An Interview with Carine Zeeni, MD

Marie Angele Théard, MD
Chair, Membership Committee

Marie Angele Theard
Marie Angele Théard, MD

Dr. Carine Zeeni serves on the SNACC Membership and Education Committees. She is an Assistant Professor and Director of Neuroanesthesia at the American University of Beirut Medical Center (AUBMC). After completing medical school at Université Saint-Joseph de Beyrouth and her anesthesiology residency in Lebanon (both in French), Carine decided to pursue a neuroanesthesia fellowship in the United States at Northwestern University. Upon completion of her fellowship, Dr. Zeeni returned to Lebanon to help develop a strong educational program for residents. She and her core group of faculty members were successful in securing a four-year accreditation by the ACGME-I for her department. Her institution is the second in the Middle East and North Africa (MENA) region to obtain this accreditation.

Carine Zeeni

Carine Zeeni, MD

As clinicians, scientists, educators, and leaders, the COVID-19 pandemic has presented us with a plethora of challenges in the care of our patients, which we continue to face head-on through education, collaboration and comprehensive care. This pandemic is in addition to so many other trials and tribulations we face as members of our respective medical communities, from health disparities to war. After reading Dr. Zeeni’s interview, I invite you to read her latest publication, Beirut, in the Mind to Mind section of Anesthesiology where she so eloquently depicts the harsh reality of work as a neuroanesthesiologist during the activation of a disaster protocol after the Beirut port blast in August of this year.

What/Who influenced you to choose a career in neuroanesthesia?

Ironically, what influenced me to choose a career in neuroanesthesia was my weak exposure to this subspecialty during my residency in Lebanon. During an elective rotation in the anesthesia department of a major United States hospital, I discovered the world of neuroanesthesia, which piqued my curiosity, and I decided that this would be the expertise that I would bring back home with me after my fellowship. I like the fact that neuroanesthesia is a broad subspecialty that applies to all ages, incorporates genetic and acquired diseases, and includes a variety of elective and urgent surgeries. I love working in this subspecialty, and since returning to practice at the American University of Beirut, I am glad to have had the opportunity to make a difference in patients’ lives. Work during the recent Beirut port blast on August 4 of this year compels an even stronger sense of purpose, which this specialty has provided me as a hospital caregiver during this tumultuous time.

Where did you receive most of your training in neuroanesthesia?

I received most of my neuroanesthesia training during my two-year neuroanesthesia fellowship at Northwestern University, Feinberg School of Medicine in Chicago, Illinois.  I found that the program at Northwestern was well led and it is a well-structured and inviting program with opportunities for research and great team chemistry.   

At what point in your career did you meet your first mentor?

I met my first real long-time mentor during my neuroanesthesia fellowship. Since that time, I have benefited from guidance from a number of advisors, guides and role models.  I feel the fellowship years are very conducive to academic growth. I was lucky to meet a wonderful group of mentors and friends that I still bounce ideas off of even to this day, ten years out of fellowship.

How has your mentor(s) helped you in your career in anesthesia/neuroanesthesia?

Mentors play a big behind-the-scenes role, in my opinion, especially in academic anesthesia. They helped steer me in the right direction and find my niche in my institution. They still help me stay focused on important objectives as well as provide me that extra push and encouragement if I start procrastinating. It is so wonderful to have role models to look up to and who can help support you in your desire for more balance between work, professional growth and family life.

How did you find out about SNACC, and when did you join?

I learned about SNACC and joined as soon as I started my neuroanesthesia fellowship and have been a member ever since then. I cannot stress enough how important fellowship training is for international medical graduates like myself or for local graduates, even if It means being away from family for a while or taking a pay cut. This fellowship has opened up a world of opportunities, both academically and socially, and I look back on those years as being utterly fulfilling and becoming the springboard that helped me shape my career. Through SNACC and its wonderful network of collegiate professionals, I have been able to meet new colleagues and subject matter experts who have helped me stay abreast of the most recent neuroanesthesia research. This organization has also been a great resource of material for resident education, and I am glad to be able to participate in its growth both in the United States and internationally.

Which area of clinical neuroanesthesia interests you the most and why?

