Robert F. Hustead Memorial Lecture
What are We Doing Here?
Gary L. Fanning MD
Robert Frank Hustead was born and raised in Pueblo, Colorado. He was one of three children. He was educated at Yale University in New Haven, CT, receiving his bachelor’s degree in 1950 and his MD in 1954. From 1957 to 1959 he served in the US Army at the Edgewood Chemical Biological Center in Aberdeen, MD, working at Johns Hopkins on weekends. He joined the faculty at Johns Hopkins in 1959 and served in the departments of anesthesiology and OB/GYN there until 1961, when he moved to Kansas City and joined the faculty of the University of Kansas School of Medicine. In 1973 he moved to Wichita, KS, and he and his wife, Joy, a CRNA, dedicated the rest of their lives to ophthalmic anesthesia.
Bob was an extraordinarily gifted and talented man. He was an inventor of several medical devices, the most noted of which may be the Hustead epidural needle. He was an expert in neonatal resuscitation and was the first president of the Society for Obstetrical Anesthesia and Perinatology. Needless to say, he was an early and enthusiastic advocate of epidural anesthesia. In Wichita he became devoted to developing and teaching the use of painless local anesthesia for eye blocks. He authored many scientific articles, and his textbook of ophthalmic anesthesia is considered by many of us as the connoisseur’s treatise on the subject.
In addition to his professional achievements and skills, Bob had many other interests. He became an avid winemaker and connoisseur and brewed beer as well. He was a skilled pilot. He and his family survived a tragic accident many years ago due to an engine failure of the plane they were in. He and Joy have 9 children, all of whom are highly educated in a variety of areas, including medicine, veterinary medicine, nursing, law, and geology among others. He was also very proud of their 16 grandchildren.
We remember Bob as the founder and principal mentor of the Ophthalmic Anesthesia Society. He died in December 2008 of ARDS, having suffered a series of small cerebrovascular accidents over a prolonged period. His loss has been most grievous to those of us who knew him well and who depended on him for knowledge in the area of ophthalmic anesthesia. His contributions have been enormous to the success of this organization, and we shall miss him sorely.
To help us remember him, I asked several longtime members of OAS to send me their recollections of Bob over the years. I hope that you will treasure some of the things they had to say.
“I first met Bob in Texas at an educational-organizational meeting for the OAS. I found it interesting witnessing the dynamics of three professional disciplines coming together for one primary focus. Political tensions between the ASA and AANA were as usual…After reviewing the proposed bylaws, I presented several amendments that I felt were necessary to align the new CRNA membership. I was pleased with Bob’s innovative leadership, giving respect to the ideas and the final draft of the OAS bylaws. This initial round of cooperation among the membership convinced me that this organization could succeed in making a real difference in patient care.
Bob’s passion for focusing on orbital anatomy, block techniques, and patient comfort were essential in inspiring all of us to take a hard look at our practices and make improvements. Bob led the interactive discussions at the meetings, which were stimulating and informative. The respect that was given to all participants further helped the group cohesion. His passion
—Randy Harvey, CRNA
“I recall that Bob had a great passion for his work, his friends in the medical community, and for the betterment of care for those undergoing eye surgery. There is no question that he spent endless hours trying to learn the very best in care and technique and then to teach it to everyone who would listen and learn. I believe it was also a plus that he believed that everyone in the eye arena was on level ground when it came to responsibility, care, technique, and outcomes. I believe few others work as hard as he did to try to advance the profession based on what he knew to be right according to the study, research, and practice he carried out for so many years.”
—Clyde Tempel, CRNA
“I started practice in 1974 and got to know Bob Hustead shortly thereafter. He was in Wichita, about 200 miles to the east and our closest large town. Bob was always available to help us with tips on ophthalmic anesthesia. I visited him and Joy several times and he was always helpful and generous in sharing his knowledge. Many of his tips, such as diluting lidocaine with BSS for a painless injection, were very helpful. I will always remember Bob, not only for his brilliant mind, but for his generosity in sharing his knowledge with others.”
—Luther Fry, MD
“Back in the early days of the OAS, Dr. Hustead and others had approached the ASA about obtaining some type of associate status for our Society. As everyone knows, we were established as a society for all health professionals interested in ophthalmic anesthesia: MDAs, CRNAs, and ophthalmologists.
I understood that when Dr. Hustead spoke to whomever was in position in the ASA to make these kinds of determinations, he was told that if it were to happen, the OAS would have to go on record as accepting the ASA Anesthesia Care Team statement of the time. Dr. Hustead innocently felt that there would be no problem with this, and he announced it in a letter to members, stating that all we had to do to be accepted as a specialty society within ASA was to adopt the Anesthesia Care Team statement.
As a CRNA in solo practice in an ASC, I quickly realized that if the statement were adopted by OAS, I would have to drop out, because I could hardly be a member of a society that stated that my practice was substandard. I called Dr. Hustead and informed him of my concerns. After hearing me out, he told me that he agreed with me. Even though he had high hopes of our being recognized by ASA, he changed his mind when he realized what it would mean for the CRNAs in the Society. It was a difficult decision for him, but he made it without hesitation when he realized the negative effect it would have had on our Society. My admiration for him was boundless. Here was a man who had his eye on the mission: excellence in ophthalmic anesthesia. He would not let professional rivalries sidetrack us as we seek the best for our patients.”
—Dan Simonson, CRNA
“Early on Bob Hustead taught me things that were contradictory to what I had been taught in residency. The first and most important was how to position the patient’s eye before administering an orbital block. We had always been taught to have the patient look up and in before inserting the needle. Bob taught us that it is safer to have the patient’s eye in the position of primary gaze, because the up-and-in positioning of the eye places the optic nerve in great peril.
