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Member Spotlight: Dr. Alessia Pedoto on Culture Shock, Her Path to U.S. Practice, and the Many Mentors Who've Helped Along the Way

Dr. Alessia Pedoto is an Italian transplant who has spent most of her anesthesiology career in New York, where she completed her residency and has practiced for more than 20 years. In this Member Spotlight, she tells ASA Community about her initial culture shock, her experience bearing the brunt of COVID-19’s first wave, and how she is preparing for the expected surge.

Nominated by @Vittoria Arslan-Carlon, MD, FASA: “She is an incredible mentor and role model to residents and students.”

(Is there an ASA member you'd like to nominate for a Spotlight? Tell us here.)

You earned your medical degree in Italy and completed your residency in New York, where you continue to practice. What was that transition like? Did anything surprise you in terms of differences in approach to medical education?

I came to the U.S. as a research scholar in 1996, after finishing my training in Italy. I must admit, my first year in this country was a big cultural shock. It was my first time being away from home, I never traveled abroad growing up, I never lived alone, and I did not speak enough English to be self-sufficient, let alone work in a lab. Despite all these possible hurdles, I was very excited for the lifetime opportunity I was being offered. Thinking that something like this may not present again, I enthusiastically accepted before all parties realized what they were going to deal with. I took it as an adventure. After all, if it were a total disaster, I could have returned home to my parents.

During my time in Syracuse, I met a lot of very nice and patient people who helped me navigate the system. It all started with Miss Cheryl Barber, the secretary of the Department of Anesthesia Chair, who took me to JC Penny to shop for proper upstate New York winter clothing (settling for the children department, since the adult session was too big to fit me) and to the bank to open an account. She very patiently explained to me the difference between checking and savings, followed by a visual demonstration on how to write a check and pay bills. One of my elderly neighbors gave me a lecture on how to do laundry in the laundry room, starting with color separation and finishing on how to avoid setting the room on fire when using the dryer.

I did not start practicing medicine until 1999, when I started my internship as a transitional resident. Until then, I lived in the lab and studied for the USMLE steps. The exams were a bit of a struggle, since all my exams in medical school and residency were written open questions followed by oral exams. I had to learn how not to read too much into the questions to become proficient in the multiple-choice format. It took a lot of practice, but since it snows for many months in Syracuse, I had plenty of time to master this new skill.

My first encounter with medicine was at St. Joseph’s Hospital in Syracuse. Since all my training was in Italy, and in Italian, I was linguistically and technically challenged. My co-interns were my saviors. They took the time to teach me the secrets of “SOAP” and bedside manners and all what was needed to survive for the entire year. After all the extra hours spent trying to catch up with the system, I still had few patients getting upset for the use of the metric system to calculate drug dosages, screaming in the middle of the halls to go back home, saying I was stealing jobs from the American people. The chief residents during these rotations came to the rescue and assigned me to different sets of patients. However, these comments left deep marks on my confidence and my overall ability to provide good care, making me doubt if I really was here stealing jobs from the American people. On a more practical standpoint, these interactions taught me the necessity to be unlisted in the phone book.

Internship made me realize that health care in this country is a business rather than part of life, like in mine. Everything here is very organized and efficient when compared to Italy, but it is only available to few people who can afford it. It took me a long time to understand the concept of health insurances and how powerful they are in affecting medical decisions. Despite all this, trainees are an integral part of the health care system. The hands-on experience I had during training was unique. While my fund of knowledge was very detailed, even though in a different language which required constant translation and gave me the basis to pass the first two parts of the USMLE, I had a lot of work to do for the clinical parts. My co-interns and the entire faculty at St. Joseph’s took it upon themselves to make sure everyone in the class passed the tests, independently from their background. I do not think I would have survived my first year in the U.S. if my scholarship had been in New York City.

How would you describe your “mentorship style” and what (or who) has had the greatest impact in shaping it?

I am not sure there is a “style” that describes my mentorship. I strongly believe in the necessity of having good mentors during training and after. Mentors are the people who shape us in who we become. Without good mentors and good training, our profession will die.