That is a difficult question to answer: how do you narrow down your interests to a few areas? I would say probably epilepsy surgery is an area that I enjoy. I feel it is an area where the way in which we conduct our anesthetic immediately influences patient’s long-term outcomes. I enjoy pediatric cranial vault reconstruction as well because of the high stakes, but also the substantial rewards that you can see and measure immediately after surgery. Lastly, neuromonitoring for spine or intracranial procedures is always interesting. I enjoy teaching the concepts of neuromonitoring to residents as well as helping them to understand the real-life benefits of neuromonitoring patients during their neurosurgical procedures.   

What area of neuroscience research most interests you and/or what is the focus of your neuroscience research?

I am mostly interested in clinical outcomes research, be it related to high-risk spine surgery or intracranial procedures. I have also begun to develop a more comprehensive understanding of the pharmacodynamics of dexmedetomidine and its use in a variety of clinical settings.

What has been the most challenging aspect of your educational career and/or training?

Moving from Lebanon to the United States for fellowship with a different culture, as enriching as it may be, always presents some challenges at least in the beginning. Transitioning from studying medicine in French and the French school of thought to English and the American way was thought-provoking as well. I am grateful to have had co-fellows and attendings that were both supportive and understanding. They afforded me an opportunity to quickly adapt to my new environment. 

What has been the most gratifying aspect of your academic career?

I began my career here as a new female junior attending in a big institution, and I carved out my place slowly but surely in a challenging and competitive male-dominated environment. I feel that I succeeded in creating what I like to call a ‘neuro bubble’ where anesthesia and neurosurgery residents and attendings, as well as neurologists could communicate, prepare, and conduct difficult cases collaboratively. That, to me, is a great accomplishment! On another, more significant level, bringing awareness about this subspecialty and its benefits to my program in Lebanon as well as the MENA region and having residents express their interests in pursuing a career in neuroanesthesia has been thoroughly gratifying.

What has been the highlight of educating residents/fellows in neuroanesthesiology?

Historically in our department at AUBMC, the neuroanesthesia rotation was disliked due to the long hours, the heavier workload and the stressful environment. Turning that harsh reputation around, through an emphasis on teaching and medical education individualized to the needs of each rotating resident, was a welcomed opportunity. The positive feedback I received from our trainees, as well as the teacher of the year award, are some of the highlights of my efforts as an educator. In the digital era that we are living in, medical information is now a commodity that is easy to access. However, our contributions as mentors and educators are to help residents find the drive, develop ethics and encourage the pursuit of excellence in their work. We are here to model for residents the importance of being compassionate with their peers and toward their patients.  A high point that I like to mention is getting messages or calls out of the blue from my former residents, now fellows or attendings dispersed all over the world. I enjoy their sharing with me stories of patients they cared for in the operating room and how some little detail I had discussed with them had helped them navigate the case successfully. That kind of feedback is tremendously satisfying to me!

What advice/story would you like to share with medical students, residents, fellows, and junior faculty choosing a career in neuroanesthesia?

Neuroanesthesia is a stimulating field that requires endurance, technical skills, expertise and attention to detail. Every day there is the potential to learn something new. Even if you are the most seasoned neuroanesthesiologist, you never know at what moment you will be challenged like you have never been challenged before. You must be prepared to use all of the skills and knowledge that you have acquired over the years during the most straightforward of cases to some of the more catastrophic events like that of the Beirut blast, which left over 6,000 injured.

What is your advice to women interested in pursuing work in this field?

Neuroanesthesia offers women an opportunity to be leaders, scientists, and educators in the academe. For those of you who choose to commit to this specialty, I think that patience and a constant continuous effort, regardless of what else is going on in your life or what obstacles are in front of you, are required in order to succeed in this career path especially if you plan on having a balanced family life in parallel. I look forward to helping inspire more women to enter this wonderful subspecialty of neuroanesthesia and to add to the small handful of officially trained neuroanesthesiologists in Beirut.  

I invite you to read a recent piece by Carine Zeeni et al. Women in Anesthesiology: Is it Different in the Arab World? Published in International Anesthesiology Clinics.

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