Newsletter

Volume 51, Number 10

Inside This Issue

Picture of Joseph Chen, MD

Joseph Chen, MD

CANS President

Cause and Effect

President's Message

As my term as your CANS President nears its end, I again wish to express my gratitude to you, the members of this organization.  Our organization and elected board strives to serve your interests as California Neurosurgeons.  

We take seriously our mission and responsibilities to you: the defense of the physician-patient relationship, the right and means to serve our patients with dignity, the advancement of patient care with science and technology.  There are many forces that seek whether intentionally or not to deprive us of these key pillars of the public service that we are devoted to.

Our annual meeting has been for over half a century been a forum for us to network, learn and organize on behalf of the profession that we hold dear.

I’m honored to invite you to attend our next annual meeting, at the historic Intercontinental Mark Hopkins Hotel on Nob Hill in San Francisco, January 12-14, 2024.  Your association has been able to negotiate special room rates at a superb venue.

A varied and exciting program has been put together:  

We will be welcoming a new generation of California academic neurosurgical leadership, examine the aftermath of AB35 on the malpractice scene, learn about physician unionization from the largest health care labor organization in the country, hear of the continued systemization of care, the evolving legal basis of brain death, and many more topics.  

A minisymposium on the topic of the elderly spine has been assembled by recognized experts in the field.  Leadership from national organized neurosurgery will deliver timely updates.  Also, the latest scientific advancements by neurosurgical trainees from across the state will be presented.

Importantly, you will have the opportunity to learn about the latest technical offerings from biomedical companies and instrument manufacturers that may aid or even transform your practice.

Lastly, I’m looking forward to celebrating with you our profession at our Saturday banquet. Please register here and reserve your room before the discount expires HERE!

On behalf of CANS, our best wishes to you and your loved ones for the Holiday Season and New Years.  Take care and see you soon.

Best,

Joseph Chen, MD

Picture of Moustapha AbouSamra, MD

Moustapha AbouSamra, MD

Chair Publications Committee
Editor CANS Newsletter

Editor's Corner

Joanie and I celebrated our 50th wedding anniversary on August 18, 2023, but planned an elaborate trip to Spain and Morocco from October 6 to November 8 to commemorate this milestone in our family life.

Austin Colohan, CANS Historian and frequent contributor to the newsletter, kindly accepted to guest edit the October issue in my absence. The issue was published without incidents. Thank you, Austin.

A colleague and member of CANS, Henry E. Aryan, MD, wrote me a letter as the editor, wondering why the events in Israel and Gaza were not even mentioned in the newsletter; he was concerned as a physician about the unfolding humanitarian crisis.

As a neurosurgical, non-political, socio-economic association, CANS has no history of taking a position on political issues or humanitarian disasters, so there are limitations on what it can deal with.

Please find a statement by “organized neurosurgery” issued on October 13, 2023. The “organized Neurosurgery” group included the American Association of Neurological Surgeons, the American Academy of Neurological Surgery, the American Board of Neurological Surgery, the Society of Neurological Surgeons, and the Congress of Neurological Surgeons.

Also, please read an essay by Ian Ross about the “need to tread carefully in polarized times.”

In this issue, please read President Chen’s invitation to the Annual Meeting, January 12-14, 2024. A registration form and a link to make a hotel reservation are included. You will also find the routine columns. However, “Changing Times” will not be published this month due to an editorial disagreement with the Executive Committee. “Changing Times” columns were published without interruption for over six years.

If you have any questions or suggestions, please call me at 805-701-7007 or email me at mabousamra@aol.com

Organized Neurosurgery’s Statement on the Events in the Middle East

As neurosurgical professional organizations, we are shocked and saddened by the events occurring in Israel and the Gaza Strip, resulting in the loss of innocent lives and widespread fear and suffering. We strongly condemn this terrorist attack on Israeli civilians and the horrific systematic and intentional targeting of innocent civilians — particularly women, children and infants — by Hamas. While decrying the unspeakable atrocities committed by that organization, we simultaneously and fervently maintain that any governmental response to that savage, unprovoked attack must abide by international standards of moral conduct, particularly protecting, wherever and whenever possible, civilian lives. 

As organizations dedicated to education, research, treatment and advocacy related to diseases of the brain and spine — conditions that constitute many of humanity’s most common, consequential and debilitating afflictions — we are committed to advancing the health, safety and well-being of individuals worldwide, regardless of nationality, ethnicity or religious background. As such, we extend our heartfelt condolences to the victims and their families affected by this tragic event, and we stand with the medical professionals — including our neurosurgical colleagues in the region — and first responders who are working tirelessly to provide life-saving care to those injured in the attack and ongoing conflict.

Furthermore, we wish to express our unequivocal condemnation of violence as a means of advancing individual or national self-interests, wherever and whenever such tyrannical disregard for human life, dignity and freedom takes place. There is never any justification for the planned and intentional slaughter of innocent civilians, sexual violence and hostagetaking.

We hope for a swift cessation of hostilities, the release of the hostages and the restoration of regular societal order that is respectful of the basic rights that fundamentally and inherently belong to all human beings and enables health care providers to carry out their essential work in an environment of safety and security.
Sincerely offered by the American Academy of Neurological Surgery, American Association of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons and Society of Neurological Surgeons on behalf of our neurosurgical colleagues and the global society we are privileged to serve. October 13, 2023.  

Picture of Ian Ross, MD

Ian Ross, MD

A Personal View

The Need to Tread Carefully in Polarized Times

“That love is greater than hate, understanding greater than ire, peace nobler than war, this is exactly what this unholy … war should burn into our memories.”

Hermann Hesse wrote these words and then had them published in a Swiss newspaper, Neue Zürcher Zeitung, on November 3, 1914 just a few months after the start of World War I. He was German. The title of his little article was “O Freunde, nicht diese Töne!” (Oh friends, not these sounds). Some classical music fans will know that these are the first words of the choral finale of Beethoven’s 9th symphony, Ode to Joy, which was also the title of a 1785 Friedrich Shiller poem from which Beethoven borrowed/modified the lyrics. The triumphant poem addresses the unity of all mankind.

Hesse was responding to the toxic nationalism that was fueling the “Great” War, attempting to appeal to the educated, intellectual elite. Hesse, a German national, was then living in neutral Switzerland. But he was an influential writer and got a lot of flak from all levels of German society that had been swept up by nationalist fervor. It is not a surprise that he did not end up a great fan of Nazism, either. Hesse was interested in Eastern religions and spent time travelling in Southeast Asia before settling down in Switzerland. His novels, most of which explored the individual’s quest for self-knowledge and spirituality, won him the Nobel Prize for Literature in 1946.

There is much that has been written on the recent hostilities in the Gaza Strip, and considerable acrimony has resulted. It is at the point that my wife and I have decided to not discuss it among ourselves, let alone friends. Feelings are strong. There has been tremendous suffering on all sides. The root causes and possible solutions are complex. Any equation for remediation will require coefficients that presently seem incalculable.

It is simple to express condemnation and concern regarding the suffering that has been imposed by this conflict. Modern media makes current conflicts less abstract than those from a century ago. We humans are capable of great sympathy and it is impossible to not be moved by what is going on, and to feel some compunction to do something.

But what? Are words appropriate? Even they can be injurious. Perhaps it is better to say nothing.

