Updated: Sep 12, 2018
I never intended to go into pain management. "There's nothing in the world that could make me go into that field!" was my mantra in residency; it was O.R. all the way for me. Until...
"You've got to help! They're killing her!" I was leaving the preop bay where I had just finished assessing a patient and consenting her for anesthesia for an operation intended to try to help with her severe chronic pain issues when I felt my arm being grabbed from behind. The distraught young man was pleading fervently about his wife, but I had no context for his entreaties. After a few moments I figured out that he was talking about the young woman I had just seen, and tried to consent for combined epidural and general anesthesia per her surgeon's request. I had found the request a little odd, since we don't generally place epidurals for that particular operation, but the surgeon (who knew the patient's history) foresaw that she wouldn't do well without it from a postoperative pain standpoint - she was addicted to prescription opioid drugs.
I'd tried to sell her on the surgeon's plan, but she'd had less than zero interest, and we certainly don't push people into these things. So I'd consented her for general anesthesia and was heading into the OR to get ready for the case when the young man ran me down in the hallway. He proceeded to explain through his tumultuous emotions that due to failure of various physicians from Wasilla to Seattle to be able to adequately control her pain, she'd wound up at a pain clinic in Anchorage and became hooked on opioids. At this point she was a zombie, taking enough opioids and other sedatives to literally kill someone who hadn't built up a strong tolerance to the drugs, and everyone in her family besides her could see the handwriting on the wall.
I went back into the preop bay to speak with her again, and meanwhile her mother had been persuading her to go along with the surgeon's plan. Having more background, and being moved by Something I couldn't explain, I told her that since I'd be in the hospital for the next 72 hours anyway (those weekend call shifts were brutal back then) I would be happy to keep her pain-free using an epidural catheter for 3 days while detoxifying her off of her normal drugs. She reluctantly agreed to try, and over the course of the weekend, I saw a life reclaimed - snatched from the inevitable pathway of ruin she had been on. A completely different person left the hospital - one I wouldn't have recognized at all the Friday prior.
We kept in touch for several months after that, and although she doesn't know it, from time to time after we stopped communicating I've checked on social media to make sure she was still doing well. Last time I looked (it's been probably 4 or 5 years at the time of this writing) she was being promoted. She hadn't worked in a few years prior to our meeting.
There were other factors that led me to leave the O.R. I knew and enjoyed so much, but that experience carried the most emotional currency yet at that point. In some ways, having seen that story play out so many hundreds of times since, I've wondered why I was so reticent to get involved in chronic pain management previously. (In the decade prior, I was involved while serving in the USAF because our commander mandated it, but once I became a civilian I left all pain management other than acute pain issues in the hospital behind me.) That is, until the opioid epidemic began to rear its ugly head full-force in the medical field here in SouthCentral Alaska, reaching even into the perioperative arena and capturing my attention with stories like the one above.
There were numerous other personal growth developments that needed to happen first in my life before I'd be remotely ready to try to help guide people - body, mind, heart, soul and spirit - through the crucibles of their suffering. And I pray and trust that my competence and compassion continue to be shaped by my Great Teacher and Physician to navigate that wilderness.
A couple years prior to my transition into full-time pain management, I'd been blessed to serve for a month on a short-term medical mission trip with Franklin Graham's World Medical Mission, in remote Western Kenya (Kapsowar.) I'd been searching for something to try to fill a growing spiritual void in my life, and certainly my professional one. While the experience was one of the highlights of my life, I learned a very valuable lesson on that trip : you can't really make a difference someplace unless you are entrenched in, and committed to that community. Not that we (or short term workers in general) can't and don't do an awful lot of good; but without relationships being cultivated, long-term trust being earned, etc., one's impact is really pretty limited.
And so after lots of deliberation, discussion, prayer, and a radical mid-career overhaul, we formed Northern Anesthesia & Pain Medicine LLC out of its predecessor. We have believed, and continue to believe with all our hearts that God called us to this mission in our own neighborhood.
