This Month in Anesthesia: June

Humphry Davy portrait by Thomas Phillips

This Month in Anesthesia History: June

1667 June 15: Although the exact date is disputed, a Parisian physician and astrologer, Professor Jean-Baptiste Denis (1640?-1704, sometimes spelled "Denys"), performed the first blood transfusion involving a human on either June 15 or 28, 1667. The patient was a feverous young man on whom other doctors had employed leeches 20 times; after Denis transfused him with several ounces of either dog or lamb's blood, he "rapidly recovered from his lethargy." Denis used a similar method to cure a madman, and a few more experiments by scientists in France and London were deemed successful. Denis had first experimented with animal-to-animal transfusions; he published a letter in the Journals des Scavansdescribing his work. But after one patient died, Denis was tried for murder. He was exonerated -- because it turned out the patient's wife had used poison -- but soon blood transfusions were banned throughout Europe. Over a century passed before the first attempts at human-to-human transfusions. [From the Center for the Study of Technology and Society's "Today in Tech History"; see also Moore P. Blood and Justice: The Seventeenth-Century Parisian Doctor Who Made Blood Transfusion History. Wiley, 2003]

1752 June 13: English novelist and diarist Fanny Burney was born. One of her best known works is Evelina, or The History of A Young Lady's Entrance into the World, her first novel published anonymously in 1778. When her authorship of the popular novel became known, Burney's fame was assured. In 1802 Burney and her family moved to France, where they remained for ten years. On September 30, 1811, Burney underwent a mastectomy for suspected breast cancer; she refused any drugs or alcohol. Between March and May 1812, Burney wrote a detailed letter describing her experience of surgery without anesthesia. The letter, along with the doctors' report written on October 1, 1811, can be found in Hemlow J, et al, eds., The Journals and Letters of Fanny Burney (Madame d'Arblay) (Oxford at the Clarendon Press, 1975, Vol. VI, pp. 596-616). Burney died on January 6, 1840.

1783 June 19: Friedrich Wilhelm Adam Ferdinand Serturner was born in Neuhaus, Germany. In 1805 Serturner, an assistant apothecary, discovered morphine, the active ingredient in laudanum. Serturner died in 1841.

1800 June 25: Humphry Davy completed the introduction to his classic work, Researches, Chemical and Philosophical; Chiefly Concerning Nitrous Oxide, or Dephlogisticated Nitrous Air, and its Respiration. The work is published the following month by London publisher Joseph Johnson.

1805 June 21: Charles Thomas Jackson was born in Massachusetts. In 1846 one of his students at the Harvard Medical School, dentist William Thomas Green Morton, was searching for a gas to use to obtain pain relief in his dental patients. In January, 1845, Horace Wells had unsuccessfully tried to demonstrate anesthesia at the Massachusetts General Hospital using nitrous oxide. Jackson suggested to Morton that he use sulfuric ether; Morton experimented with that agent on animals, himself, then his dental patients and finally in the successful surgical anesthetic at MGH in October, 1846. In the subsequent bitter debate over who "discovered" anesthesia, Jackson attempted to claim the achievement himself. He also claimed to have given Samuel Morse the idea for the telegraph and to have invented the explosive known as guncotton. Jackson had received his medical degree in 1829, taught at Harvard for a number of years and was also known for his achievements in geology and chemistry. By 1873, however, Jackson—who apparently suffered a stroke-- had been admitted to an insane asylum where he died in 1880. A recent biography that attempts to give Jackson his true place in anesthesia history is Charles Thomas Jackson “The Head Behind the Hands” by Richard J. Wolfe and Richard Patterson [History of Science, 2007].

1811 June 7: James Young Simpson was born in Bathgate, near Edinburgh, Scotland. In late 1847 Simpson and others discovered the anesthetic properties of chloroform.