The First Amendment gives us the right to say what we want, most of the time, without fear of legal repercussions. But that does not mean that everything we say or do will meet with universal approbation. Sadly, things are so polarized that almost any expression of empathy for one group or the other will be met with harsh criticism from the other side. We need to tread carefully.

I am not a hawk, but nor am I a dove. I have served in the military (albeit very briefly as a reservist and never in a conflict). My father fought in Korea, while both of my grandfathers fought in Europe in the Great War. I understand that it is often necessary to take a side and fight.

The expression of humanitarian sympathy for a certain group seems benign to me, but I do understand how the world works. Hesse got in trouble for what he said. Was it his sin that he did NOT take a side? His words ring true, at least to me, after all these years.

John Lennon’s song Imagine, though a little too idealistic, has a similar resonance during these times. I suppose that I am going to offend someone, but I am willing to go on the record for this one, as I try to (i)magine all the people living in peace …

Quote of the Month

My only consolation when I am really sad is to love and to be loved.

Marcel Proust

Never apologize for showing feeling, my friend.

Benjamin Disraeli

Picture of Sharona Ben-Haim, MD

Sharona Ben-Haim, MD

UC San Diego, Department of Neurological Surgery
Chair, Women in Neurosurgery – WINS

Women in Neurosurgery

Mentorship – Parental Leave

In 1961, Ruth Kerr Jakoby became the first female Diplomate of the American Board of Neurological Surgery. Since that time, we have seen an exponential increase in the number of women entering the field each year. While we are on a promising trajectory, we continue to fall far short of achieving gender equity in our profession. Women now make up a majority of medical students, and yet currently comprise only 19% of neurosurgical residents, and approximately 12% of board certified

neurosurgeons. While we expect this number to continue to rise, it is evident that if our subspecialty continues to suffer

from this striking gender mismatch, we will face a shrinking pool of interested applicants.

Female ABNS Diplomates by Decade. Adapted from Plonsker, et al. 2022

If we are to continue to attract the “best and brightest” into our specialty, we need to make a concerted effort to address the systemic barriers in the recruitment and promotion of talented women in the following ways:

  • Mentorship – Because women make up a minority of existing neurosurgeons, we need to intentionally provide broad and early access to mentorship for female medical students interested in entering the field. Furthermore, we should strive to improve mentorship at all levels, including for residents, and women neurosurgeons in early practice. In attempting to address this barrier, over the past 3 years Women in Neurosurgery (WINS) has instituted a national mentorship program, pairing residents with medical students and practicing neurosurgeons with residents. Mentorship meetings occur in small groups, which serve to create accountability and foster networking. So far, over 400 women have participated in this program, with promising results.
  • Parental Leave Policies – It has become clear that female medical students are aware of the challenges with pregnancy, breastfeeding and inadequate parental leave policies in many surgical specialties, and some cite these as influential in career planning. Neurological surgery boasts one of the longest residencies, which largely coincides with prime childbearing years, for both women, as well as the spouses of male neurosurgeons. While parental leave policies are ultimately governed by several policies, including local GME, ACGME, ABMS, and ABNS policies, it is ultimately the interpretation of these policies on a Departmental level, and the local culture surrounding parental leave, which governs how comfortable residents are in utilizing these policies. To combat this, Departments must promote and enforce family leave policies for all neurosurgeons, normalize conversations around these issues, and actively discourage discrimination, including peer-to-peer discrimination. The field of neurosurgery, along with WINS, has identified this as a barrier, and is currently working to create a more standardized approach to integrate these concepts into our culture.
  • Harassment – The historical culture of neurosurgery was fraught with an alarming rate of harassment. While this has largely significantly improved, some remnants of this culture continue to deter women from entering the field. Departments must actively look to identify and address harassment with a zero-tolerance policy, including establishing a safe reporting structure.

As a neurosurgical community, we must strive to continue adapt to a workforce ethic that increasingly values work-life balance, stress mitigation, and avoidance of burnout, and do so in a way that maintains our culture of excellence. Although we have made great strides in the representation of women in our field, we look forward to the next decade to bring us closer to achieving gender equity and creating a culture for women to not only survive, but thrive, within the field of neurosurgery.

Plonsker, Jillian H. MD*; Benzil, Deborah MD; Air, Ellen L. MD, PhD§; Woodrow, Sarah MD; Stippler, Martina MD; Ben-Haim, Sharona MD*. Gender Equality in Neurosurgery and Strategic Goals Toward a More Balanced Workforce. Neurosurgery 90(5):p 642-647, May 2022. 

Gupta M, Reichl A, Diaz-Aguilar LD, Duddleston PJ, Ullman JS, Muraszko KM, Timmons SD, Germano IM, Abosch A, Sweet JA, Pannullo SC, Benzil DL, Ben-Haim S. Pregnancy and parental leave among neurosurgeons and neurosurgical trainees. J Neurosurg. 2020 May 29;134(3):1325-1333.

Benzil DL, Muraszko KM, Soni P, Air EL, Orrico KO, Rutka JT. Toward an understanding of sexual harassment in neurosurgery. J Neurosurg. 2020 Nov 10:1-10.

Benzil DL, Abosch A, Germano I, Gilmer H, Maraire JN, Muraszko K, Pannullo S, Rosseau G, Schwartz L, Todor R, Ullman J, Zusman E. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. J Neurosurg. 2008 Sep;109(3):378-86. 

Dixon A, Silva NA, Sotayo A, Mazzola CA. Female Medical Student Retention in Neurosurgery: A Multifaceted Approach. World Neurosurg. 2019 Feb;122:245-251. doi: 10.1016/j.wneu.2018.10.166. Epub 2018 Nov 2.

Photo of the month

 

Photo taken by Moustapha AbouSamra, MD at 5:59 PM, on November 6, 2023, in Málaga, Spain. iPhone 13 Pro

Picture of Anthony M DiGiorgio, DO, MHA, FAANS

Anthony M DiGiorgio, DO, MHA, FAANS

Academic Practice Corner

Is This Fair?

Should California’s wealthiest citizens have access to social support programs which were designed for the poor?

MediCal (California’s version of Medicaid) is one such program.  Funded by state and federal taxes, it is to provide healthcare financing for the poor and the disabled.  It was designed to help those with limited resources receive access to essential healthcare.  There are income and asset thresholds for Medicaid to ensure the wealthy cannot divert scarce resources away from those who need it. 

However, California is opening MediCal for millionaires and billionaires by eliminating all asset thresholds for qualification.

California’s poor will be harmed by this policy.  MediCal is a large funder of long-term services and supports (LTSS), which provide both institutional and home-based care for patients who are no longer independent.  We, as neurosurgeons, see many of these patients who need a lifetime of care. Because LTSS are already so scarce, we see brain-injury patients linger in the hospital for months even after they are medically stable.  These patients will be further deprived if the wealthy are allowed access to MediCal.

Accessing MediCal allows the wealthy to protect their assets from being depleted in paying for long-term care.  Medicare has limits on long-term care payment, so people who don’t qualify for MediCal must often find ways to finance LTSS.  If the wealthy use MediCal, their generational wealth will be preserved while the government foots the bill for LTSS.  Furthermore, since the federal government splits the costs for MediCal, US taxpayers are funding this.  The rest of the nation already looks down on California.  How will federal taxpayers react when they realize they are funding the perpetuation of rich Californian’s generational wealth?

