since 1925 include:
- 1924-1953: John S. Lundy, M.D.
- 1953-1959: Robert T. Patrick, M.D.
- 1959-1966: John T. (Tom) Martin, M.D.
- 1966-1976: Alan D. Sessler, M.D.
- 1976-1991: Ronald J. Faust, M.D.
- 1991-1994: Leslie N. Milde, M.D.
- 1994-2007: Steven, H. Rose, M.D.
- 2007-2023: Timothy R. Long, M.D.
- 2023-present: Bridget P. Pulos, M.D.
Subspecialty Fellowships.
As the specialty expanded dramatically in the 1970s and 1980s and anesthesiologists began to subspecialize, the need for advanced training in the subspecialties arose. Fellowships (post-residency education programs) gained popularity. Many of these fellowships were clinically-oriented, but others were primarily focused on research. In general, these fellowships were uniquely designed to match the needs of the individual fellows. There were no strong guidelines or regulations that determined the content of these self-determined fellowships.
Prior to 1981 and the creation of the Accreditation Council for Graduate Medical Education (ACGME), there was no regulatory oversight of graduate medical fellowships. As these subspecialty fellowships and the subspecialty fields themselves matured, subspecialty societies began to recommend the curriculums and experiences that fellows should expect in their training. Standardization of fellowships began to grow. With standardized subspecialty fellowships ensuring full spectrums of subspecialty training, the American Board of Anesthesiology felt more confident in the consistency of the training programs and began to certify anesthesiologists in the subspecialties. The first of these was Critical Care Medicine in 1986. Pain Medicine certification started in 1993, followed by Pediatric Anesthesiology in 2013 and Adult Cardiothoracic Anesthesiology in 2023.
At this time, it is not clear when our department began to have fellowships in the various subspecialties. It is clear that the department had unaccredited subspecialty fellowships prior to 1981. It also is clear that many unaccredited subspecialty fellowships continued after ACGME accreditation became available. This discrepancy began to change in 2005 when Drs. Mark Warner and Steve Rose, in their roles as the leaders of the Mayo Clinic School of Graduate Medical Education, began to require that all graduate medical education fellowships that were accreditable by the ACGME must become accredited.
Over the years, there have been nine subspecialties with fellowships in the Rochester department. Of these, all but a fellowship in Transplant Anesthesiology continues. After an extensive search of the Mayo Clinic School of Graduate Medical Education, paperwork available within the department, and recollections of senior staff members and individuals who were fellows, I believe that the “official” start dates and the initial program directors for each of the accredited fellowships and the Transplant fellowship include:
- 1989: Critical Care Medicine in Anesthesiology; Dr. David J. Plevak
- 1993: Pain Medicine; Dr. Joseph M. Messick, Jr.
- 1994: Transplant Anesthesiology; Dr. Steven H. Rose
- 2004: Pediatric Anesthesiology; Dr. Randall Flick
- 2007: Adult Cardiothoracic Anesthesiology; Dr. David J. Cook
- 2013: Clinical Informatics; Dr. Brian W. Pickering
- 2015: Neuroanesthesiology; Dr. Jeffrey J. Pasternak
- 2017: Regional Anesthesiology; Dr. Adam D. Niesen
- 2018: Obstetric Anesthesiology; Dr. Katherine W. Arendt
In the coming year, we will collect complete data on who led our fellowships and who trained in them . . . in all of our Mayo Clinic sites. The collection of this information will take extensive reviews of department minutes, Mayo Clinic records, and visits with individuals who were involved in the subspecialty fellowship programs. Once collected, the information will be displayed in our department history repository, Anesthesiology Department | Mayo Clinic | History and Heritage. The wonder of the site is that corrections and modifications may be easily made. Please contact me if you have any errors that you identify.
Summary of the Rochester Residency and Fellowship Programs
At the end of June this year, the Rochester residency and fellowship programs will have graduated nearly 1,100 anesthesiologists. Eight-five of these graduates have become academic department chairs in the U.S. and outside the country, creating a strong link between Mayo Clinic and the development of the specialty around the world. In addition, the Rochester residency and fellowship programs have produced former trainees who have play major specialty leadership roles during their careers. These roles have included:
- Nine presidents of the American Society of Anesthesiologists
- Eleven presidents of the American Board of Anesthesiology
- Seven chairs of the Board of Trustees of the International Anesthesia Research Society
- Presidents of the three primary ASA foundations (Foundation for Anesthesia Education and Research, Anesthesia Patient Safety Foundation, and Wood Library Museum of Anesthesiology)
- Presidents of six of the eight primary subspecialty societies in the U.S.