James Young Simpson

1835 June 2: Phineas Taylor Barnum's circus began its first tour of the United States. In 1841, Barnum opened his American Museum on Broadway in New York City. The museum featured five floors of changing exhibits and attractions and gained a reputation as the most visited place in America. For a brief period between November 1844 and March 1845, the museum offered exhibitions of laughing gas inhalation. One of his advertisements in the New York Tribune declared, "This most amusing exhibition will be given at each performance, and its ludicrous effects will be manifested in the most unique speeches, songs, gestures, etc." Why Barnum ended these demonstrations after a few months is not clear; however, they were one example of many in New York and other American cities throughout most of the nineteenth century. [See, for example, Wright AJ. Gardner Quincy Colton’s 1848 visit to Mobile, Alabama. In: Barr AM, ed. Proceedings of the History of Anaesthesia Society 25:31-47, 2000] The American Museum was destroyed by fire on July 13, 1865. Barnum, born on July 5, 1810, died on April 7, 1891.

1857 June 26: John G. Orton, a Binghamton, New York, physician, first used amylene successfully in the United States. Amylene was an anesthetic agent first used clinically in England by John Snow, who quickly abandoned its use after two of his patients died.

June 16, 1858: John Snow [born in 1813] died; he is considered the first professional anaesthetist in Great Britain. In 1847 he began to administer ether at St. George's Hospital in London and published a book on ether anesthesia. In 1853 and 1857 he administered chloroform to Queen Victoria for the births of Prince Leopold and Princess Beatrice, the last two of her nine children. These successful anesthesias were instrumental in promoting obstetrical pain relief in Great Britain. After that first anesthetic, the Queen confided in her diary entry for Friday, April 22: “Dr. Snow administered that blessed chloroform and the effect was soothing, quieting and delightful beyond measure.” Snow is also an important figure in epidemiology; in 1854 he identified the source of a cholera epidemic in London as the contaminated public water pump in Broad Street. That achievement is explored in Steven Johnson’s The Ghost Map: A Story of London’s Most Terrifying Epidemic—and How it Changed Science, Cities, and the Modern World [2007]. A major biography of Snow, Cholera, Chloroform, and the Science of Medicine by Peter Vinten-Johansen et al, was published by Oxford University Press in 2003.

John Snow [1813-1858]

1863 June: Gardner Quincy Colton revived use of nitrous oxide in Hartford, Connecticut, when he administers it for dentist J.H. Smith. The gas had not been used in that city since Horace Wells last used it for his dental patients in 1845. 

1878 June 16: Crawford Long [born in 1815] died. On March 30, 1842, Crawford Long made the first use of ether as a surgical anesthetic when he removed a tumor from the neck of patient James Venable. Long did not report this use of ether until after William Morton's demonstration of ether anesthesia for surgery in Boston in October, 1846

Crawford Long, M.D. on a 1940 U.S. postage stamp

1898 June: Bayer Company introduced heroin [first synthesized from morphine in 1874] for use as a non-addictive painkiller. The drug is later found to be more addictive than morphine and removed from market.

1909 June 7: Virginia Apgar was born in Westfield, New Jersey. In the late 1940s Apgar began developing the scoring system for newborn evaluation that bears her name; she presented the system at a meeting on September 21, 1952, and published it the following year. Dr. Apgar died in 1974. In October, 1994, a twenty-cent U.S. stamp honoring Virginia Apgar was released at the annual meeting of the American Academy of Pediatrics in Dallas, Texas. Selma Calmes, M.D., has written and lectured extensively on Dr. Apgar; one of her articles is “Virginia Apgar: a woman physician's career in a developing specialty.” J Am Med Womens Assoc. 1984 Nov-Dec; 39(6):184-8. A recent biography written for young people isVirginia Apgar: Innovative Female Physician and Inventor of the Apgar Score by Melanie Ann Apel [Rosen, 2004]. Continuing popular interest in Dr. Apgar is demonstrated by the article “How's Your Baby? Recalling The Apgar Score's Namesake” by Melinda Beck was published in the May 26, 2009, issue of the Wall Street Journal.