He also taught us about hyaluronidase. We used to use a whole ampoule of it for every syringe we drew up, as we had been taught. We were giving thousands of units of the drug when so much less was enough. [You may recall that Bob used only 0.5 unit/mL in his practice.]
His idea to do painless outpatient ophthalmic anesthesia is a great service to the patient and also a terrific marketing tool for the ophthalmologist. If I need cataract surgery, I hope it is painless for me.
I say God bless Robert Hustead. He helped me and my patients. How many older patients had both eyes done because it was so easy to endure? As a result, they ended up with stereopsis and were less likely to fall down and break a hip.”
—Neil Ross, MD
“How well Ann and I remember him and Joy at the OAS meetings. He was always very much of a gentleman and provided much knowledge and experience to help further the development of a new medical subspecialty. I can remember evenings sitting with him and others in the hotel discussing the development of eye anesthesia and what should be allowed in the free standing clinics. Like many of us, he was adamant that good medical practice in a free standing clinic should include a clinician other than the ophthalmologist, one who could evaluate and treat general medical conditions before surgery was performed or before the patient was discharged.”
—Sid Smock, MD
“Simply said, Bob Hustead changed my life. I met him at the Hawaiian Eye in 1986, learned about the Hustead painless technique, and took the lessons home. The next clinical day, I noticed a huge difference. Patients were happier and my professional life improved. In that regard, Bob added years to my professional practice.
Over the years, Bob’s obsession with patient safety and improving ophthalmic anesthesia has helped millions of patients have a better and safer experience during eye surgery. [Don’s comments here underscore the sentiments of so many. Bob’s life and works have benefitted untold numbers of patients, not just those he personally cared for, but also all of the patients cared for by those of us who learned from him and who continue to spread his lessons.]
I went to visit him in Wichita in 1987. I observed his techniques and just toured Wichita. I had never been to Kansas and the visit changed my opinion of the area. Nine years later Bob invited me to continue his practice at the Ochsner Eye Clinic when he and Joy retired. I came to Wichita and have been glad I did ever since.
In obstetrical anesthesia, I have used the Hustead needle. Unlike many others, Bob never profited from his design. He dedicated his life to patients.
My life was changed the day I met Bob Hustead. I am grateful to him every day.”
[Again, Don voices a sentiment shared by those of us who knew Bob personally and were influenced by his work.]
—Don Hirschman, CRNA, MHA, ND
“I started working in Gimbel’s Eye Centre [in Calgary, Alberta, Canada] in January 1983. Shortly after that I became cognizant of a new society, the Ophthalmic Anesthesia Society that had just held the first of what would become annual meetings. The driving force behind this was a Bob Hustead, whose name was known to me in association with a special epidural needle which bore his name. I registered for the second annual meeting to be held in Houston, Texas, and there I was to meet Bob for the first time. I very quickly knew that within that society I could acquire insights into techniques pertaining to ophthalmic regional anesthesia that were not available anywhere else. I made certain from then on that I would not miss that annual event. The annual meeting some years later was held in Banff, Alberta, my home province, and it was a great thrill to have Bob in our midst. This included his doing some eye blocks right in our clinic.
The medial compartment block was introduced and fine tuned by Bob. I was delighted that he agreed to publish his experience with it in 1994 in the Journal of Cataract and Refractive Surgery.
Bob was a bit of a practical joker. Some years back he and Joy joined with Betty and me at a restaurant. When my soup was served, there floating in the middle was a colorful plastic eyeball!
About three years ago we at the Gimbel Eye Centre had the honor of having Bob as our patient for bilateral cataract surgery.”
—Roy Hamilton, MB, BCh
“My first memory of Bob is different than most. I attended my first OAS meeting in Banff in 1991. During a break I went into the Men’s Room, and there was Bob Hustead talking to Roy Hamilton. Bob was talking fast and trying to convince Roy to become the next president of OAS. Neither of them knew me at that point, so it was like being a fly on the wall. While reluctant at first, Roy ultimately agreed to become president, a very good thing, indeed.
My employers, Lynn Hauser and Neil Ross, insisted that I do two things before being formally accepted into their practice: I had to attend a meeting of the OAS and I had to spend a day with Bob Hustead in Wichita. In July 1991, I left Ames, Iowa, on a Sunday and drove to Wichita and became a guest of Bob and Joy. As things were rather busy that afternoon in the Hustead household, they invited me to take a walk around the neighborhood, which included a rather large pond. I knew that I was making a monumental decision in my life, leaving a very successful practice and heading into the unknown. It was an interesting walk around that pond, filled with thoughts of uncertainty and trepidation. That night Bob gave me a stack of literature to read and sent me off to bed. Early in the morning we were off to the hospital. There I witnessed a man dedicated to his work, skilled in its execution, and supported by a CRNA, his wife, Joy, who gave their patients extraordinary care and kindness. Together they epitomized the competent and compassionate anesthesia team. When the day was over I felt very comfortable with my decision to embrace ophthalmic anesthesia, and I haven’t regretted it for one moment.
Both Bob and Roy were brought to Sycamore by my employers, Lynn and Neil, to evaluate and critique my practice. We did a dissection together at Northern Illinois University while they were there. Several months later we did another one, putting this one on tape so that we could show it at the next OAS meeting. Learning orbital anatomy first hand from the two of them was one of the most wonderful gifts I have ever received.
Bob Hustead was a unique individual, someone who influenced us all. We wouldn’t be here, had it not been for his passion and devotion. Quite simply, Robert Hustead was one of the most unforgettable human beings I have ever known.”—Gary Fanning, MD