There are a myriad of tax loopholes and protections for the wealthy to pass assets on to their children.  California is creating another one through MediCal.  Using a program designed to help the poor and disabled so that the wealthy don’t need to liquidate assets just diverts more money away from the vulnerable and into the generational wealth of California elites.  Paying for care in old age is why a lifetime of saving is encouraged with the current tax code.  Those assets are meant to pay for care in old age.  If anything, MediCal should be more aggressive about reclaiming assets to pay for LTSS.  The amount diverted is already in the billions of dollars with existing loopholes.  The California law, which goes into effect in 2024, will only worsen matters.

We, as neurosurgeons, also know that MediCal reimburses below Medicare for most physician services.  If more funds are diverted to pay for LTSS in wealthy beneficiaries, less funds are available to pay for physicians, therapists, social workers, and hospital services.  This will worsen access to care, as fewer clinicians will accept MediCal.  This is how poor policy choices perpetuate and worsen disparities. 

This is just another instance of California’s attempts to expand MediCal.  Legislators have been trying for years to get a single-payer plan enacted, which would, essentially, be MediCal for all.  This scheme appears to be a bribe to ensure the wealthy back this plan and that state-run healthcare is politically palatable as long as it protects generational wealth. 

The change has been approved at both the state and federal level.  The law was signed on July 27, 2021 and approved by the federal Centers for Medicaid and Medicare Services (CMS).  Notably, this was done without public comment.  Ironically, CMS recently rescinded a Texas waiver to create an uncompensated care payment fund because of a lack of public comment.  CMS should correct this mistake and ensure there is public comment for the change to MediCal.  Because federal taxpayers are partially funding this expansion, they have a constitutional right to comment.  Congress can also intervene by cutting off federal funds to states that are out of compliance with the original Medicaid legislation’s intent.  The program is meant for the poor and should be protected so it is just for the poor.

This issue should cross partisan lines.  Even if one favors a single-payer system, expanding MediCal to the wealthiest is not the first step.  Let those who can afford to pay for their healthcare pay for it themselves while programs meant for the poor can finance their care.  We should speak up to stop these policies from exacerbating disparities.

From CMA

DMHC to require annual inflation increase to AB 72 default payment methodology

As a result of California Medical Association (CMA) advocacy, the California Department of Managed Health Care (DMHC) has finalized regulations that will add an annual inflation adjustment to the interim payment methodology required by California’s out-of-network billing and payment law (AB 72, 2016). AB 72 applies to covered services provided to fully insured enrollees by out-of-network physicians providing non-emergent care at in-network facilities.

Biden orders HHS to take wide-ranging action on artificial intelligence in health care

The Biden administration this week issued a landmark executive order on artificial intelligence (AI). The order establishes new standards for AI safety and security, protects Americans’ privacy, advances equity and civil rights, stands up for consumers and workers, promotes innovation and competition, advances American leadership around the world, and more.

DMHC releases first round of behavioral health investigation reports

In 2021, the DMHC Division of Plan Surveys began conducting investigations of all full-service commercial health plans regulated by DMHC to assess barriers and challenges providers experience in providing behavioral health services. DMHC recently released the first five reports resulting from its initial round of investigations.

CalHHS announces nine Qualified Health Information Organizations for DxF

In a significant move toward enhancing health care and social services data exchange in California, the California Health and Human Services Agency (CalHHS) has designated nine Qualified Health Information Organizations (QHIOs). QHIOs play a fundamental role in the success of the Data Exchange Framework (DxF), effectively bridging gaps in California’s data exchange infrastructure.

CalHHS now accepting applications for Round 3 of data sharing grants

With a January 31, 2024, deadline approaching for many entities to begin securely exchanging health information under DxF, the CalHHS Center for Data Insights and Innovation (CDII) is now accepting applications for the third round of Data Sharing Agreement (DSA) Signatory Grants starting June 30, 2023.

Humboldt County physician receives CMA’s 2023 Plessner Award

Humboldt County internist Bruce Kessler, M.D., received CMA’s most prestigious award, the Frederick K.M. Plessner Memorial Award. The award honors the California physician who best exemplifies the ethics and practice of a rural country practitioner. Both during his time as a practicing physician and after his retirement in 2018, Dr. Kessler worked to create and expand medical programs and services for rural residents.

Sacramento physician receives CMA’s 2023 Gary Nye Award for promoting physician wellness

Sacramento ob-gyn Laurie Gregg, M.D., received the 2023 CMA Gary S. Nye Award for Physician Health and Well-Being. The award is presented each year to a physician who has made significant contributions toward improving physician health and wellness. As the chief wellness officer at Sutter Independent Physicians, Dr. Gregg instituted an organizational focus on well-being.

Shasta County physician receives CMA’s 2023 Compassionate Service award

Shasta County family medicine physician Debra Lupeika, M.D., received the 2023 CMA Compassionate Service Award. The award is given annually to the California physician who best exemplifies CMA’s commitment to community and charity care. Dr. Lupeika is the Family Medicine Program Director at the Shasta Community Health Center (SCHC), where she was instrumental in establishing an accredited family medicine residency program.

PHC announces latest cohort of CalHealthCares awardees supporting underserved communities

The California Department of Health Care Services (DHCS) and Physicians for a Healthy California (PHC) announced a new commitment of $73.4 million to help pay down student loans for 266 physicians and 36 dentists in California to expand the health care workforce and increase access for Medi-Cal members. The CalHealthCares student loan repayment program supports and incentivizes physicians and dentists to increase their participation in the Medi-Cal program.

PHC medical student grant application cycle now open

Medical students, do you have an idea for a project that benefits your community but need funding? The PHC MedStudentsServe program offers grant money to support medical student projects that enhance the health and well-being of California’s communities. The current application cycle ends January 5, 2023, at 5 p.m.

Historical Vignette


History of Academic Neurosurgery in the Inland Empire

The Inland Empire (referred to as the “IE”) is a region approximately sixty miles inland from the coastal parts of southern California and the Pacific Ocean, and centered around the cities of San Bernardino and Riverside, and their eponymous counties. The IE borders six southern California counties: San Diego and Imperial Counties to the south, Orange County to the south-west,  Los Angeles and Kern counties to the west, and Inyo county to the north (see map).   At slightly over 20,000 square miles, San Bernardino county is the largest county in the USA, being four thousand square miles larger than the country of Switzerland.  The combined areas of San Bernardino and Riverside counties is larger than ten US states, and fifty-seven member countries of the United Nations. The IE is currently home to 4.7 million people, or approximately half of Los Angeles County, and comprising the second largest population area in California.  

