Arthur St Andre MD FCCM

By MedStar Health

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Section Director, Surgical Critical Care Services
Start Date: 1980

ADVANCING CRITICAL CARE:
THE GROWTH OF A DISCIPLINE

I vividly remember my first day at MedStar Washington Hospital Center. I was starting as an attending internist along with another new doctor on the service: Joy Drass, now CEO of MedStar Georgetown University Hospital! We were joined by Fred Finelli—then a resident, now president of the Hospital Center's medical staff—and surgeons Bikram Paul and Mario Golocovsky, who were critical care and trauma attendings at the time. I still have the original schedule from that first week.

It was an exciting time to be at the Hospital Center. Technological and therapeutic advances were allowing us to keep ill patients alive longer than ever before. To give them the best chance of survival, we found a need for physicians who were, in effect, generalists in all organs but with a special focus on the complexities of acute illness and injury. And thus was born the field of critical care medicine-and outgrowth of Internal Medicine, Surgery, Anesthesiology and Pediatrics.

The Hospital Center was one of the first to establish its own Surgical Critical Care program, and today is one of the best in the nation. It has developed and evolved extensively over the years, and now includes an experienced critical care team representing many different disciplines, including nine intensivists. From two Surgical Intensive Care Units and 27 beds in 1980, we have grown to 59 beds spread out over five Critical and Intermediate Care Units.

In parallel, the systems of medical and neonatal critical care have significantly evolved. Today, in addition to training the hospital's own surgical and pulmonary critical care residents, we also have students, residents and fellows from the National Institutes of Health, Walter Reed Army Medical Center, Bethesda Naval Medical Center, MedStar Georgetown University Hospital and the Uniformed Services University of the Health Sciences.

While most surgical patients have better than a 95 percent survival rate, one difficult part of our job is knowing when to say "enough" for the few who are beyond help. We need the wisdom to recognize when patients won't get better, and to know when to step away from technology. Then our attention turns solely toward helping patients, families and even other providers through the final days of life, providing comfort to all.

Every day, the Critical Care team is challenged to use our skills, technology and available resources expertly, safely and compassionately.