Fresh Air, CBC May 9, 2020: COVID-19 and the real back story
“Good evening gentlemen, CBC Radio’s Fresh Air would like to have you two (+Dr. Azad Mashari) on to talk about the split ventilator…they like the story of how you conceived of this thing 20 years ago, and then in the midst of this global emergency you brought it out and dusted it off and these young guys actually made it real. They also love the open source element of this story.
Rosa Kim Senior Public Affairs Advisor University Health Network, Toronto General Hospital and Peter Munk Cardiac Centre “
In summer 1991 I had just taken over from Dr. Gerry Edelist as Chief of Anesthesiology at Mount Sinai Hospital in Toronto (See also Scott Mission Story ). Apparently the Department was short one staff anesthesiologist. My handover from Gerry included the information that he had been in Israel as visiting Professor and arranged with the Chief of Anesthesia at Ichilov Hospital in Tel Aviv to rotate one of his staff to MSH for a year at a time as an ongoing fellowship program. They get the experience, we get the staffing. This fellow was to have arrived the previous spring. Now it was the new year, we were definitely short staffed and I had not heard from the fellow or the Ichilov Department. In mid January I dug out the Chief’s phone number. After some pleasantries, I got down to business: “What is the progress with the fellow you were supposed to send?” There was silence on the phone. Then, with an unmistakable note of irritation he said “Look, don’t you watch the news? Have you any idea what is going on here?”
Yes, sort of. Saddam Hussain was playing unpredictable bad boy. He was threatening, that no matter who attacks him (UN and Americans threatening), he was going to shoot off his arsenal of missiles with paralyzing gas at Israel. In response, Israel, not a party to the conflict, had nevertheless emptied out their gas mask stores and handed them all out to the population. News played videos of people climbing over each other at airline ticket counters trying to grab flights out of the country. They also showed ordinary people on the streets walking around with gas masks hanging from their belts. They showed families using masking tape to seal the doors and windows in a room in their homes to form a safe room to shelter them from Saddam’s poison gas.
The Chief then said, “Look, your f___n fellow is the last thing on my mind.”
I said, “OK. Is there anything I can do to help you?”
He said, voice dripping with sarcasm “Ya. Send me 40 ventilators tomorrow or the next day.”
“What for?”
“Well, the government assigned 140 paralyzed patients to my hospital. I scoured the hospital and found 80 ventilators. I found another 20 in the animal labs. What am I going to do with 40 awake but paralyzed people?”
“I am going to design a way for you to ventilate all 140 patients with what you have.”
“Thank you Dr. Fisher. Good by.” And he hung up the phone without waiting for me say good by.
The day before that call, a young final year medical student, Doron Sommer, had knocked on my door. He wanted to know if I had a small research project he could do around the OR area during his anesthesia rotation. I didn’t on that day, but I did now.
Turns out that when I was a resident, I spent a year in St. Michael’s Hospital in Toronto working on a research project with Dr. William Noble and Colin Kay, the chief Anesthesiology lab technician. As part of that project I had designed a special ventilator that enabled me to ventilate the lungs in a dog in the normal way, but when I needed to, to switch and ventilate each lung with its own gases and separately collect the exhaled gases (PMID 6793220). Well, the idea for Ichilov Hospital would be similar: ventilate two sets of lungs, but each in their own body, each pair of lungs with its own breath size, and oxygen concentration--with a single ventilator--regardless of how different the patients were in size.
I drew some diagrams on the white board in my office. The next morning I met with Doron and a few of the Respiratory Therapists from the OR, Susan Marshall and Mike Vidic and we brainstormed the final design. Some were sure it would never—can’t ever—work. I told them that there “was a 747 plane going to crash at the airport early this afternoon and we were going to get 200 of the 600 survivors.” The patients will be here by this afternoon, so they better make it work. I gave them two mechanical lung simulators to simulate the 2 patients. “You only have one vent. I will come around this afternoon and see what you have.”
That evening we were ventilating the two lungs with full individual control. We found a few manikins and took some photographs seen in the published article (Sommer et al. Critical Care Medicine 1994. 22(4);705). The next morning I faxed copies of the schematic diagram to Tel Aviv.
Fortunately they didn’t have to use them because all of Saddam’s 30 missiles were duds. But the idea, I thought may still have some merit. A few days later Doron said: “Why don’t we present it at this conference?” He handed me a brochure from the World Association of Disaster Medicine, meeting in the spring in…Stockholm (for which I would pay for). Indeed, the abstract was accepted and we flew to Stockholm. When we got there it was apparent that Doron hadn’t prepared a single slide for his talk. I have kids so I don’t take to well to being told “Don’t worry, I’ll have it done” 2 days before an international conference. He wanted to wait to the night before to do it. I objected and threatened to beat him to a pulp (its plausible if you happen to be a black belt in Shotokan Karate). In two days, Doron, still (mostly) in one piece, presented his 20 minute talk on this system. People loved it! It was the last talk in the morning session and when the lights went on, people poured down from the auditorium and mobbed us. I was approached by young gentleman in a suit (characteristic dress of the venders) with badge and logo of a very large French company making everything from tents to vehicles for disaster and rescue.
“Dr. Fisher. This will be very useful in many of the places around the world where our products are found. We would like to get the rights to make kits so people can quickly assemble these ventilator circuits. Is it patented?”
“Thats great. Please go ahead and make them.” I answered, “I have decided to leave this in the public domain so it is open for anyone to make.”
“Why would my company, or anyone else, spend the resources to perfect this when everyone else will just copy it and sell it cheaper?” Good question.
“Dr. Fisher,” he said with eyes burning, “you have just seen to it that despite people continuing to die by the thousands during one upcoming disaster after another, this will never see the light of day. ”
And for the past 25 years, so it was. Lesson well learned.
And here we are today.
