Lawyer Monthly - March 2022

Please introduce yourself and tell us a little about what led you to specialise in anesthesiology. My name is John Lundell. I have been practicing full-time as an anesthesiologist since 1999. From an early age I knew I wanted to be a doctor. When a mentor advised me to choose a college major which could be a viable alternative to a career in medicine, I chose electrical and computer engineering. Later, none of the wide variety of specialties I tried during my third-year medical school rotations seemed right for me. My wife, a medical school classmate at Yale, suggested I try anesthesiology as one of my electives. It appealed to my engineer-trained brain. I liked the combination of procedural intervention and cerebral diagnosis and the immediacy of the treatment and response. I felt privileged to interact with the body’s well-engineered controls for heart rate, blood pressure, respiration, etc. to my patient’s benefit. I had one major concern encapsulated by a friend’s question: “You have such a good bedside manner—why waste it in anesthesia where your patients are all asleep?” Ultimately, I decided that a good bedside manner was even more important in anesthesia, where I first meet patients on the day of surgery and have only 10 minute to allay their fears and get them to trust me with their life! Now I routinely call patients the night before to see if they have questions or concerns. This brief conversation really impresses and reassures my patients. They also appreciate my offering to converse in Spanish if that makes them more comfortable. I became fluent in Spanish during a two-year volunteer missionary service before medical school. After medical school and internship, my wife and I headed to North Carolina, where I completed anesthesia residency and cardiothoracic anesthesia fellowship at Wake Forest before beginning a fiveyear commitment to the US Air Force. While on active duty, I trained anesthesia residents at the Air Force hospital in San Antonio. I led the cardiac anesthesia section and the medical student rotators and served a tour of duty in Iraq supporting Operation Iraqi Freedom. Upon completion of my military service, we moved to San Diego, where I accepted a faculty appointment in the UCSD Department of Anesthesiology while my wife pursued a one-year Radiology fellowship. We then returned to Texas, settling in the Dallas area, where I joined a prestigious private practice group at Baylor University Medical Center. I have been with this same group for more than 16 years, weathering changing clinical commitments, group mergers, and hospital and insurance contract renegotiations, while seeing my children graduate, my parents pass, and my wife and I mature and grow closer. I have been blessed. What sorts of cases require your anesthesiology expertise and how is the information you provide crucial to the outcome of these disputes? As an anesthesiologist I give patients medication to induce anesthesia. I place breathing tubes, arterial catheters, central venous catheters, and nerve blocks. I manage consciousness, patient safety and positioning, blood pressure, heart rate, respirations, urine output, blood loss and transfusions under changing surgical conditions. I control emergence from 71 MAR 2022 | WWW.LAWYER-MONTHLY.COM EXPERT WITNESS anesthesia, reversal of muscle relaxants, removal of the breathing tube, and a variety of patient management issues in the PACU (post anesthesia care unit). I transport critical patients between the OR and the ICU, manage critically ill patients for emergency surgery and run intraoperative codes. Complications can happen during any of these activities. I have been consulted to evaluate failed intubations, intraoperative fires, injuries possibly due to patient positioning, nerve blocks, central lines, and intraoperative warming devices. I have been consulted to evaluate intra-op hypotension, intraop stroke and cardiac arrest, possible medication errors, overdoses and toxicity, post-op respiratory arrest and perioperative management of OSA (obstructive sleep apnea). I could be consulted in any area of anesthesia where there might be a complication. My experience in anesthesia is quite broad, but there are a few areas (e.g. OB, peds, cardiac) that I no longer practice and will refer to colleagues. Usually, attorneys want to know if the anesthesiology team followed the standard of care. Sometimes they ask my opinion about causation. Some cases are straightforward — the anesthesia team followed the standard of care, or the patient injurywas unrelated to anesthesia. Plaintiff attorneys are often unsurprised by my opinion but still appreciate knowing when there’s not much of a case. Other times, the deficiencies in care are easily identified. Plaintiff attorneys are excited You have such a good bedside manner—why waste it in anesthesia where your patients are all asleep?

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