Virginia Apgar, M.D.
1909-1974
[Source: http://www.usstampgallery.com/ ]

1910 June 13: Francis F. Foldes, MD, was born in Hungary. Dr. Foldes was an expert on muscle relaxants, local anesthetic agents, and myasthenia gravis who published almost 600 papers and co-authored four books. In 1962 he became the first Chair of the Department of Anesthesiology at Montefiore Medical Center in the Bronx, New York, and served in that post until his retirement in 1975. Dr. Foldes died on May 19, 1997.

Francis F. Foldes, MD
[1910-1997]
[Source: Hungarian Society of Anaesthesiology and Intensive Therapy http://www.anesztinfo.hu/info.aspx?&web_id=&sp=9 ]

1915 June 1: One of the great English-language poems of the twentieth-century, "The Love Song of J. Alfred Prufrock," was first published in Poetry magazine. Author T.S. Eliot had actually completed the poem several years earlier. This portrait of modern spiritual and emotional paralysis opens with the lines "Let us go then, you and I,/When the evening is spread out against the sky/Like a patient etherized upon a table..." The month after its publication, Eliot married Vivien Haigh-Wood, who later became addicted to ether; she died in 1945. Their relationship is depicted in the 1994 film Tom and Viv. Born in St. Louis in 1888, Thomas Stearns Eliot moved to London in 1915, where he died in 1965.Among his other many famous works is the long poem The Waste Land and Old Possum's Book of Practical Cats, the basis of the musical Cats.

T.S. Eliot in 1934

1926 June 3: Allen Ginsberg, one of the best-known poets of the twentieth century, was born in Newark, New Jersey. His most famous works are probably the long poems "Howl" and "Kaddish for Naomi Ginsberg," the latter written for his mother. Associated with "beat" writers such as William S. Burroughs and Jack Kerouac, Ginsberg experimented with various consciousness-altering substances over the five decades of his writing career. "Kaddish" was written under the influence of various drugs, including nitrous oxide. Ginsberg also wrote a poem called "Laughing Gas" and refers to the effects of its inhalation in other poems such as "Five A.M." Ginsberg died in New York City on April 5, 1997.

Allen Ginsberg in 1985

1981 June 11: Sufentanil was first used in a human patient in the United States at University Hospital, University of Alabama School of Medicine in Birmingham. Led by Paul Samuelson, MD, the anesthesia team also included Kathy Dole, CRNA; Dee Wright, RN; and Lindsay McFarland, RN. The patient underwent cardiopulmonary bypass. Also involved in the clinical study of sufentanil were Drs. J. G. Reves and Eva Buttner. Details can be found in the Anesthesiology UAB Newsletter 2(3): 2, summer 1981. 

Intermediate Chess Opening Video

Here is a video about opening pawn structure for the intermediate chess player.

Pawn Structure

This Month in Anesthesia: May

James Young Simpson, M.D.

This Month in Anesthesia History: May

1734 May 23: Franz Anton Mesmer was born. "Under the protection of Marie Antoinette, this Viennese physician received a grant of 30,000 francs from Louis XVI to study the magnetic influence of the stars on human beings. His Memoire sur la decouverte du magnetisme animal[1779] described cures with magnets and hypnosis." [Accardo, The Medical Almanac] Mesmer died in March, 1815. In the years before ether's anesthetic properties were demonstrated by Morton in 1846, such British surgeons as James Esaile, John Elliotson and James Braid experimented extensively with "mesmerism" as a method of surgical pain relief and published various accounts of their successes. 

Franz Anton Mesmer

1744 May 31:  Inventor Richard Lovell Edgeworth was born in Bath , England . In his long career Edgeworth served as a member of Parliament and was a Fellow of the Royal Society. His friends included French philosopher Rousseau, engineer James Watt, and Dr. Erasmus Darwin, Charles' grandfather. Edgeworth was both a prolific author and inventor. One of his inventions was the "tellograph" for which 30 tall towers were built across the 130-mile distance between Galway and Dublin. Coded messages were to be transmitted in eight minutes using large triangular pointers; however, Ireland 's weather prevented the consistent visibility needed for success of the project. Edgeworth fathered 22 children by four wives. One of his daughters, Anna, married Dr. Thomas Beddoes, who along with Humphry Davy and numerous others investigated the properties of nitrous oxide inhalation in Bristol in 1799 and 1800. Another daughter, Maria, became a novelist of some note and was a frequent observer of the nitrous oxide experiments. Edgeworth was also a financial patron of Beddoes' Pneumatic Medical Institute where those experiments were conducted. Edgeworth died in 1817; his amazing life is detailed in D. Clarke’s biography, The Ingenious Mr. Edgeworth.