To avoid Julius Cesar’s penchant to refer to himself in third person, I take the liberty to use the pronoun “I” where it is appropriate.  Having completed neurosurgery residency in London, Ontario, Canada with Dr. Charles Drake,  I arrived in the IE in 1996, right out of fellowship with Drs. Ossama Al-Mefty and Gazi Yasargil.  In the past 27 years that I have been living in the IE, I have observed an immense growth in “knowledge industries”, including expansion of healthcare and biomedical technology jobs.  In 2023, the IE is one of only six cities/regions in the USA with four medical schools and three neurosurgery residency programs, the other five being Boston, Chicago, Los Angeles, New York, and Philadelphia.  Located within 30 minutes drive of each other,  the four medical schools in the IE include Loma Linda University School of Medicine (1909), Western University College of Osteopathic Medicine (1977), UC Riverside School of Medicine (2008), and California University of Science & Medicine School of Medicine (2015).  These medical schools have attracted students and faculty, elevating the upper end of the educational demographics in the IE.  The IE is served by two county hospitals, Arrowhead Regional Medical Center and Riverside University Health System Medical Center, both of which are teaching hospitals for all four regional medical schools, while also hosting multiple residency programs, including distinct neurosurgery residency programs.  Loma Linda University Medical Center is the oldest academic facility in the IE, being home to multiple residency programs, including neurosurgery.  Accordingly, the IE has the a very important historical and evolving role in medical education, and neurosurgery training, in the broader higher education story of California.  I am proud to have founded, from scratch, a team of neurosurgeons that has had an impactful influence on two of the three neurosurgery residency programs in the IE, and directly or indirectly on students from all four medical schools.

This brief historical vignette on academic neurosurgery in the IE is limited to the neurosurgery residency programs at Arrowhead Regional Medical Center (ARMC) and Riverside University Health System Medical Center (RUHS-MC).  I refer the reader to Drs. Ramanathan and Dye’s Historical Vignette on “History of Loma Linda University Neurosurgery” in the CANS August 2023 Newsletter issue.

CANADIAN INFLUENCE:   One interesting quirk I do want to mention about all three IE neurosurgery residency programs:  there has been a striking Canadian connection to all the IE’s neurosurgery residencies.  Five of seven neurosurgery chairs at LLUMC, starting with the founder Dr. George Austin, and including Drs. Lloyd Dayes, Dr. Shokei Yamada, Dr. Austin Colohan, and ending with Dr. Warren Boling were Canadian or Canadian-trained (largely, but not exclusively, at the Montreal Neurological Institute).   As former President of CANS and the Western Neurosurgical Society, Dr. Austin Colohan, played a significant and meaningful role in the Inland Empire, and in organized neurosurgery; his role in academic neurosurgery in the IE should not be underestimated.

As the founder of both the ARMC and RUHS-MC Neurosurgery residency programs, my own Canadian roots are also self-evident.  My own Neurosurgery Residency Program Directors, Dr. Charles Drake and Dr. John Girvin, were avid supporters of cross-border neurosurgery education collaborations between Canada and USA, and it was very common for us to have one or more American neurosurgery fellows at any given time.  The fact that Dr. Wilder Penfield was an American, who became Canada’s most famous neurosurgeon, surely had something to do with this intimacy between Canadian and American neurosurgery; the fact that USA and Canadian medical schools share an accreditation body also allows for easy movement across the border.  It is no exaggeration to say that Canada has had an impressive influence on academic neurosurgery in the Inland Empire, perhaps culminating in 2016 with the Government of Canada awarding me a Coat of Arms from the Governor General of Canada, on behalf of the Queen of Canada, in recognition of my contributions to neurosurgery education in the USA.  (Reference:  https://www.gg.ca/en/heraldry/public-register/project/2769).  The legacy of Canada’s most famous neurosurgeons, Drs. Wilder Penfield and Charles Drake, are alive and well in the IE, and being actively transmitted to our own residents.

The ARMC Neurosurgery Residency Program:

What is currently the ARMC Neurosurgery Residency Program was founded by me in 2015 at Desert Regional Medical Center (DRMC) in Palm Springs as an AOA-accredited residency program, which reached a peak of 14 residents.  Prior to 2015, former ARMC/RUHS Neurosurgery residents rotated at DRMC for a decade as my medical group arrived in Palm Springs to establish an academic presence.  The DRMC Neurosurgery Residency Program remains AOA-accredited, and was re-named the ARMC Neurosurgery Residency Program on 7/1/2023, when ARMC became the Primary Site (with DRMC, Redlands Community Hospital, and Kaiser Anaheim continuing as highly popular off-site rotations).  Children’s Hospital of Los Angeles, as well as Naval Medical Center San Diego, were important former rotations for the original DRMC neurosurgery residents, but these two rotations faded away as the program arrived at ARMC with remaining 8 residents being PGY5 or higher in rank.  The current eight ARMC Neurosurgery residents are expected to ‘train out’ at ARMC by 2026, and will not be replaced as they graduate.  This will end a unique aspect of academic neurosurgery in Palm Springs, and at ARMC.  The current eight ARMC neurosurgery residents are from eight different states, reflecting the national scope and contribution of the program and faculty. 

The RUHS-MC Neurosurgery Residency Program:

Founded in 1999 by myself as an ARMC Neurosurgery Residency Program, what is currently the RUHS-MC Neurosurgery Residency Program will be celebrating its 25th anniversary in 2024.  This residency program and its faculty have made an immense contribution to the IE, and in the USA more broadly.  This started as an AOA-accredited program, sponsored by Western University (Pomona), and evolved over time to the become the current ACGME-accredited program at RUHS-MC.   Along the way, the program was a joint program between ARMC and RUHS-MC, but the latter became the Primary Site at the time of ACGME transition. Multiple IE hospitals made important contributions to the training of RUHS-MC neurosurgery residents, including ARMC, Kaiser Fontana, Redlands Community Hospital, and DRMC.  Rotations outside the IE included Kaiser LA and excellent pediatric neurosurgery exposure was available at Children’s Hospital of Los Angeles (concurrently with USC, Cedars-Sinai and former DRMC neurosurgery residents).  The pediatric neurosurgery rotation evolved to Loma Linda University Children’s Hospital in the last couple of years, which remains a popular training site.

The ARMC & RUHS-MC Neurosurgery Faculty:

Since 1996 onwards, I had the privilege to recruit 24 neurosurgeon faculty for what are the current ARMC and RUHS-MC neurosurgery residency programs (photo below).  These faculty were all hired by Arrowhead Neurosurgical Medical Group (ANMG), which I founded and continue to lead.  (An equal number of non-ANMG faculty played a critical role in resident training and mentorship at offsite rotations including CHLA, Kaiser Anaheim, Kaiser Fontana, Kaiser LA, Kaiser Woodland Hills, Loma Linda Children’s Hospital, and Naval Medical Center San Diego).  Dr. Darryl Warner, my first neurosurgery graduate, first fellow, and early faculty member, passed away prematurely and is missed to this day; he is one of three ANMG neurosurgeons who are deceased.  Several ANMG neurosurgeons retired from the Group, and continue to keep in touch.  Four of these 24 neurosurgeons were neurointerventionalists, and were reinforced by multiple neurologist neurointerventionalists over the years (photo below).  My own subspecialty interest of skull base and vascular neurosurgery may have had some inadvertent influence on ANMG’s top heavy vascular and cranial expertise, but this was felt to be in the best interest of what the community, and our academic interests in support of our two neurosurgery residency programs.  With the exception of functional and pediatric neurosurgery, ANMG faculty provided comprehensive care for all subspecialties of neurosurgery. 

Dr. Glenn Fischberg, neurologist neurointensivists, rounded off the ANMG faculty, with a key role in training our neurosurgery residents in the neuro critical care unit over the past decade; he was joined in this mission by Dr. LeTreice Irving in 2022 (photo below).  An additional 24 neurologists worked part or full-time for ANMG over the years, adding their expertise to our medical group, and their skillsets to our academic assets—essentially, ANMG evolved into a more comprehensive and expanded version of what I had grown used to as a resident in Dr. Drake’s ‘Department of Clinical Neurological Sciences’ in London, Ontario.

