Rendezvous with Editor-in-Chief
Tumul Chowdhury MD, DM, FRCP(C)
Editor-in-Chief, SNACC Newsletter
It gives me a true honor and pleasure to have Prof. Hari Hara Dash for the very first issue of 2023 Newsletter. Prof. Hari Hara Dash is a pioneer leader, mentor, researcher and clinician in the field of perioperative neurosciences. He is an Emeritus Professor, Anaesthesiology & Pain Medicine and the current medical director of Fortis Memorial Research Institute, Gurgaon, India. He has served as the Prof. & Head, Neuroanaesthesiology at India’s premiere teaching hospital, All India Institute of Medical Sciences (AIIMS), New Delhi from 1993 till 2012. During 2006 to 2012, he was promoted to lead all neurosciences specialties as the Chief of Neuro Sciences Center (First anesthesiologist to achieve this position) of AIIMS. He has received numerous awards including the ‘2010 Teacher of The Year’ award the Society of Neurosciences Anesthesiology and Critical Care held at San Diego, USA. Prof. Dash is the Founder President of Indian Society of Neuroanaesthesiology and Critical Care (ISNACC). He is the Immediate past President of the Asian Society of Neuroanaesthesiology and Critical Care as well.
TC: When and how did you start your Neuroanesthesia career?
HHD: Let me share an interesting anecdote pertaining to your question. In 1984, three posts of Assistant Professors (one each for general, neuro and cardiac anesthesia) were advertised. At that time I was very inclined for the general anesthesia. My interview went very well. But, to my great surprise, I was selected for the neuroanesthesia position without being asked a single question on neuroanesthesia. Initially I thought it to be God’s will. But having a mixed emotion of shock and surprise, I decided to ask my Head, Dr. G.R. Gode about this rejection for the general anesthesia position. He calmly told me, ‘Dash, neuroanesthesia is an upcoming subspeciality in anesthesia and it needs dedicated people’. These words of wisdom motivated me, and still buzz in my ears. There was no looking back and here, I am today.
TC: What is the greatest reward of being a Neuroanesthesiologist?
HHD: The greatest reward for me is the growth and advancement of Neuroanesthesia and Neuro Critical care in India, and Asia continent both as a society and a subspeciality in Anesthesiology.
TC: Who are/were your inspirations?
HHD: An umpteen number of my teachers have contributed for my growth and advancements in Neuroanesthesia and to mention a few, first and foremost is Prof. S. S. Saini from whom I had learned the art and science of neuroanesthesiology and pain management. Prof. A. K. Banerjee, the Chief of Neuro Sciences Center, AIIMS, an astute administrator and an outstanding neurosurgeon who had encouraged me to develop Indian Society of Neuroanesthesia and Critical Care and subspeciality course, that is, DM in Neuroanesthesiology at AIIMS. Others who had a positive impact in my carrier were Prof. John D Michenfelder of Mayo Clinic, whose clinical research papers were inspirational for me and his unbiased comments on my abstract on “ Fluoroscopic imaging for monitoring….in sitting positions” was truly magnanimous on his part. Despite his busy schedules he could found some time to go through the abstract of an unknown entity and rendered his opinion. Such act of kindness and humility of the great man touched my heart, which I think is highly adorable and praiseworthy. I had the opportunity to attend Prof. John Drummond’s early morning (5.30am) classes as a WHO fellow at San Diego, which was a unique experience for me. I had also accrued maximum benefit because of my association with Prof. Arthur Lam ( his clinical acumen and skill ), Prof Alan Artru ( his research abilities) of Seattle, and the last but most importantly my true friend, Prof. Adrian Gelb, a teacher par excellence and a great human being.
TC: What has been your biggest challenge as a mentor?
HHD: To be very honest with you I did not confront any Himalayan challenges as a mentor as all my mentees were highly motivated and all of them were aware of their responsibilities. Initially as a mentor I had a daunting task to carry out that was, how to impart holistic training and teaching in Neuroanesthesiology as my department did not have intraoperative trans esophageal echocardiography and neuro-physiologic monitoring facilities, for which, I had to liaison with Prof Deepak Tempe, a renowned cardiac anesthesiologist of G B Pant Hospital, Delhi and Neurophysiology department of Christian Medical College, Vellore through Prof Grace Corula respectively for the initial batches(one month training at each center).
TC: Did you feel you are making a positive difference in Neuroanesthesia community?
HHD: I think this question should have been asked to my students and to our neurosurgical colleagues of India. Once you have raised this, then let me apprise you, that all the neurosurgical departments in the Government / Corporate sectors, now a days, are vying for trained Neuroanesthesiologists for the management of their patients both during surgery and in the postoperative neurocritical care. My students are in the forefront of stroke management and management of patients in neurointensive care. Last but not the least, clinical research work carried out by our students are being recognized in the prestigious international conferences. Our scientific research publications are also making impact in peer-reviewed journals.
TC: What is the most creative thing you have done to engage your students?
HHD: I always motivate them to dream for the moon for which my responsibilities were to provide conducive atmosphere so that there was no complaint from their side. Fostering students independence pertaining to their clinical research projects, I think is highly essential. This way I could instill due diligence and discipline in them.
TC: What do you see as a past, present and future of Neuroanesthesia?
HHD: Why to brood over the past? What is gone is now history. Nonetheless, this is just to enlighten you, in the past, neuroanesthesia means, hyperventilation, hypotensive anesthesia, enormous blood loss during surgery, patient not waking up after anesthesia and at the end, increased in morbidity and mortality. But, there was paradigm shift in patients management due to better understanding of the pathophysiology of the disease process, technological advancements, improved neuro-interventions, better availability of anesthetic drugs, application of neuroprotective methods and establishment of state of the art neurointensive care. All these have played a significant role in curtailing morbidity and mortality with very good patients outcome. In the future we would witness more and more of image-guided, précised and robotic (incision less) surgical procedures.
TC: What is your advice for the budding Neuroanesthesiologists?
HHD: Young budding ones are well aware of their responsibilities. Nonetheless, I want to make two appeals. One must try to think something new or unique clinical research projects and try to get involved in multi center funded projects. Please build a good rapport with your neurosurgical colleagues, neuroradiologists and other perioperative physicians and this effort will surely move your step towards better patient management. Undoubtedly, exchanging ideas invariably helps in accruing recent knowledge and establishes a great team.
TC: If you were given a chance to choose a specialty career once again, would you choose the same or different and why?
HHD: How could I think of something different than Neuroanesthesia when the Almighty had arranged it for me way back in 1984? God’s gift was the greatest boon which I ever had. What so ever, name, fame , position and accolades I have received is all because of my carrier in neuroanesthesia and neurocritical care. Now the question of separation does not arise at all.