Richard Lovell Edgeworth in 1812
[1744-1817]

1794 May 8: Antoine Laurent Lavoisier [b.1743], a tax collection official, was beheaded in the early days of the French Revolution. Also a chemist, Lavoisier proposed "oxygen" as the name of the substance isolated by Joseph Priestley, who had called it "dephlogisticated air." Lavoisier is known as the father of modern chemistry because of his theories of combustion, his creation of a new system of chemical nomenclature and his authorship of what is considered the first modern chemistry textbook.

Portrait of Antoine-Laurent Lavoisier and his wife by Jacques-Louis David, ca. 1788

1819, May 31: Walt Whitman, one of America's greatest poets, was born in West Hills, New York. In 1855 Whitman self-published the first version of his collection Leaves of Grass; he would continue to expand and revise the work until his death in Camden, New Jersey, on March 26, 1892. Whitman's great work is, among other things, a portrait of the United States that includes such technological advances as photography, locomotives, steam-driven ferries--and the use of ether for surgical pain relief. During the Civil War Whitman served unofficially as a nurse in several hospitals in the Washington, D.C., area. His poem "A March in the Ranks, Hard-prest" twice mentions "the smell of ether" along with "the odor of blood" and "the doctor's shouted orders." A recent biography of Whitman is Walt Whitman: The Song of Himself by Jerome Loving [University of California Press, 1999].

1829 May 29: Sir Humphry Davy died; he was born in 1778. In addition to his pioneering work with nitrous oxide in Bristol in 1799 and 1800, Davy in 1815 invented a miner's safety lamp that saved many lives in British coal mines. Davy served as Professor of Chemistry at the Royal Institution in London from 1802-1812 during which he made numerous contributions to that science. In 1820 he was elected President of Britain's Royal Society, and at his death he was one of the world's most renowned scientists. His great contribution to anesthesia history is the massive book Research, Chemical and Philosophical, Chiefly Concerning Nitrous Oxide, published in the summer of 1800. Davy was the first human to inhale that gas. 

1846 May 8: First major battle of the U.S. war with Mexico was fought at Palo Alto, Texas. Ether anesthesia was first used in a military conflict in this war, sometime in the spring of 1847 under the direction of American surgeons Edward H. Barton and John B. Porter. [See Aldrete JA, Marron GM, Wright AJ. The first administration of anesthesia in military surgery: on occasion of the Mexican-American War. Anesthesiology 61:585-588, 1984 AND Houghton IT. Some observations on early military anaesthesia.  Anaesth Intensive Care. 2006 Jun;34 Suppl 1:6-15] The Library of Congress offers an excellent list of resources on this conflict athttp://www.loc.gov/rr/program/bib/mexicanwar/http://www.loc.gov/rr/program/bib/mexicanwar/

1848 May: The first annual meeting of the American Medical Association was held in Baltimore.
This meeting produced an extensive report by the Committee on Surgery: Anaesthetic agents. Transactions of the American Medical Association 1:176-224, 1848. The report included a discussion of the physiological effects of ether and chloroform and includes lists and reports of cases at the Massachusetts General Hospital in Boston, the New York Hospital and the clinics of the University of Pennsylvania and Jefferson Medical College. Ether anesthesia had been demonstrated at MGH by William Morton just the previous October.