- One president of the American Association of Nurse Anesthetists
- One executive director of the American Association of Nurse Anesthetists
Mystery Photos
Last week’s Mystery Photos were Robert T. Patrick, M.D. and Mary Ellen Warner, M.D.
Robert (Bob) T. Patrick, M.D. is from Des Moines, Iowa and was born on August 29, 1920. After graduating from Denison University in Granville, Ohio, he attended medical school at the University of Louisville, Kentucky, earning his M.D. in 1944. After a two year period in the U.S. Navy, he entered private practice in Norwalk, Ohio. By 1949, he decided to become a resident in anesthesiology. He came to Mayo Clinic and completed his training, joining the Mayo staff in 1952. While a fresh new consultant in Rochester, he was recalled to the Navy and spent much of 1953 and 1954 back in the service. He returned to Mayo Clinic in late 1954 and stayed until 1961 before leaving to a private practice in Casper, Wyoming. While in Wyoming, he was a member of the state’s medical board. He also became one of the few private practitioners at that time to be asked to serve as a director of the American Board of Anesthesiologists. He was a director of the ABA from 1967 through 1975, including a year as president of the ABA in 1971. More about his career may be found in a 1972 article in the Denison University Alumni Newsletter in which he was recognized by citation.
While at Mayo Clinic for 9 years, he had many remarkable achievements:
- Development of a Cardiopulmonary Bypass Machine. Team member of the Mayo cardiac innovators who tested and developed extracorporeal circulation, the “Mayo-Gibbons heart-lung machine.” Other team members included giants in medicine and physiology such as Drs. John Kirklan (cardiac surgery), Earl Wood and Jeremy Swan (physiology), James DuShane (pediatrics); and Richard Jones (biomedical engineering). An outstanding summary of the development of cardiopulmonary bypass and the first 50 years of cardiac surgery at Mayo Clinic was published in 2005 in Mayo Clinic Proceedings.
- Initial Clinical Trials of Cardiopulmonary Bypass. The primary Mayo Clinic anesthesiologist during the early clinical trials of cardiopulmonary bypass. Dr. Patrick provided the anesthetic care for the first 40 patients to undergo intracardiac surgery from March 22, 1955 through January 1956. This initial trial established the protocols used today for cardiopulmonary bypass and cardiac surgical volumes skyrocketed. The anesthesiologists involved in the team increased with the addition of Drs. Richard Theye, Robert Devloo, and Emerson Moffitt. An excellent story about one of the first children to undergo intracardiac surgery at Mayo Clinic (and in the world) may be found in Smithsonian Magazine at This 1950s Heart-Lung Machine Revolutionized Cardiac Surgery | Smithsonian (smithsonianmag.com).
- Building our Residency Training Program. Dr. Lundy implicitly trusted Dr. Patrick and handed over the role of residency program director to him in 1953. As noted above, he served in this role through 1959.
Dr. Patrick and his wife, Dorothy Ann, had six children. He passed away on August 30, 1999.
Mary Ellen Warner, M.D. was born in Chillicothe, Ohio on May 29, 1954. After graduating from the University of Florida in 1975, she entered the Medical College of Ohio (now the University of Toledo). While there, she met and married fellow classmate, Dr. Mark A. Warner. While at the Medical College of Ohio, they were mentored by Dr. John T. (Tom) Martin, former division chair and residency program director at Mayo Clinic and the chair of the Department of Anesthesiology at the medical college. Dr. Martin arranged for both Mary Ellen and Mark to be award medical student preceptorships from the American Society of Anesthesiologists. At Dr. Martin’s encouragement, they spent their preceptorships in Rochester. They were supervised by Drs. Duane Rorie and Alan Sessler. While there, they established great friendships with staff (e.g., Drs. Ron Faust, Jim Prentice, Bob Devloo, Paul Didier, Mike Marsh, and Matt Divertie) and residents (e.g., Drs. Ted Janossy, Mark Sperry, Charley Rich, Gary Baggenstoss, and John McMichan).
These preceptorships and their admiration for the parents of Dr. David Warner (pediatric anesthesiologists Drs. Jack and Louise Warner of Children’s Hospital in Columbus, Ohio) led them to seek residency training at Mayo Clinic upon graduation from the medical school in 1979. Mary Ellen completed her residency training in June 1983. First year classmates from that entering resident group in 1979 included her husband, Mark; Bob Chantigian; and Steve Rettke. These four colleagues continue their long-standing ties to the department with a cumulative 162 years of time as anesthesiologists in the institution.