I like to think I am the final product of all my mentors, starting with Dr. Gattinoni, the man who gave me the opportunity to come to this country by offering me the scholarship. He knew my English was nonexistent, but he still went ahead. Many other great mentors paved my way in the past 25 years. It was a challenging journey but was worth the struggle. @Enrico Camporesi gave me the scholarship to come to his lab in 1996; Dr. Apostolos Tassiopolous taught me how to catch a rat and set up the experiments; @Tawfic Hakim, my first research mentor, gave me the chance to present my work and be first author for my research. He also helped me to change my immigration status to a person of special interest for the country through our research; Dave, one of the technicians in the lab at SUNY in Syracuse, offered for four years to hide me in his basement until the next amnesty, in case my visa was a problem (I thanked profusely but refused); @Philip Hartigan, the man who transferred all his thoracic anesthesia knowledge to me via osmosis during my fellowship, and all my Brigham and Women “consultants,” who taught me asking for advice is a sign of maturity, not weakness; @Peter Slinger, who introduced me to the Thoracic Anesthesia Symposium for the SCA when it all started, and took me under his wing as a committee member all the way to become the current Chair; and finally @Meg Rosenblatt, who has been a loud supporter of my career progress and great teacher for the past nine years .

However, my best model was my mentor during my internship, Dr. DeAnn Cummings. She was an excellent, very kind mentor who had the ability to putting everyone at easy. She would meet me every four months and go over evaluations, starting with the good and ending with the bad. Her main feature was her smile and very calm demeanor. She always had a plan to make things better. The goal of training is to learn and excel in the profession we chose. It is impossible to improve without knowing our deficiencies. Offering a list of solutions for improvement is very important, but it is critical to go back and reassess the events over time. This is how she helped me grow during my internship. Unfortunately, there are not too many Dr. Cummings during training, and I missed her dearly once I left St. Joseph’s.

During my residency I was in survival mode and did not think about teaching until 2005, when I returned to Memorial Sloan Kettering Cancer Center (MSKCC) from my time spent at Brigham and Women’s Hospital (BWH). I was still debating between academia and private practice. While working solo, I did a lot of procedures and proved myself I was a safe anesthesiologist, but I did not have anyone to talk about any cases. It felt selfish, after spending a year in an excellent fellowship program, not to share my learning with the new generation.  I had to work very hard on how to effectively teach, rather than just giving instructions. This is when my St. Joseph’s time started coming back to memory, how patient my classmates were, going over and over how to take care of patients. At the time, I asked how I could pay them back; their answer was to do the same with the new generation. I am trying my best to pay back any time I have the opportunity. It took few years to find the confidence to let the trainee “struggle” without compromising patient care and delay the schedule. I took the good parts from all my education and transferred it to MSKCC, in an adapted version. 

My goal for the future is to become part of the mentorship faculty for the Cornell residents, since MSKCC does not have a residency program of its own. As I work on this project, I am an informal mentor for our monthly residents, our thoracic anesthesia fellow or anyone who feels the need to chat.

I won the Cornell “Teacher of the Year” award a few time, I received the “Distinguished Award in Education” from the ASA-SAE last year, and this year I was in the Society of Cardiovascular Anesthesiologists spotlight as “AWEsome (Anesthesiology Women of Excellence) woman. However, the most gratifying, heart-melting time was when one of the residents convinced his sister to name her child Alessia. I was telling him my story and he liked the fact that I dared to take the opportunity to come to this country. He hoped young Alessia would be as daring as the old one. It seems to be working so far. She will be four years old in December and is being raised to go after the world.   

What first inspired you to focus on thoracic anesthesia? What do you find most exciting about it today?

My interest in thoracic anesthesia is multifactorial. I was always intrigued by respiratory physiology. My physiology professor in medical school was a very passionate and creative man, who made us build alveoli out of balloons placed in stockings, to demonstrate the change in compliance with insufflation. I still remember blowing the balloons to the plateau of the pressure-volume curve. This was 30 years ago.

This passion was groomed at the end of medical school while I was working on my thesis in Milano with Professor Gattinoni. I witnessed his creativity and genius at every odd hour of the day and evening, when we would transport patients from the ICU to the CT scan to look at changes in ventilation and compliance while supine and prone. A lot of what we did in Italy 25 years ago is still part of the standard treatment of ARDS, especially now with COVID.

The foundations of thoracic anesthesia are very much built on the physiology of the respiratory system, so the choice of subspecialty was obvious at the end of residency. My thoracic fellowship was the best academic year of my life. I only wish I combined it with a cardiac fellowship to be more marketable in an academic place. When I trained, thoracic was separated from cardiac.