1859 May 22: Arthur Conan Doyle was born.  His creation Sherlock Holmes first appeared in print in A Study in Scarlet on December 1, 1887. [See Maltby JR. Sherlock Holmes and anaesthesia. Can J Anaesth 35:58-62, 1988 and Bergman NA. Sherlock Holmes and his gasogene. Pharos 58(3): 35-37, summer 1995]

1862 May 6: Henry David Thoreau, American naturalist and author, died from bronchial and respiratory problems at age 44. Thoreau moved into his famous cabin on Walden Pond on July 4, 1845. Thoreau apparently had just one experience with anesthetics a few years later. In May 1851, Thoreau received ether when his dentist removed some teeth. On May 12, Thoreau described the event in his journal. "By taking the ether the other day I was convinced how far asunder a man could be separated from his senses," Thoreau began the lengthy journal entry. "You expand like a seed in the ground. You exist in your roots, like a tree in winter. If you have an inclination to travel, take the ether: you go beyond the farthest star." In the final paragraph of his description, Thoreau seems to undercut his own enthusiasm. "It is not necessary for them to take ether, who in their sane and waking hours are ever translated by thought..." His account is one of a number from the late nineteenth and early twentieth centuries that describe mystical experiences while undergoing anesthesia. Thoreau was born in Concord, Massachusetts, on July 12, 1817.  

Daguerreotype by Maxham of Henry David Thoreau from 1856

1863 May 2: Confederate General Thomas Jonathan "Stonewall" Jackson was wounded by fire from his own troops at the battle of Chancellorsville. "Jackson's left arm was shattered 2 inches below the shoulder joint by a ball that also severed the brachial artery with a second ball passing through the same arm between the elbow and the wrist." Under enemy fire, his men lifted and dragged Jackson toward their lines. Finally placed on a litter, he fell off when one of the bearers was killed. Another bearer stumbled, dropping Jackson again. At last Jackson reached a field hospital, and he was placed under the care of Dr. Hunter Holmes McGuire, an innovative surgeon and expert on the use of chloroform. Early on the morning of Sunday, May 3, McGuire, aided by his anesthetist, a Dr. Coleman, amputated the left arm about two inches below the shoulder. Open drop chloroform was used. Jackson soon awoke, but by the following Thursday had taken a turn for the worse. Finally, on Sunday, May 10, Jackson died with his wife and child by his side. "Let us cross over the river, and rest under the shade of the trees" were his final words. [See Albin MS. The wounding, amputation and death of Thomas Jonathan "Stonewall" Jackson --some medical and historical insights. Bull Anesth History 19(4): 1, 4-7, 15-16, October 2001]

1870 May 6: Scottish physician James Young Simpson died. Simpson discovered the anesthetic properties of chloroform and introduced the agent into obstetrical practice. At the time of his death Simpson was one of the best known physicians in Europe; 80,000 people were said to have lined the streets of Edinburgh for his funeral procession.

1886 May 15: American poet Emily Dickinson died. One of her most famous poems includes: "Pain has an element of blank;/It cannot recollect/Where it began, or if there were/A day when it was not."

1899 May: Paterson described a face mask with an air dilution port.

1920 May: Arthur Guedel’s first paper “on the importance of the physiologic factors in inhalation anesthesia” [Keys, The History of Surgical Anesthesia, p. 77] appeared in the Bulletin of the National Anesthesia Research Society.

1922 May 19: Heinrich Irenaeus Quincke, German internist died in Frankfurt am Main [Quincke was born on August 26, 1842]. Among other notable medical achievements, in the early 1890s Quincke introduced lumbar puncture as a diagnostic and therapeutic tool.

Heinrich Irenaeus Quincke

1997 May 19: Francis F. Foldes, MD, died. Dr. Foldes was an expert on muscle relaxants, local anesthetic agents, and myasthenia gravis who published almost 600 papers and co-authored four books. In 1962 he became the first Chair of the Department of Anesthesiology at Montefiore Medical Center in the Bronx, New York, and served in that post until his retirement in 1975. Dr. Foldes was born June 13, 1910, in Hungary. An obituary published in the ASA Newsletter can be found in the July 1997 issue.

Francis F. Foldes, MD
[1910-1997]

[Source: Hungarian Society of Anaesthesiology and Intensive Therapyhttp://www.anesztinfo.hu/info.aspx?&web_id=&sp=9 ]

2000 May 25: The first National Anaesthesia Day was held in Great Britain under the auspices of the Royal College of Anaesthetists.