Mary Ellen has held numerous leadership roles in the department and institution. In addition to serving as chair of the former “South” Division at Methodist Hospital, she also chaired the department’s Performance Improvement Committee for nearly two decades. In the institution, she has chaired its Conscious Sedation Task Force that implemented sedation and monitoring standards for the institution, chaired the Surgical Committee’s Procedural Practice Group, and been medical director for Rochester’s Outpatient Procedure Centers. In this latter role, she established new practice models that have been emulated around the world.
Her dedication to her patients, their safety, and the effectiveness of Mayo’s procedural practices resulted in her selection as a recipient of the Mayo Clinic Distinguished Clinician Award in Rochester in 2010. Only three anesthesiologists in Rochester have received this award. The other two are Sait Tahan (1993) and Martin Abel (2005). Two of our colleagues have received this award in Arizona, Joel Larson in 2005 and Terry Trentman in 2018. Roy Cucchiara earned the award in Florida in 2005.
Outside Mayo Clinic, Mary Ellen has been president of the Wood Library Museum of Anesthesiology, one of the world’s leading anesthesiology historical repositories. In 2023 she was the recipient of the WLM’s Distinguished Serve Award. She currently is vice-president of the Anesthesia Foundation.
Mary Ellen and her spouse, Mark, have four sons. They each continue to work clinically in the department.
Mystery Photo Contest Winner
Last week’s contest winner was Todd Witzeling.
Here are this week’s Mystery Photos. Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.
Please email your response at warner.mark@mayo.edu within 3 days of this update. I will also need your name and contact information. All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card. Only one winner per individual over the 80 weeks of Mystery Photos. If you win a weekly drawing, however, please keep submitting your responses. An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.
Photograph: Thomas J. Grau, M.D., undated
The Mayo Clinic Department of Anesthesiology: Educators Internally, Leaders in Education Everywhere
The Department of Anesthesiology has played a major role within the institution in the Education Shield as well as in extramural education societies, on anesthesia-related boards, and in education regulatory organizations. In the next four Updates, I will describe the history and development of our department’s education programs and the contributions of our department members to institutional and national leadership in anesthesia and respiratory care education. Specifically,
- Last week we highlighted the Rochester education programs in nurse anesthesia and respiratory care.
- This week we will focus on the LaCrosse, Wisconsin nurse anesthesia program and the anesthesiology residency and fellowship programs in Florida and Arizona.
- In the third week we will describe the Rochester anesthesiology residency and fellowship programs.
- In the final week we will showcase department members who have played major education leadership roles within in the institution and nationally.
The Department of Anesthesiology and Educational Programs: La Crosse Nurse Anesthesia Program and Florida and Arizona Residency and Fellowship Programs
Nurse Anesthesia in LaCrosse, Wisconsin
The Franciscan Healthcare School of Anesthesia within the Mayo Clinic Health System currently has 40 students in its three-year training program. The program is affiliated with the University of Wisconsin-LaCrosse and its Biology Program and the Viterbo University School of Nursing. Students receive much of their clinical training within the Mayo Clinic Health System, with the majority of that training in LaCrosse but also in Eau Claire and Mankato. Students began going to the Mayo Clinic Health System site in Eau Claire in 2020 and in Mankato in 2022. Students may pursue subspecialty training (e.g., pediatric) in other specialty hospitals, primarily in Wisconsin. Upon completion of their training, graduates receive Master degrees in Biology from the University of Wisconsin – LaCrosse and Doctor of Nurse Practice degrees from Viterbo University.
The School of Anesthesia was started by Franciscan Sister Yvonne Jenn in 1942 in response to a tremendous need for anesthesia providers in LaCrosse and the surrounding areas of Wisconsin, Minnesota, and Iowa. From inception through 1987, the program was hospital-based within St. Francis Hospital. When the Council on Accreditation of Nurse Anesthesia Educational Programs required Master degrees for its graduates of nurse anesthesia schools in 1987, the St. Francis program aligned with the University of Wisconsin – LaCrosse and added a Master degree in biology. In 2017, the Council of Accreditation further advanced degree requirements for educational program graduates and the school affiliated with Viterbo University and its School of Nursing to grant Doctor of Nurse Practice degrees.
To date, there have been 620 alumni of the LaCrosse School of Nurse Anesthesia.