ANMG Neurologist NeuroInterventionalist Faculty, 2010 to 2023:

ANMG Neuro Critical Care Neurologist Faculty, 2012 to 2023:

Glenn Fischberg, LeTreice Irving

Visiting Professors:  Starting with my mentor, Dr. Gazi Yasargil, as our first in-person Visiting Professor, our two neurosurgery residency programs have had an embarrassment of riches with respect to several dozen Visiting Professors, inperson pre-Covid19, and virtually during and after Covid19.  While most of our Visiting Professors were neurosurgeons, there were six notable non-neurosurgeons, including Doug Ethell (neuroscientist), Nicholas Kristoff (Pulitzer Prize winning journalist), Vivian Lee (healthcare and health tech executive and scholar), Christopher Murray (globally renowned epidemiologist and founder of the  Institute for Health Metrics & Evaluation), and Richard Pan (CA State Senator).  All visiting professors agreed to mentor our residents when necessary, and the residents’ training was truly enriched by interacting with giants in our field.  A list of these remarkable role models for our residents and faculty are listed below, in alphabetical order (with non-neurosurgeon names underlined:
AbouSamra, Moustapha
Adler, John
Ananda, Ajaya
Armstrong, Larry
Baaj, Ali
Beier, Alexandra
Berger, Mitchel
Cantando, John
Colohan, Austin
Del Maestro, Rolando
Dogan, Aclan
Ethell, Doug           
Gantwerker, Brian
Gonzalez, Nestor
Goplen, Gary
Hakuba, Akira        
Hariri, Omid
Hartl, Roger
Kim, Kee
King, Christopher
Krieger, Mark
Kristof, Nicholas
Lee, Vivian
Lee, Marco
Mangano, Franchesco           
Morgan, Jay
Mummaneni, Praveen
Murray, Christopher
Nussbaum, Eric
Pan, Richard
Panchal, Ripul
Quinones-Hinojosa, Alfredo
Qureshi, Adnan
Panchal, Ripul
Ratliff, John
Sekhar, Laligam
Siddiqui, Adnan
Siddiqui, Khan
Singh, Harman
Spetzler, Robert
Spinner, Robert
Steinberg, Gary
Taussky, Philip
Yasargil, Gazi
Yocom, Steven

International Medical Missions:

Other than ANMG neurosurgeons providing care to all Inland Empire patients,  irrespective of their ability to pay, we have also contributed to international humanitarian works via faculty and residents. For the last fifteen years, ANMG Medical Missions were conceived and led by Dr. Dan Miulli, the RUHS-MC Neurosurgery Residency Program Director.    This arduous but note-worthy work resulted in Dr. Miulli being presented the American College of Osteopathic Surgeons 2023 Humanitarian Award, which is acknowledgement for his international medical mission work that started in the orphanages of Tibet, and then expanded in their geographic reach to include work in India, Peru, Palestine, and for the last several years in Liberia.  This international medical mission work is an important contribution of the Inland Empire to the Global South.

Neurosurgery Graduates’ Success & Commitment to Life-Long Learning:

The two residency programs that I founded continue to have a 100% Post-Graduate Fellowship Rate, which I believe is a singular achievement.  All FIFTY ARMC and RUHS-MC neurosurgery graduates (photo below) have gone on to post-graduate fellowships at all but one neurosurgery residency program in California.  Stanford University and UC Davis have accepted the largest number of our graduates into their fellowships.  Outside California, our graduates have done post-graduate fellowships at Johns Hopkins, Mayo Clinic, Mayfield Clinic, University of Florida, University of Washington Seattle, and Swedish Neuroscience Institute, to name a few.  The subspecialty choice for our post-graduates have included skull base, functional neurosurgery, neuro-oncology, pediatric neurosurgery, peripheral nerve and vascular neurosurgery, though spine and endovascular neurosurgery are among the most popular.  Our dozens of faculty at both our Primary Sites, and our multiple off-site rotations, can take great pride in inspiring our graduates to take a broad interest in all aspects of neurosurgery.  Our Inland Empire neurosurgeon graduates have spread out across the USA, and currently practice in a wide swathe of the USA, from Alaska to Florida (albeit none in Hawaii as of yet).  Several of our graduates went away for their fellowships, and returned to join

our faculty, thus serving the Inland Empire community that trained them.

Both the ARMC and RUHS-MC neurosurgery residency programs maintain a high first attempt pass rate on the neurosurgery board certification exam, with the ARMC program having an enviable 100% first attempt pass rate thus far.

FIFTY NEUROSURGEONS THUS FAR:

The ARMC and RUHS-MC Neurosurgery Residency Programs have together graduated fifty neurosurgeons (see photo below), approximately 40% of whom have settled in California, half of them in the Inland Empire, but most in southern California.  Had all our graduates stayed on in California, our two neurosurgery residency programs would have trained approximately 17% of neurosurgeons in California.  These fifty graduates, and the dozens that will come after them, are our two residency programs’ greatest contribution to Neurosurgery in the Inland Empire, in California, and nationwide.

Top Row, L to R: Darryl Warner, John Spitalieri, John Cantando, Dennis Cramer, Jon Taveau, Daniel Hutton, Gayatri Sonti, Nguyen Do, Elijah Wogu, Blake Berman, Vladimir Cortez

2nd Row, L to R:  Ripul Panchal, Shawanaz Qureshi, Brian Miller, Yoav Ritter, Andrew Bieber, John Capua, Shokry Lawandy, Kamran Parsa, Katie Hyuhn, Quang Ma

3rd Row, L to R: Vivek Ramakrishnan, Raed Sweiss, Deependra Mahato, Tanya Minasian, Marc Cabanne, Omid Hariri, Jerry Noel, Tyler Carson, Bobby Dahlin

4th Row, L to R: Marc Billings, Jason Duong, Christopher Elia, Bailey Zampella, Mark Krel, Gohar Majeed, John Ogunlade, Tiffany Odell,  Kevin Ray, Stephen Albano

Bottom Row, L to R:  Jacob Bernstein, Brian Fiani, Hamad Ghanchi, Alison Ho, Samir Kashyap, Ira Bowen, Harjyot Toor, Chao Li, James Berry, James Fowler

_________________

In summary, the history of academic neurosurgery in the Inland Empire is comprised of three neurosurgery residency programs, two of which were founded by me, and reinforced by like-minded and committed faculty I recruited, and by residents we trained.  Our two Primary Sites, and our multiple off-site rotations, have

managed to train 50 neurosurgeons through June 2023, soon to be 55 by June 2024—this is no small achievement for a part of California that has historically had difficulty recruiting physicians, as the brighter lights of Los Angeles and San Diego seemed more attractive.  The fact that almost 40% of our neurosurgeon graduates remained temporarily or permanently in California after graduation reflects the contribution of the Inland Empire to our state, and to our country.

Picture of Phil Kissel, MD

Phil Kissel, MD

Physician of the Year

Members in the News

Dr. Phillip Kissel, past president of CANS, was chosen by the Central Coast Medical Association, which includes Santa Barbara and San Luis Obispo County, as Physician of the Year. Phil has been in practice in San Luis Obispo for 34 years. Phil’s reaction: “It has been a wonderful acknowledgment by the community and fellow physicians of 34 years of commitment to San Luis Obispo.

