During the opening ceremony of Euroanaesthesia 2017 in Geneva, I received an ESA Honorary Membership from President Zeev Goldik. On this occasion, I expressed that I was extremely happy and grateful. While I was hearing, humbly and moved, the contributions to the profession and ESA that the Board considered in giving that honour, I was feeling that this recognition is another gift that my professional life gives to me just for doing what I have enjoyed – that is working for the interest of anaesthesiology.
I do not intend to emphasize the great and magnificent that is currently our specialty, pivotal in the health system of the twenty-first century, but to highlight some aspects of my profession that have made me the way I am. This is an opportunity to reflect on my 44 years in this profession and the enormous and favourable changes that have occurred in its exercise. When I compare, amused, the exercise of our specialty in my beginnings and how it is now I think that it is amazing that I, like all my generation, have been able to acquire the level of expertise in so many medical, technological, and organizational changes. This has made me reflect constantly and stress to my students how important it is to have the “brain” well-grounded in solid foundations: anatomy, physiology, physics, pathophysiology, because within that framework the progression in knowledge and necessary skills are easily accomplished. What we do and how we do it now is very different from what we will do in the future and it is important to have firm foundations to move the old and insert the new.
I was fortunate to start my training in 1973 at the Hospital Clínico of Barcelona, which had a well-structured program. Even so, it lasted only 3 years and those who taught us had been self-taught and therefore with a lack of structure to teach, but with great clinical judgment, which benefited me. Instrumental monitoring had not yet been introduced; anaesthesia was based on clinical observation and blood pressure by sphygmometry. Fortunately, anaesthesia in the “darkness” of endoscopic surgery did not exist and we had enough light for patient observation. In my first year of residence, continuous ECG and plethysmography were introduced, and as new monitoring and controlled ventilation were introduced, we realized how many pathophysiological responses to anaesthesia and surgery had gone unnoticed. Anaesthesia was based on halothane, meperidine, d-tubocurarine, and even suxamethonium in continuous infusion, and manual ventilation for hours. Fentanyl and droperidol arrived, opening alternatives to inhalational anaesthesia. Assistance to severe ill or poly-traumatic patients was almost heroic. The introduction of instrumental monitoring to the level we know today not only allowed us to really know the pathophysiological results of what we did but to develop new safe drugs. That acquired clinical judgment enabled me many years later to manage anaesthetic care in Sierra Leone, with very scarce resources and means.
The early years in the profession are key to guiding the rest and meeting anaesthesiologists who are models of personal and professional performance that make you know what you want and do not want to be. In my second year of residence I obtained a scholarship to stay two months in the Withington Hospital of Manchester, UK, with Prof Parkhouse. The visiting doctors were all males so it was not considered “right” to put me in their residence area and they put me in the nurses’ room that was inside the hospital itself. And that was fortunate because it allowed me to dedicate almost 24 hours a day, an extraordinary advantage of those two months. I remember a senior Registrar returning from the USA bringing the epidural technique for childbirth. When I returned to my hospital I became the initiator of epidural in childbirth with an incidence of dural taps that now horrify me. How “patient” were the patients at that time.
At the end of the residency I obtained a staff position in my own hospital, but not before spending three months in the Neurological Intensive Care Unit of Ca Granda Hospital of Milan, with Prof Bozza and Dr Rosanna Rosanda, both of whom showed me the wide field of anaesthesiology. These two women performed their organisational responsibility in an outstanding and dedicated way, but they had ascended to their positions due to the absence of men, who were involved in the armies of World War II. A consultant there told me that when women reach positions of responsibility or one profession is feminized it is because men are not interested or were not available. It triggered my first reaction of professional feminist rebellion that I have never let go of!
Since then I have had opportunities to alternate my positions in Hospital Clinic and the University of Barcelona and stays in different centres in Europe and USA. Visiting other departments is an essential element of residents’ training and continuous professional development; one leaves the destructive criticism and incorporates improvements when he/she returns, and above all establishes personal and professional relationships that enrich life.
I met models of anaesthesiologists who I aspired to emulate and that triggered my teaching vocation and Europeanisms. I was fortunate to have Prof Miguel A. Nalda and Prof Vicente Chulia as mentors, both enthusiastic founding members of the European Academy of Anaesthesiology (EAA) to which they introduced me. In 1986 I obtained the EDAIC in the first examination held in Barcelona; since then EDAIC has been organised in my department, where I stimulated the extension of the examination to Spain with great success. I was Treasurer of the EAA, a fascinating and stressful experience in the Europe of multiple currencies. In those five years in which everything had to be solved by postal mail or telephone, I travelled every month by a night train from Barcelona to Bern, worked with the banks in the five bank accounts corresponding to five currencies, and had an interview in a glamorous office of a private bank for the updating of investment. I remained permanently obsessed by the currencies exchanges.
Professors Philippe Scherpereel, Johan Spierdjik, and Maurice Lamy were models from whom I learned and who pushed me to participate in what I consider to be one of the most brilliant projects in European anaesthesiology, the FEEA (CEEA at present). FEEA Centre of Barcelona, one of the first in Europe, has operated without interruption since 1988 and has contributed to the successful expansion of the program in Spain and Latin America.
In 1992, European anaesthesiology bodies merged into the ESA and the EDAIC, the European Journal, the FEEA, and the Hospital Visiting and Accreditation Programme gained a new impetus integrated within a broad teaching platform. Within the ESA I have had the opportunity to participate and contribute in its educational projects: Hospital Visiting and Training Accreditation Programme, leading the Trainee Exchange Programme, and CEEA; in all I have had responsibilities and the confidence of the different ESA Boards. In ESA I humbly contributed to the education and professionalism of young European anaesthesiologists, I have promoted the participation of Spanish anaesthesiologists in ESA projects, and above all I have become personally and professionally enriched by sharing friendship, confidence, and projects with so many anaesthesiologists.
The different positions of responsibility that I have had and I still have in my hospital and the University of Barcelona, together with uninterrupted clinical and teaching activity have given me the opportunity to influence the changes in the speciality, its performance in my country, the education of students and residents, and the involvement of anaesthesiologists in the health organization.
I am deeply grateful for everything I have received, personally and professionally.