While I am still interested in respiratory mechanics during thoracic surgery, I am also intrigued in postoperative analgesia during minimally invasive surgery and the role of peripheral nerve blocks. This is a fast-evolving area which is keeping us busy.  

What’s your biggest “pet peeve” in the OR?

I have several.

My first one is “be neat and use the trash can.” During my residency I spent a lot of time doing trauma, cardiac and vascular. Dr. Slepian demonstrated to me the difference between sloppy and neat. It was mind opening. In case of an emergency you need to be able to quickly find all what you need. He was very adamant on keeping the syringes clean and having them labelled in a way that was visible at any angle. This stuck in my brain and is the second thing I teach to all residents, especially the first year, after the use of the trash can.

I have very high standards, since I feel every patient should receive the care the provider wish was given to themselves if laying on the OR table. I have learned it is essential for a good relationship to discuss expectations at the very beginning of the rotation. This conversation must be a two way one to be successful. Ideally it should happen at the beginning the month with a recap at the end, to see if expectations were met.

Finally, during my first week of residency, @Chris Edmonds at Hospital for Special Surgery told me that, “Residency is a three-year job interview. Your attitude and behavior will shape how people are going to perceive you. Anesthesia is a very small world, where everyone knows each other.” I found this to be the best advice I had during my training and I still quote him to the residents and our fellow any time I can.

NYC was a COVID-19 hotspot early in the pandemic. Do you care to share your personal experience from that time? What were your biggest challenges, and how well prepared do you feel for the next potential wave?

COVID-19 in a cancer center was very different compared to what happened in other hospitals in NYC. Like every hospital in the city, our department prepared to face the influx of many patients in need for ICU care. The OR shut down except for emergencies, we divided the staff based on exposure risks and deployed everyone to areas of need. We all took a crash course in basic ICU care and were ready for the challenge. However, we never had the surge of critically ill patients we expected.

My exposure to COVID+ patients was in the Emergency Room for intubations and few cases in the ICU I helped with prone position. I still have a very vivid memory of the face of my first COVID+ intubation. I don’t think I will ever be able to erase it from my brain. She came in after feeling sick all night. By the time she arrived, she was gasping for air and very ashen. I have not seen anyone so sick yet, but I am following the numbers, like everyone else at work, wondering when the big surge will happen again.

I was and still am very fortunate that my hospital had provided us with protective equipment. I cannot say the same for a lot of my friends working in other institutions. Every time I come in close contact with a COVID+ patient, I am concerned about becoming positive but so far following the CDC recommendations has proven to work.

We are getting ready for the next wave, and I have seen it slowly happening at work. We are back to the daily COVID census emails, the reminders about travel restrictions, etc. I think all the hospitals who dealt with the first surge learnt the lesson and are using the information to be prepared for the next one. Hopefully a vaccine will be available soon to rescue us all.

Is there anything else you’d like to add?

I would like to give credit to my husband and close friends who put up with my mood changes, especially during COVID. It is hard to keep work and personal life separate, and this year was quite challenging.

Long-distance running has been my preferred outlet to balance work and life. It clears my head and helps me find inner peace. This activity though has been curtailed by injuries, forcing me to add other forms of exercise to cope with life and aging.

I love cooking but not eating, so I still bring my “products” at work for the residents, a practice I started in 2003 as a fellow. They are very kind and eat all what is offered. The baking is a bit “creative,” to the point that two of our thoracic anesthesia fellows felt the need to give me books on how to make the substitutions more scientific and less random. COVID-19 introduced me to the art of sourdough bread, like 80% of the American population stranded at home with no dry yeast in sight and no bakeries open. I am perfecting the technique. The process of making a loaf of bread is very therapeutic for the mind. However, the production is exceedingly higher than the consumption. Thank goodness for the same residents and the PACU staff!

Alessia Pedoto, MD, FASA is an anesthesiologist and professor affiliated with Memorial Sloan Kettering Cancer Center. She currently serves on ASA's Committee on Cardiovascular and Thoracic Anesthesia and Educational Track Subcommittee on Cardiac Anesthesia. She is also Chair for the Thoracic Anesthesia Symposium for the Society of Cardiovascular Anesthesiologists.

(Is there an ASA member you'd like to nominate for a Spotlight? Tell us here.) 

ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.