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Anesthesiologists are service oriented professionals who make crucial decisions and perform critical. sometimes lifesaving, procedures behind the scenes. The absence of drama usually implies a job well done.

But after over thirty eight years of private practice, I realize there is an important and intriguing story that needs to be told. A key part of this story is the history of how new intraoperative monitors, improved alarms and safety upgrades on anesthesia machines along with better drug and syringe labeling in the 1980's dramatically decreased the risks associated with general anesthesia. In the 1990's we saw an explosion of technology with the internet, cell phones and the early phase of computerized records. We also experienced the end of one medical corporation and the rapid growth of anesthesia services with the new one.

The new millennium brought continued growth with advances in equipment, new technology and new sites of practice. The big surprise was a complete takeover of our hospital by a mega hospital system ( Carolinas HealthCare System ) in 2007. Unfortunately, these upgrades in our everyday practice were accompanied by the tragic death of a beloved partner, the demise of the county's leading industry and the incarceration of my oldest son.

With all the destabilizing factors surrounding our medical practice, it is noteworthy that some basic principles were immutable. Personal dedication and vigilance remained the core virtues required in our daily practice. The basic skills of airway management and circulatory support with IV access were ever critical to the successful practice of our art. Other skills and concerns at times gained center stage; but one could safely say : The more things change, the more they stay the same".

So in these " confessions" I have dealt with a number of important issues; the changes in my medical practice, political and economic changes at the local and national level, personal and family instability, and lastly my own struggle to search for meaning and logic to these events. I think anyone who struggles in their career can relate to the need and sense of satisfaction in gaining that insight.

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No controversy in recent history has been as enduring and pervasive. yet  also polarizing and inflammatory, as the debate over climate change and its many ramifications. This debate is closely related to our concern for an abundant safe water supply. However, actions that would dramatically decrease the burning of fossil fuels---the probable cause of global warming and a major source of pollution---would likely result in a major suppression of global economic activity, at least in the short run. Naomi Klein framed this debate as  " Capitalism vs the Climate" in her important treatise, This Changes Everything. In the last few years I have become increasingly obsessed with this dispute. Nearly in consensus, scientist appear to be bitterly opposed by industry leaders and conservative politicians. In my world, scientists ruled; but in realpolitik, scientist are merely another player.

 

Greenbrier Chronicles is the story of how I became aware of these environmental issues, from my early childhood through forty years of medical practice ,to now in early retirement. In a quest to redefine my personal goals as I aged, I reviewed a number of vignettes that I believe were pivotal to my development, including my obsession with water, medicine, and chemistry. This search for my Personal Legend comes to an inevitable conclusion : climate change and environmental welfare are issues no one should ignore.

 

As an added treat, this story centers primarily in the beautiful Greenbrier Cove of East Tennessee, my family's favorite vacation locale since I was five. It is here that the fictional Think Tank from Alpha Centauri emerges to help elucidate the climate debate. Through arguments made in this unlikely scenario, I expose the debate's most contentious issues. Although this may seem to undermine my credibility initially, the result is raw insight into the most important dilemma facing our county in the 21st century, one that's being played as a political chess game without people's knowledge.

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