WINNER in Focus: An Interview with A. Elisabeth Abramowicz, MD

M. Angèle Théard, MD
Quality Director 
Oregon Anesthesiology Group 
Associate Anesthesiologist 

Legacy Emanuel Hospital
Portland, Oregon

Ehab Farag, MD, FRCA, FASA
A. Elisabeth Abramowicz, MD
M. Angèle Théard, MD
M. Angèle Théard, MD

The Women In Neuroanesthesiology and Neuroscience Education and Research (WINNER) are integral to SNACC’s mission of education, neuroscience research and improving outcomes. Many of their noteworthy accomplishments reflect their resilience and serve to inspire the next generation of physicians and scientists. I am very pleased to share with you this new section of our SNACC newsletter which highlights the women members of SNACC: their inspiration and challenges during their pursuit of careers in neuroanesthesia. I hope that you will enjoy this first interview of one of our WINNERS, Dr. A. E. Abramowicz.

A. Elisabeth Abramowicz, MD has been a member of SNACC for over 20 years. She is Professor of Clinical Anesthesiology at New York Medical College and she serves as Residency Program Director at Westchester Medical Center.  

M. Théard: What/who influenced you to choose a career in neuroanesthesia?
A.E. Abramowicz: For a year, between high school and medical school (the European pathway) I worked as an apprentice EEG technician in the Department of Neurosurgery at the Medical University of Warsaw; it was an amazing world of bow-tied, smart and very well trained people (some of whom had trained with Dr. Wilder Penfield). I helped with a large population of epilepsy patients and learned about the applications of electrocorticography in the OR. Working with Dr. Aurelia Szpiro-Zurkowska, an aloof but highly respected neuroanesthesiologist and her team got me “hooked” on this area of medicine. I could not help but be completely fascinated by these extremely intelligent doctors who were treating the most mysterious of our organs. As a third year medical student, I began attending Anesthesia Interest Group meetings led by the Chairman of Anesthesiology at the Medical School, Dr. Bogdan Kaminski, a brilliant and visionary administrator-leader of a large department which included an utterly impressive group of women among overseas-trained senior anesthesiologists (MGH in the United States and Scandinavia) who were all completely accepting of the uniqueness of neuroanesthesia. Meeting Jim Cottrell, a young and charismatic Anesthesiology Chairman from Downstate, New York at a meeting in Warsaw, Poland influenced my interest in a career in neuroanesthesia. After some political upheaval in Poland, I arrived in the USA via Switzerland, re-did my residency and did a neuroanesthesia fellowship with Jim in the late 1980s. To this day, I love what I do.

M. Théard: Where did you receive most of your training in neuroanesthesia?
A.E. Abramowicz: I completed a formal neuroanesthesia fellowship at State University of New York (SUNY).  I also learned from all the wonderful neurosurgeons and fellow neuroanesthesiologists with whom I worked; Jim Cottrell’s team was an integral part of my education, together with Dr. Eugene Flamm and his demanding Department of Neurosurgery which nurtured and fostered a high-quality collaboration with anesthesiologists.

M. Théard: How did you find out about SNACC?
A.E. Abramowicz: As a fellow in Jim Cottrell’s Department. The unique role of SNACC as a vehicle for advancing neuroscience research and improving outcomes was strongly emphasized. There was always talk of SNACC and its importance. In 1987, I joined as a fellow.

M. Théard: Which area of clinical neuroanesthesia interests you the most?  Why?
A.E. Abramowicz: Acute ischemic stroke and the other endovascular interventions are what I am most interested in, primarily because I still like emergencies and I think anesthesiologists have so much to contribute in this setting; after all, most of the time, we are the only ‘whole-patient’ physicians in neuroradiology. Having witnessed a full, immediate recovery in an MCA stroke patient in 2008 after a Merci retriever thrombectomy, I became convinced that this type of procedure would serve as a game-changer for so many patients. I find it fascinating that it is the technology utilized by our IR colleagues and not our pharmacological ‘protective’ contributions that plays a critical role in the modern care of AIS!