Here is a list of the outstanding anesthesiologists and nurse anesthetists who have served as medical and education directors of the nurse anesthesia program:
Medical Directors
- 1988 – 2014 Dr. Thomas J. Grau
- 2014 – 2017 Dr. Peter J. Schams
- 2017 – 2024 Drs. Peter J. Schams, John Merfeld, and Theodore W. Van Der Horst
- 2024 - present Drs. Theodore W. Van Der Horst and Jason Beckerman
Education Directors
- 1942 – 1981 Sister Yvonne Jenn, RN
- 1981 - 1982 John Garde, CRNA
- 1982 – 2017 Barbara Jochman, CRNA
- 2017 – present Jessica J. Peterson, CRNA, PhD
Mayo Clinic Florida: Residency and Fellowships
In 1988, our Rochester resident training program began rotating residents who wished to participate to Mayo Clinic in Florida (Jacksonville) as part of their overall 3-year anesthesia training. Dr. Mark Ereth was the first Rochester resident to rotate to Jacksonville. The relatively new Accreditation Council on Graduate Medical Education (ACGME) considered Mayo Clinic to have an integrated residency program between Rochester (home site), Jacksonville, and Scottsdale (Phoenix) from that time through 1997 and residents in Rochester would periodically rotate to both Jacksonville and Scottsdale. The ACGME changed its course in 1997 and the program was no longer considered to be integrated.
During the 1993 – 2000 period, our anesthesiologists in Jacksonville established a number of fellowship programs. The programs and their initial program directors were:
- 1993: Pain Medicine; Dr. Tim J. Lamer
- 1994: Pediatric Anesthesiology (at Wolfson Children’s Hospital); Dr. Stefanie F. Schrum
- 1994: Critical Care Medicine; Dr. Gavin D. Divertie
- 2000: Obstetric Anesthesiology; Dr. Chris F. James
- 2000: Cardiothoracic Anesthesiology; Dr. Monica Mordecai
- 2008: Regional Anesthesiology; Dr. Roy A. Greengrass
At this time, the active fellowships are Pain Medicine, Pediatric Anesthesiology, and Regional Anesthesiology.
In 2000, Dr. Marie L. DeRuyter started the application process to establish an independent Mayo Clinic Florida residency in anesthesiology. She was supported by our Jacksonville department chair, Dr. Michael J. (Mike) Murray. The program was accredited in 2002 and the first class of four residents was recruited and started in July 2003. Marie was the initial program director and remained in that role through 2013. At that time, Dr. Bruce J. Leone became program director through 2015. Since 2015, Dr. Beth L. Ladlie has served as our program director.
Since the first graduating class of residents in 2006, 77 anesthesiologists have completed their residency training in Jacksonville.
Mayo Clinic Arizona: Residency and Fellowships
As with our resident rotations in Jacksonville that started in 1988, residents began to go to our Scottsdale campus and other affiliated sites in Phoenix in 1989. Approximately 14-20 residents each year between 1990 and 2007 rotated from Rochester (and a few from Jacksonville in the latter part of that period) for clinical experiences in our Mayo Clinic sites in Scottsdale and Phoenix.
In 1998, our Arizona colleagues established a fellowship program in Pain Medicine. Dr. Jesse Muir was the program’s initial director. Program directors for the fellowship have included:
- 1998 – 2002 Dr. Jesse J. Muir
- 2002 -2013 Dr. David P. Seamans
- 2014 – 2019 Dr. John A. Freeman
- 2019-2023 Dr. Christopher S. Wie
- 2023 – present Dr. Jillian A. Maloney
In 2000, Dr. Renee E. Caswell started the application process to establish an independent Mayo Clinic Florida residency in anesthesiology. She was supported by our Arizona department chair, Dr. Daniel (Dan) J. Cole. The program was accredited in 2005 and the first class of three residents was recruited and started in July 2007. Dan was the initial program director and remained in that role through 2009. At that time, Renee became program director through 2016. She was succeeded by Dr. Andrew (Andy) Gorlin who served until 2022. Since 2022, Dr. Monica W. Harbell has served as our program director.
Since the first graduating class of residents in 2010, 42 anesthesiologists have completed their residency training in Phoenix.
Mystery Photos
Last week’s Mystery Photos were Harold Michael (Mike) J. Joyner, M.D. and Gurinder (Gary) M. Vasdev, M.D.
Michael (Mike) Joyner, M.D. was born in Lafayette, Louisiana in 1958 and was raised in Tucson, Arizona. He earned both his undergraduate and medical degrees from the University of Arizona. Mike was an outstanding member of the university’s track team as an undergraduate. During that time, he became involved in human physiology research. He continued this research during medical school, graduating from the University of Arizona College of Medicine in 1987.
Mike joined our Mayo Clinic Department of Anesthesiology in Rochester as a resident in 1987. His classmates included Maria DeCastro, Paul Stensrud, Mary Weber, Doug Dubbink, David Cook, Jeff Jax, and others. Maria and many others, including me, distinctly remember our surprise when Mike asked several complex questions of our visiting professor in July of Mike’s intern year. It was clear at that moment that Mike was going to have a unique and illustrious academic career.