Well deserved, Phil, we are proud of you!

 

Alexander Tenorio, MD

Increased Injuries with Increased Border Wall Height

Alex continues to work hard to keep the issue of increased neurological injuries due to the increased height of the border wall in public awareness. We initially published a letter he wrote. Please see https://cans1.org/april-cans-newsletter/

On November 27, 2023, the NY Times published the following article:

https://www.nytimes.com/2023/11/14/us/border-wall-migrant-injuries.html?smid=url-share

Picture of Ian Ross, MD

Ian Ross, MD

Catch 22

From the Trenches

NURSE TO OBTAIN CONSENT: “ANTERIOR CERVICAL DISCECTOMY AND FUSION, C5-6”. I wrote this order the day before surgery and got a phone call from the nurse in the preoperative area just before the surgery, saying that the consent wording must be changed. I was told that “it is dangerous because there is an abbreviation in the consent, that it might cause confusion and lead to legal problems.” Thanks for the lecture, nurse. I am also instructed that this type of abbreviation is not allowed, per policy.

Excuse me. I have practiced neurosurgery for over 30 years, almost 20 years at this hospital. I am a true life-long learner. I get to learn new things every day. Like everyone, I have a love/hate relationship with my job, but this is too much.

I walk over to the pre-operative area and ask the nurse if the consent, as worded, is really that unclear. I must sound irritated. She then suggests that the nurse on the floor should have known not to write out the “C” and instead write “CERVICAL,” even though that is not how I wrote it. I say that, if this type of order is unclear, then should floor nurses be really allowed to make the presumption that the “C” stands for “CERVICAL?” Conversely, if it is so obvious, what is the problem with “C?” I get a blank stare.

Catch-22, I think. Frustrating, though it gets me thinking. A bigger frustration is that I am not a good enough writer to turn this into something funny, a story that could be made into a book, maybe a movie. Anything to escape the mind-numbing grind of clinical medicine/surgery these days.

It is Friday afternoon, at the end of a very long week. I want to get through this little procedure and get out of Dodge. But, for the nurses, this is a serious problem that needs to be addressed. To make matters more difficult, the patient has had a stroke. He struggles to understand why he must sign the consent again. He is “with it,” but his speech is impaired. The whole kerfuffle delayed the surgery for over 30 minutes.

During the delay, I go up the chain of command of nursing administration but keep hearing the same tune about policy. One nurse gives me a line, “What if there is a lawsuit?” … suggesting that the nurse, I, and the hospital could be found liable for a misunderstanding that led to a wrong operation. She was trying to explain this wonderful policy was there to protect all of us. Sweet.

I laughed at the absurdity of the situation and strode off to the OR, the patient having finally made it to his destiny with me.

Now I do appreciate nurses. Really. Nurses understand that doctors, too, are human and make mistakes. We sometimes mess up orders. I am almost always happy to clarify a medication order. But this was ridiculous. It took me a little while to calm down and get through the operation.

This sort of thing never used to happen. I work in what was once a stand-alone community hospital, run by a doctor-friendly CEO, reporting to a Board of very reasonable and intelligent people. But the Board of Directors, in their wisdom, decided that they should sell the hospital. We became affiliated with a “nonprofit” health system. We were told that the merger would be an anodyne affair. Perhaps the Board and CEO who completed the amalgamation sleep better now.

But, with the merger, most of the middle management does not. Almost everyone, including the nursing management, seems scared for their jobs. Perhaps it is good that people are now more on their toes. But the result is that the fear of messing up overwhelms some people, and, more than occasionally, common sense gets defenestrated. The work environment has become tenser.

Joseph Heller in his book CATCH-22, pointed out some of the absurdities of war. The most memorable situation, the Catch-22 in the book, refers to the predicament of Air Force personnel who ask to be grounded under the pretext of being mentally unfit. You must be crazy to agree to fly such dangerous missions, it is pointed out to them. So, if you apply to be excused because you are crazy, then you cannot be crazy because it is a rational thing not to want to fly dangerous missions.

The only medical book that comes close in terms of accurately depicting the realities of being in the trenches as a junior doctor is Samuel Shem’s HOUSE OF GOD, which some of the junior members of our society may not be familiar with.

Life, in general, is full of ridiculous rules and impossible situations, most of which are man-made. We live in very uncertain times regarding the future of the practice of medicine, where “the man” dictates more and more how we should practice. Like for many diseases we come up against, I believe that there is no cure. But that does not mean there is no hope. You must take everything with a grain of salt. I like to believe what a now-forgotten man of letters, Benjamin De Casseres, once wrote. “Progress is nothing but the victory of laughter over dogma.”

Shem’s book has been credited with having contributed to the positive evolution of humanism and ethics as they relate to the training of physicians. While Heller’s book, and indeed a plethora of other anti-war books, has not stopped war from occurring, it may have had some role in keeping the last three-quarters of a century relatively free of major worldwide conflagrations.

It is better to laugh than to cry or try to “get even.”


Picture of Paras Savla DO

Paras Savla DO

CANS Resident Consultant PGY5 – Riverside University Health System

Residents Corner

A Journey of Gratitude: A Neurosurgery Resident’s Thank You

As I reflect on the incredible journey of my neurosurgery training this Thanksgiving, I am overwhelmed with gratitude for the collective effort that has made this transformative experience possible. The intricate world of neurosurgery is not one navigated alone, and I find myself compelled to express my heartfelt thanks to the diverse group of individuals whose unwavering support has shaped my path.

  1. Our Leadership:

At the helm of this journey is the leadership of our institutions, whose visionary commitment to medical education has laid the foundation for an environment of excellence.  From hospital administration to graduate medical education to our program directors, thank you. The investment in cutting-edge resources, state-of-the-art infrastructure, and a dedicated team of professionals underscores their understanding of the critical role education plays in advancing the field of neurosurgery.

  1. Guiding Lights – Attending Physicians and Mentors:

I extend my deepest appreciation to the attending physicians and senior neurosurgeons who have been my guiding lights. Their wealth of knowledge, clinical expertise, and willingness to invest time in mentorship have been instrumental in shaping my growth as a neurosurgeon. The lessons learned in the operating room, during rounds, and in educational sessions have left an indelible mark on my professional journey.

  1. The Backbone of Operations:

Behind every successful training program is a team of dedicated individuals who ensure its seamless operation. To the nursing staff, administrative personnel, support staff, program coordinators, and the like, I extend my gratitude for your tireless efforts. Your commitment to maintaining an organized and supportive environment has not only facilitated our training but has also created a foundation for success.

  1. Comrades in Arms – Fellow Residents:

The camaraderie among fellow residents has been a source of strength and inspiration. Together, we have faced challenges, celebrated triumphs, and created a community that understands the unique demands of neurosurgery training. The shared experiences have not only enriched my learning but have also fostered a sense of unity that transcends the complexities of our chosen field. To those who have already graduated and become attendings, and those who are just starting their training, I also thank you all for being a part of the process. And I extend this thanks to residents of all specialties at our hospitals who uniquely understand the trials and tribulations of residency training; without you, residency would not be this much fun.