1995. After a few years of working a lot of odd jobs (a microbiology degree doesn't count for much in the real world, I learned the hard way) I began working on a Master's Degree in Public Health at the University of Colorado. I finished the degree in 1997, and for nearly twenty years had no idea what relevance that time (and expense) would have to the rest of my career.
1997. I started medical school at the University of Colorado. After graduating in 2001 we moved back East to complete an internship and residency in anesthesiology at the peerless University of Virginia.
2005. I served as an anesthesiologist and pain physician, and ultimately medical director of the anesthesia department at Elmendorf Air Force Base in Anchorage, Alaska.
2008. For the next four years after leaving the Air Force I worked as an anesthesiologist and pain physician at various hospitals in SouthCentral Alaska. In 2011 I had a life-changing experience taking care of a young woman addicted to opioids, and that experience (her recovery) was one of a few key events that catalyzed the decision to go back for more in-depth formal training in advanced interventional pain management. I was fortunate to meet and train with Drs. Paul Lynch and Tory McJunkin (Arizona Pain Specialists, Paindoctor.com) as the second fellow in their private practice fellowship program. The sheer volume of patients and procedures was staggering; I performed over 350 radiofrequency ablation procedures alone (and hundreds of other procedures) during the year I spent training with them.
2013. We diversified Northern Anesthesia, LLC to include Northern Anesthesia & Pain Medicine, LLC, opened our new clinic in Eagle River, and I finally left the operating room for good. In addition to my previous board certification in Anesthesiology, I became board certified through the American Board of Pain Medicine, and more recently (given the pressing community need) through the American Board of Addiction Medicine (now overseen by the American Board of Preventive Medicine.) Over the past few years I've been honored to serve as the Secretary and more recently Vice President of the Alaska Society of Interventional Pain Physicians.
For the past three years I have been privileged to serve as the medical consultant to Set Free Alaska, a Christian treatment center that uses a mind-body-spirit approach to addiction recovery. In response to requests from our Department of Health and Human Services, I've served on the Alaska Medicaid Drug Utilization Review Committee and on the Statewide Opioid Action Plan Committee.
I have thoroughly enjoyed serving as a clinical instructor for the University of Washington School of Medicine's Department of Anesthesia & Pain Medicine, and the Providence Family Medicine Residency Program, teaching and influencing the next generation of physicians. Education is a privilege and responsibility we take very seriously, and I'm proud to say that so far we have received the equivalent of a 5-star rating from every single student that has come through our clinic. I'm proud to say that an academic book I wrote in 2017 (Opioid Dependence: A Clinical and Epidemiologic Approach) has been selected as the text for a new University of Alaska Anchorage course addressing the opioid epidemic, and I've been honored to be a part of the faculty for that course as well. I've gladly provided several lectures to community physicians and other providers from Girdwood to Fairbanks over the past several years on topics related to pain management upon request - again, we take education very seriously.
Contributing to the global state of medical knowledge is tremendously important to me, and here at NAPM over the past few years we've been able to amass a considerable amount of data providing ever-expanding clinical research, some of which we are beginning to publish at this point.
Recently I've been honored by the American Academy of Pain Medicine to act as one of two contributors to the AAPM blog, hosted by MedPage Today. (That role is actually what catalyzed the creation of this site, and those posts are reproduced here on this site.)
None of these things though are what keep me going in pain management, a field that as some may know can take a heavy emotional toll. Being invited to share in the pain of another human being and at the very least offering sympathy (if not symptomatic improvement) is a sacred privilege full of emotional, intellectual and frequently spiritual reward that I wouldn't trade for any other vocation. I'm blessed beyond my imagination to work with the best people in the world at NAPM, every single one of whom is committed to our mission of trying to show the love of God to people in pain . Above all though, I believe firmly that this is what I've been called to, and where I'm supposed to be - and that's Heaven's response to my challenge from nearly two decades ago. As it turned out, nothing in this world did push me into this field - it came from beyond.
-Heath McAnally, MD, MSPH
27 Aug 2018
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