Mike was motivated to be at Mayo Clinic in part by the opportunity to do both clinical training and work with Dr. John Shepherd, a noted physiologist in Rochester. Dr. Shepherd was the first dean of Mayo Medical School, a president of the American Heart Association, and a giant in blood pressure regulation. Mike earned his first NIH grant in 1992 while still a resident and joined our staff in 1993.
He has had many institutional roles on Mayo’s Research Committee, has been involved in leadership teams directing major center grants, and has run a large lab that has been continuously funded by the NIH since 1992. Mike now serves as the department’s Vice Chair for Research. He currently holds a prestigious NIH Outstanding Investigator R35 award. He also is one of the world’s most widely quoted anesthesiologists in the media.
More than 30 fellows have received training in the “Joyner Lab” and many of his Ph.D. fellows now direct independent research programs at major research universities. More than 100 undergraduate and medical students have spent time in his lab, including more than ten current staff members. He is a collegial and caring mentor and facilitator to an incredibly diverse group of mentees and colleagues.
Mike’s research group has made major contributions to our understanding of:
- How blood flow to muscle is regulated
- Sex differences and blood pressure
- Hypoxia
- The physiology of human athletic performance
In March of 2020, early in the COVID-19 pandemic, the US Government asked him to lead an expanded access program for convalescent plasma to treat COVID-19. Mike repurposed his research program and, with his collaborators from around the world, showed that convalescent plasma given early in the course of disease reduced mortality. As the pandemic progressed, he showed that it was especially useful in immunocompromised patients.
Mike and his wife, Teri, have two boys along with Mike’s two daughters.
Gurinder (Gary) Vasdev, M.D. was born in Nairobi, Kenya in 1962. He attended medical school in London at the Middlesex Hospital Medical School and earned his MBBS in 1985. The school is part of the University of London, England. Gary completed his general training in anaesthesia at Addenbrokes Hospital, Cambridge, England. He subsequently was awarded the Fellowship of the Royal College of Anaesthetists in both England and Ireland. It was at his graduation ceremony in Dublin in 1990 that Gary first met Dr. Alan Sessler who was bestowed an honorary fellowship at the same time. It truly is a small world!
With Alan’s encouragement, Gary moved to Rochester in 1991 as a fellow in obstetric anesthesiology. He completed that fellowship as well as a critical care fellowship. From 1993 through 1994, he served as a Mayo Clinic Special Clinical Fellow in liver transplant anesthesia.
After completing his advanced training in Rochester, Gary moved to Hartford, Connecticut and joined the University of Connecticut for a short period. He returned to Mayo Clinic in Rochester in March1995. In 1992, he received a Zuspan Award from the Society of Obstetric Anesthesia and Perinatology (SOAP). This award led to what was the beginning of his national rise in OB anesthesiology. In 2007, he became our first Mayo physician to be President of SOAP.
Gary has served our department as director of OB anesthesiology and various other committees. He currently is our department’s vice-chair for Diversity, Equity, and Inclusion. He continues to support Mayo Clinic's national exposure and will soon become President of the North American Sikh Doctors and Dentists Association (NASMDA). Gary has been instrumental in his outreach work with international anesthesiology societies as they develop CME education programs. He has been an advocate for helping his colleagues gain valuable presentation experiences internationally. Gary is a fun travel companion and has done much to bring people together both within our department and the institution.
Gary and his wife, Billie, an outstanding Rochester dentist, have 3 children. Amrit is an anesthesiology resident at Mayo Clinic in Rochester; Ranveer is a urology resident also here in Rochester; and Tanveer is a dental student at the University of Iowa.
Mystery Photo Contest Winner
Last week’s contest winner was David Seamans.
Here are this week’s Mystery Photos. Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.
Please email your response at warner.mark@mayo.edu within 3 days of this update. I will also need your name and contact information. All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card. Only one winner per individual over the 80 weeks of Mystery Photos. If you win a weekly drawing, however, please keep submitting your responses. An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.
Credits
This webpage was designed in partnership between the Department of Anesthesiology and Perioperative Medicine, the W. Bruce Fye Center for the History of Medicine, Mayo Clinic Archives in Rochester, and Mayo Clinic History & Heritage.
The information, photographs, videos, and attachments that are found on this webpage have been curated together in partnership between the Department of Anesthesiology and Perioperative Medicine, the W. Bruce Fye Center for the W. History of Medicine, Mayo Clinic Archives in Rochester, and Mayo Clinic Media Asset Management (MAM).