  1. The Heart of it All – Patients and Their Families:

To the patients and their families who have entrusted us with their care, I offer my deepest gratitude. Your resilience, trust, and willingness to participate in the educational process are the cornerstones of our training. It is a privilege to be part of a profession built on compassion, empathy, and a commitment to improving the lives of those we serve. We would not be here without you.

This journey through neurosurgery training has been nothing short of extraordinary, thanks to the collective effort of an exceptional team. To all those who have played a role, whether seen or unseen, your contributions have left an indelible mark on my professional and personal growth. And even though in the darkest and lowest points of training it may be difficult to be thankful, I know that my fellow neurosurgery residents ultimately feel the same way.

Thank you all!

Innovators in Neurosurgery

Eugène Louis Doyen

Cranial Perforator

Editor’s Note: this article was republished with permission from Elsevier.

World Neurosurgery

Volume 153, September 2021, Pages 26-35
Elsevier

Lukasz Strulak 1Ferda Gronki 2Kaveh Shariat 1, Daniel Schöni 1Alex Alfieri 1 3

Surgical trepanation, the initial step in performing an osteoplastic craniotomy, has been historically performed since the Neolithic times with the first reports dating back to the Corpus Hippocraticum from 400 BC.11 Osteoplastic craniotomies were first described at the end of the 19th century by Wilhelm Wagner in Prussia, now Germany. His 1889 publication in the “Zentralblatt für Chirurgie” described the first temporary cranial resection to treat intracranial pathology.11

Eugène Louis Doyen (Figure 2A) further elaborated on this surgical technique and devoted an entire chapter in his book Traité de thérapeutique chirurgicale et de technique opératoire, published in 1908, in which he described multiple new approaches as well as designed a complete set of craniotomy instruments.12 In addition, Doyen developed an electrical engine to create more efficient electrical craniotomies (Figure 2B). His work was so revolutionary that 10 years later Harvey Cushing, who himself is considered the father of modern neurosurgery, referenced 2 of Doyen’s instruments in his own publication: the cranial perforator (Figure 2C), and the burr (Figure 2D).12,13 These 2 instruments are still used today, not only in craniotomies, but also in spinal operations and, due to Cushing’s publication, are frequently also named after him. Doyen’s contributions, however, were not only limited to neurosurgery but also extended to gynecological, gastrointestinal, cardiothoracic, orthopedic, and urologic procedures.14

Doyen and Bolesław Matuszewski, a Polish cameraman, were also the first to film surgeries. Doyen believed that films had a high didactic value and used them at congresses and at lectures as teaching tools for students and surgeons in training. Perhaps his most famous film is the separation of the 2 xiphopagous sisters Radhika and Dudhika Nayak, which was performed in Paris in 1902.11,14,15 Interestingly, he was also one of the first surgeons who promoted asepsis in surgery, used electrocoagulation, and developed the first modern surgical table.11,14

Eugène Louis Doyen was born in Reims, France, on December 16, 1859. He commenced his medical career at Reims Medical School under the guidance of his father, Octave Doyen, who was a Professor of Surgery. In 1881, he was an intern at Tenon Hospital of Paris learning under Just Lucas-Championnière. One year later, he left France to continue his surgical education in Heidelberg and Wurzburg, in today’s Germany and eventually settled in Vienna in the Austro-Hungarian Empire.11,14 He returned to France in 1885 and defended his thesis at the Institute Pasteur of Paris.14 In 1888, he served as the chief of anatomical investigations in Reims Medical School, and in the same year, was elected Associate Professor of Clinical Surgery. Almost a decade later, he returned to Paris and established his first private clinic, which consisted of 160 beds, and over the years created a network of up to 20 private clinics.11,14,15 He died at the age of 56, on November 21, 1916 in Paris, France.11,14

Tidbits

November 1 – The Federal Reserve held interest rates steady for the second consecutive time, leaving the central bank’s benchmark lending rate at its highest level in 22 years.  Despite the Fed aggressively raising interest rates 11 times since March 2022 in a bid to combat inflation, the economy expanded significantly, mostly due to solid consumer spending. 

November 1 – The American Ornithological Society announced it would rename all the birds currently named for human beings. The new names will reflect the species’ appearance or habitat.

November -2 – The National Center for Health Statistics reported an increase in the US infant mortality rate for the first time in two decades. Infant and maternal mortality, which are inextricably linked, are widely considered to be markers of a society’s overall health, and America’s rates are higher than those in other industrialized countries.

November 3 – A 5.7 magnitude Earthquake struck eastern Nepal.

November 5 – At the New York City Marathon, Hellen Obiri of Kenya won the women’s race, finishing in 2:27:23, and Tamirat Tola of Ethiopia won the men’s race, finishing in 2:04:59, a course record.

November 7 – Oncological surgeon Monica Bertagnolli was confirmed by the Senate to become the director the NIH. She is the second woman to serve in this capacity. The NIH is a $48 billion science agency. She will oversee the campus’ 27 institutes. She was awarded the Owen H. Wangensteen Scientific Forum Award by the American College of Surgeons on October 31, 2023.

November 7 – NASA’s 1968 Apollo 8 spaceflight commander Frank Borman died in Billings, Montana. He was 95. Apollo 8 carried three astronauts farther from Earth than anyone had ever traveled. It orbited the lunar surface ten times, flying nearly 60 miles above it. Apollo 8’s three astronauts, Frank Bowman, Jim Lovell, and William Anders, became the first men to orbit the moon; they captured the famed Earthrise image and read Genesis lines to deliver a brief, uplifting Christmastime message.

Reading by Apollo 8 Astronauts:

Bill Anders
We are now approaching lunar sunrise, and for all the people back on Earth, the crew of Apollo 8 has a message that we would like to send to you.
In the beginning God created the heaven and the earth.
And the earth was without form, and void; and darkness was upon the face of the deep. And the Spirit of God moved upon the face of the waters.
And God said, Let there be light: and there was light.
And God saw the light, that it was good: and God divided the light from the darkness.

Jim Lovell
And God called the light Day, and the darkness he called Night. And the evening and the morning were the first day.
And God said, Let there be a firmament in the midst of the waters, and let it divide the waters from the waters.
And God made the firmament, and divided the waters which were under the firmament from the waters which were above the firmament: and it was so.
And God called the firmament Heaven. And the evening and the morning were the second day.

Frank Borman
And God said, Let the waters under the heaven be gathered together unto one place, and let the dry land appear: and it was

so.
And God called the dry land Earth; and the gathering together of the waters called he Seas: and God saw that it was good.

And from the crew of Apollo 8, we close with good night, good luck, a Merry Christmas  – and God bless all of you, all of you on the good Earth.

Earthrise is a photograph of Earth and part of the Moon’s surface taken by Astronaut William Anders on December 24, 1968, during the Apollo 8 mission

November 8 – World Radiology Day. It celebrates the discovery of X-rays by Röntgen, who was a fifty-year-old relatively unknown physics professor at the University of Wurzburg in 1895 when he made his important discovery. Wilhelm Conrad Röntgen was born on 11 March 1845, in the town of Lennep, today a part of the city of Remscheid in the Northern Rhine Westphalia region of Germany.

November 8 – Picasso’s masterpiece “Femme à la montre,” Woman with a watch, was sold for more than $139 million, becoming the second most valuable work by the artist ever sold at auction. The 1932 oil painting took center stage at a two-day event at Sotheby’s in New York, at the sale of late philanthropist Emily Fisher Landau’s private collection. The masterpiece, which measures 51¼ x 38 inches, depicts Picasso’s lover and “golden muse,” Marie-Thérèse Walter, who featured in many of his portraits.