M. Théard: What is/has been the focus of your neuroscience research?
A.E. Abramowicz: I worked in the lab with Dr. Ira Kass and I found exploration of the basic science of brain anoxia both fascinating and stimulating. As a single mother, however, life took me in the direction of clinical practice for enough years that this chapter could not be reopened. I am primarily a clinician and an educator, and I would like to think that I have played a part in convincing my colleagues and administrators that neuroanesthesiologists bring value to large hospitals.

M. Théard: What has been the most challenging aspect of your educational career and/or training ?
A.E. Abramowicz: Making people aware that I, as an anesthesiologist, might have competencies that are likely to impact the quality of patient care and convincing them that neuroanesthesia is a bona-fide specialty. I am always taken aback when a neurosurgeon asks, “Are you comfortable with awake craniotomies?” I have some good war stories relating to some of these experiences, including rare complications that I diagnosed because of my training and expertise (like an injury to a common iliac artery during a microdiscectomy). But in general, compelling our surgical colleagues, patients and members of other medical specialties to understand our critical contributions to the perioperative care of patients continues to be a challenge.

M. Théard: At what point in your career did you meet your first mentor(s)?
A.E. Abramowicz: Early on, as a resident. I am a curious person and I always found people who were willing to give of themselves. But Jim Cottrell is the main mentor of my career – he made it his mission to give people opportunities. I am very grateful to him and his department. Dr. Ira Kass, a down-to-earth and humble scientist with a powerful intellect also deserves a special mention. He always made it clear that clinical knowledge matters and helped me and others to apply basic science to generating context for clinical work.

M. Théard: What has been the most gratifying aspect of your academic career?
A.E. Abramowicz: Longevity. I spent five years in private practice and if I continued, I would most likely have retired by now. There are aspects of clinical anesthesia that are completely mind-numbing. Luckily, in academic practice, this is very seldom the case. So, I am grateful for the progress in neurosurgery, anesthesia and for all the trainees whose needs continue to stimulate me to learn and for all the patients who tell me ‘nice to have a seasoned anesthesiologist.’ This is most fulfilling and keeps me going.

M. Théard: What advice/story would you like to share with medical students, residents, fellows and/or junior faculty choosing a career in neuroanesthesia?
A.E. Abramowicz: I have a little talk I prepared for medical students entitled “Why Neuroanesthesia?”. Essentially this talk is about what you have to like in order to enjoy this subspecialty. I think you must have a fascination with the mysteries of the central nervous system; a drive to know and understand almost as much as the surgeons and neurologists who refer patients for surgery; to enjoy taking care of one patient at a time, often in the dark, with sometimes very limited access to them (prone cases and/or turned 180 degrees away from the usual patient-anesthesiologist alignment); and to be ready for disasters (some predictable while some quite unusual). A good story that comes to mind is how I was fooled into assuming that a patient for a revision microvascular decompression for trigeminal neuralgia couldn’t open her mouth because of pain: the multiple radiofrequency ablation attempts caused muscle scarring and muscle relaxation did not improve mouth opening. If I add that this young patient then hemorrhaged from surgical injury to the transverse sinus, which required a head-up position to help the surgical repair which then increased the risk of air embolism - this is neuroanesthesia. On another, weekend occasion, the O-Arm CT scanner wouldn’t open, trapping the patient mid-surgery. The neurosurgical resident brought in his Subaru tire lug wrench which thankfully fit and bypassed the electronic lock.

M. Théard: What is your advice to women interested in pursuing work in this field?
A.E. Abramowicz: I think that you have to love what you do: the long hours, emergencies, sometimes high-stress and labor-intensive patient care that impacts good outcomes then become rewards that recharge you. Find a mentor. They are around, just waiting to be discovered. I have not experienced sexism in neuroanesthesia. It is a subspecialty which allows for a close professional relationship with specialized OR personnel, surgical/interventional partners and patient-referring physicians. Patients come to appreciate what we do – one of my patients would bring me a homecooked meal on each anniversary of her meningioma excision. The field of neuroanesthesia is rather small; this promotes a close working relationship with those who share in the care of patients. I have been very lucky to have had a great relationship with the vast majority of the neurosurgeons/neuroradiologists and interventional neurologists I have worked with, and overall, I have felt appreciated.

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