2004 May 2: John D. (Jack) Michenfelder, M.D. died at the age of 73. He completed his residency in 1961 at the Mayo Clinic and then joined the anesthesiology staff there. Dr. Michenfelder is known world-wide for his contributions to neuroanesthesia, especially for his work on cerebral blood flow and metabolism and their responses to anesthetic agents and hypothermia. He had also published important articles on venous and cerebral air embolism. He was the first President of the Society for Neurosurgical Anesthesia and helped to create the establishment of neuroanesthesia as a subspecialty of anesthesiology. Jack Michenfelder was honored by the ASA with the Award for Excellence in Research in 1990 and was the 1988 E. A. Rovenstine Memorial Lecturer. He was a member of the editorial boards of many journals dedicated to the neurosciences and from 1979-1985 was the Editor-in-Chief of Anesthesiology. As a signal honor, Dr. Michenfelder was one of only a handful of anesthesiologists ever elected to the Institute of Medicine of the National Academy of Sciences. --Maurice Albin, M.D. [UAB Anesthesiology Tuesday Report, May 18, 2004]

John D.  Michenfelder, M.D.
[Source: http://neuroanestesiologia.mx/Biogrs/JDMich.htm ]

2006 May 8: Prominent European anesthesiologist Jan F. Crul died. Between 1950 and 1995 Dr. Crul authored more than 100 scientific papers in both English and Dutch. He edited three textbooks, Legal Aspects of Anaesthesia (1989), Mass Spectrometry in Anaesthesiology [with M.D. Vickers, 1981) and Patient Monitoring (with J.P. Payne, 1970). Dr. Crul was very active in the Netherlands Society of Anaesthesiology.

Some information regarding my career in Anesthesia.

When I first started this blog, I was speaking mostly about my experiences in the field of anesthesia. Today I am going to go back to the type of information. Recently I have posted some clinically relevant information about the practice of anesthesia. These posts haven't been as popular as the older posts I have put up that talked about my personal experiences.
Today I will touch on my experiences since I have finished residency.
I finished my residency from Baystate Medical Center which is part of Tufts University and it is located in Springfield MA. It is a great program for learning. The first year of residency is called intern year or CA0 (clinical anesthesia year zero). I did required rotations in surgery, medicine, ICU, SICU, pediatrics and pain management. I would say that of all the rotations the SICU and the ICU rotations were the most enjoyable and the most brutal as far as time commitment. I would arrive by 5am and leave around 6pm if not on call. If on call I would arrive at 5am and not leave until 12pm or 3pm the next day. I know there are new time requirements for residents and interns, however, I personally believe that we as physicians are supposed to be the individuals who work their best under intense psychological and physical pressure. I for one enjoy the testing of my self. It is like a training ground for a navy seal. We are pushed to our limits and we either crack or excel. Luckily I excelled.
After intern year it is the first year of being an anesthesia resident (CA1 year). This is the year that I learned the fundamentals of anesthesia. Next is year two of residency (CA2 year) where I learned the skills of the more complex surgical cases. This is where the nuances and the fine tuning of the skills of the anesthesiologist come into shape. Year three (CA3) is the best. It is getting ready to be on my own. To perfect my skills in the areas of my interest. My interest lay in regional anesthesia, obstetrical anesthesia, and outpatient anesthesia. Regional anesthesia is multifaceted, and my interest was in regional blocks. I have become highly skilled in performing a number of nerve blocks using ultrasound guided techniques.
This skill has carried over into my career as an attending anesthesiologist. An attending is a fancy name for the boss or a doctor no longer in training. Some also refer to a practicing physician as a staff physician or a consultant. In other countries such as in Europe the terminology is slightly different. When I was about six months from completing residency, I began to interview for positions across the eastern United States. The position I settled on was at Cooley Dickinson in Northampton MA. The reason I prefered this position is because it was an independent contractor position plus I also would do my own cases without CRNA supervision. CRNAs are nurses that go for extra schooling after nursing school to learn how to administer anesthesia. I won't elaborate to much on this, unless I am requested to, as there are many facets to CRNAs and MDs and the politics and hierarchy involved, but lets just say that coming out of residency I wanted to practice on my own. In residency there is always an attending anesthesiologist that I had to answer to, that would critique my anesthesia plan and always be shadowing me to ensure that I followed the plan of the attending anesthesiologist. I wanted to do my own cases with supervising a nurse to learn the ins and outs of giving anesthesia that was entirely performed my me, solo. That decision, was a great decision. I have learned more about anesthesia and how I should practice and how I want others to practice that I will supervise than if I hadn't practiced on my own for a period of time.
Also when I first started to practice at Cooley Dickinson Hospital (CDH) I also was an independent contractor. This means I didn't belong to a bigger group and I had my own business to run. This was another excellent decision. Having the experience of being my own small business meant I had to learn how to start a business how to handle the finances of that business etc. If I could I would continue to be a 1099 S corporation. But that isn't how it has happened. The hospital thought that the anesthesiologists weren't a cohesive enough entity for the hospital to work with, so the hospital forced us to form a group. This is another great opportunity that I have been a part of. I had to dissolve my corporation set up a new corporation with a group of partners. I immediately became a partner in the new group and have advanced to Vice Chief and Administrative Director of this corporation. Not many anesthesiologists can say over a four year career that they have been a S Corp, dissolved that and started a group corporation, become a partner, practiced solo, and then practiced with a group of CRNAs. So far my career as anesthesiologist has been loaded with a lot of business and clinical practice experiences that I would never trade.
Once our I became a group with the other anesthesiologists in the hospital we had to make a lot of changes. We had to hire employees and a practice management group to help us oversee the running of the practice. This is quite a detailed story that I want to share to try to help other people understand the starting of a small business, or a corporation, and I will continue this at another time.