November 10 – The rating firm Moody changed the outlook on the credit rating of the United States to “negative” from “stable.” The change fell short of a downgrade to America’s credit rating, which is still at AAA, the highest level. Unfortunately, it is a black mark for the economy; it underscores the threat posed by rising interest rates, a mounting debt burden, and a polarized Congress.

November 11 – Veterans Day. In 1918, at the end of four years of World War I’s devastation, an armistice was declared on the eleventh hour of the eleventh day of the eleventh month. In November 1919, President Woodrow Wilson commemorated Armistice Day, saying that Americans would reflect on the anniversary of the armistice. In 1938, Congress made November 11 a legal holiday to be dedicated to World Peace.  In 1954, to honor the armed forces of wars after World War I, Congress amended the law creating Armistice Day by striking out the word “armistice” and putting “Veterans” in its place. President Dwight D. Eisenhower issued a proclamation asking Americans to observe Veterans Day: “Let us solemnly remember the sacrifices of all those who fought so valiantly, on the seas, in the air, and on foreign shores, to preserve our heritage of freedom, and let us reconsecrate ourselves to the task of promoting an enduring peace so that their efforts shall not have been in vain.”

November 13 – Arson was the cause of a massive November 11 fire that charred, damaged,  and indefinitely closed a vital section of a I-10 in downtown Los Angeles. This will cause major traffic headaches for hundreds of thousands of commuters not only in the entire LA metropolis, but also in the surrounding areas.

November 17 – Rosalynn Carter, the former first lady, entered hospice care at her home in Georgia alongside her husband, Jimmy Carter. Former President Carter has been in hospice since February. What a wonderful couple!


Jimmy and Rosalynn Carter in 2021. Erin Schaff/The New York Times

November 19 – Rosalynn Carter, the closest adviser to Jimmy Carter during his one term as U.S. president and their four decades thereafter as global humanitarians, dies at 96. May She Rest in Peace!

November 19 – On this day President Abraham Lincoln delivered his Gettysburg Address at the dedication of Gettysburg National Cemetery:

“Four score and seven years ago our fathers brought forth on this continent a new nation, conceived in liberty, and dedicated to the proposition that all men are created equal. “Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battlefield of that war. We have come to dedicate a portion of that field as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this. “But in a larger sense we cannot dedicate, we cannot consecrate, we cannot hallow this ground. The brave men, living and dead, who struggled here have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember, what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us, that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion, that we here highly resolve that these dead shall not have died in vain, that this nation, under God, shall have a new birth of freedom, and that government of the people, by the people, for the people, shall not perish from the earth.”

November 20 – Interstate 10 in Los Angeles reopened, a bit more than one week after a fire severely damaged a section of the freeway. A perfect example of how working together – local, state, and federal officials – can get things done.

November 20 – A faded and cracked felt bicorne hat worn by Napoléon Bonaparte sold for $2.1 million at an auction of memorabilia of the French emperor’s belongings collected by a French industrialist Jean-Louis Noisiez, who died last year. The auction was held in Fontainebleau, France. While other officers customarily wore their bicorne hats with the wings facing front to back, Napoleon wore his with the ends pointing toward his shoulders. The style — known as “en bataille,” or in battle — made it easier for his troops to spot their leader in combat.

November 20 – One hundred years ago, the US Patent Office granted Garrett Morgan a patent for his three-position traffic signal invention. Morgan was born in Paris, Kentucky, in 1877 to formerly enslaved parents. He called himself a “Black Edison.”

Portrait of Garrett A. Morgan, circa 1875. Fotosearch/Archive Photos/Getty Images

November 22 – John F. Kennedy was assassinated sixty
years ago in Dallas, Texas. I remember the day; I was in
Damascus, Syria.

Official Portrait of John F. Kennedy by Aaron Shikler, which was unveiled in 1971 and hangs in the White House.

November 23 – THANKGIVING

November 27 – Merriam-Webster’s word of the year is announced: AUTHENTIC, as in true to one’s own personality, spirit, or character.

November 28 – Giving Tuesday!

Calendar

WFNS Cape Town,                                                                   December 6-11, 2023
CANS, Annual Meeting, Intercont Mark Hopkins, San Francisco, CA January 12-14, 2024
CSNS Spring Meeting, Chicago                                                 May 2-3, 2024
AANS Annual Meeting, Chicago                                               May 3-6, 2024 
NSA Annual Meeting Penha Longa Resort, Portugal              June 16-019, 2024

Any CANS member who is looking for a new associate/partner/PA/NP or who is looking for a position (all California neurosurgery residents are CANS members and get this newsletter) is free to submit a 150 word summary of a position available or of one’s qualifications for a two month posting in this newsletter.  Submit your text to the CANS office by E-mail (emily@cans1.org) or fax (916-457-8202).

The assistance of Emily Schile and Dr. Joseph Chen in the preparation of this newsletter is acknowledged and appreciated.

  • To place a newsletter ad, contact the executive office for complete price list and details.

or to the CANS office emily@cans1.org.

  • Past newsletter issues are available on the CANS website at www.cans1.org.
  • If you do not wish to receive this newsletter in the future, please E-mail, phone or fax Emily Schile (emily@cans1.org, 916-457-2267 t, 916-457-8202 f) with the word “unsubscribe” in the subject line

CANS Board of Directors

CANS Board of Directors

CANS Board of Directors

President             Joseph Chen , MD            Bakersfield
President-Elect   Ciara Harraher, MD          Santa Cruz
Vice-Pres            Samer Ghostine, MD        Los Angeles
Secretary            Brian Gantwerker, MD     SantaMonica
Treasurer
             Sanjay Dhall, MD               Los Angeles
Imed Past Pres    Javed Siddiqi, MD            Beverly Hills
Past President     Mark Linskey, MD              Irvine
Directors
Northern CA
Anthony DiGiorgio, DO                                  San Francisco
Marco Lee, MD                                               Stanford
Odette Harris, MD                                           Stanford
Harminder Singh, MD                                     Stanford

Southern CA
Omid Hariri, DO                                               Orange Co
Namath Hussain, MD                                     Loma Linda
Ian Ross, MD                                                    Pasadena
N. Nicole Moayeri, MD                    Santa Barbara

Resident Board Consultants
John Choi, MD                                                Stanford
Yagmur Muftuoglu, MD, PhD                        UCLA
Paras Savla, DO                                              Arrowhead
John Yue, MD                                                  UCSF

Consultants
Past President Kenneth Blumenfeld, MD    San Jose Past President Deborah C. Henry, MD Newport Beach Past President Theodore Kaczmar, Jr, MD  Salinas
Past President     Phillip Kissel, MD  San Luis Obispo
Past President     Praveen Mummaneni      San Francisco
Past President Langston Holly                       Los Angeles
Past President John K. Ratliff, MD Stanford               Past President     Patrick Wade                     Glendale

Newsletter           Moustapha AbouSamra, MD Ventura                     
Historian
              Austin Colohan, MD         Temecula
Website Chair     Anthony DiGiorgio, DO    San Francisco

Executive Secretary         Emily Schile          Sacramento
emily@cans1.org