Albino Bird

I am going to start catching up on some things that have happened to me in the past. Last July 2014, I was able to photograph an albino bird that I had seen around the neighborhood. I am not sure what type of bird it is, although it may be a robin or bluejay that is an albino.

Tell me what you think:

The photos are a little blurry. The camera base that I have is very good it is a Nikon D7100, however the Nikor 50-300mm lens isn't as good. When I save up some more money I am going to upgrade my lenses, especially my telephoto lens.


I couldn't get too close as I was walking my buddy, who isn't exactly the epitome of stealth.

While I was at the school down the street from me where I saw that bird I also happened to see another wildlife.

As I walked some more in the school yard I came across a blueberry bush that the children of the school had planted some time ago, the blueberries may be attracting the wildlife.

Also when I was looking in the school yard I came across some nuts that had fallen out of a tree that was loaded with these nuts. I looked them up in my tree almanac and discovered that they are an edible nut, called the black walnut.

 Now just two months ago I happened to see another albino type bird as I was entering my car. I have also seen the other albino bird once again. However, this albino looks to be a morning dove or a pigeon. Interesting. Took this photo while in my yard, it was perched on the roof top of my neighbors home. Again, sorry for the graininess but I still have not purchased an upgraded telephoto lens.

While I have been through the fields of the local school I have found a lot of interesting nuts, berries, and trees. I will post those findings in a blog post at a later time.

A great day to sit outside and watch the birds

Today was a beautiful sunny day in the 70's with a slight breeze. I had the chance to watch some little chickadees using one of the many birdhouses I have put up in my backyard. It is fun to watch the mom bird stand watch at the entrance of the bird house while the dad bird stands watch on a limb outside the bird house. I have quite few bird feeders in my backyard as well so I watch the mom and dad bring in food to what I presume are some little baby birds. I used to buy wild bird food, but it made the birds too wild, so I buy suet and scratch.
Here are some photos I took with my Nikon D7100 with my AF-S DX VR Nikkor 55-300mm lens. I had the lens at the 300mm setting while taking the photos.

In the next few days I will post some pictures of an albino bird I have seen outside my house as well. Maybe someone has a name for this bird, besides albino.

Beautiful story

Taking time for the small stuff pays off