John McAuliffe: A Quiet Force for 38 Years
John McAuliffe: A Quiet Force for 38 Years
When John McAuliffe, MD, started at Cincinnati Children’s in 1985, there were about 2,000 employees working in a handful of buildings on the Burnet Campus—and he knew two-thirds of them by name. Much has changed since then, and John has his eye on retirement—first from his role as anesthesiologist-in-chief, and then as a clinician and researcher.
“I plan to step down from my in-chief position once they name my successor,” he says. “Then I’ll be continuing some clinical work on our intraoperative physiology program. The goal is to wrap up no later than December 2024.”
John’s family moved around a lot when he was growing up, starting out in Phoenix, Arizona, with stops in Yardley, Pennsylvania, and two towns in New Jersey.
“I spent my middle and high school years in Morristown, New Jersey, so that’s probably the most reasonable place to call home,” he says.
He earned a bachelor’s degree in chemical engineering from Rutgers University in 1971 and went to work for Exxon for two years. But he soon realized that this was not what he wanted to do with his life.
“I was volunteering at a local hospital and wound up on a pediatric ward,” he explains. “That was probably the trigger for going to medical school.”
He enrolled at McGill University in Montreal and obtained his MD there in 1977, followed by a pediatric internship and residency at the University of Minnesota and Children’s Hospital National Medical Center in Washington DC (1977-82).
His work in the public health service required him to be on call 24/7 and helped him discern that practicing in an office setting was not for him. Instead, he was attracted to working with kids who were more acutely ill in the hospital. His choices were to do an intensive care unit fellowship or become an anesthesiologist. He chose anesthesiology, completing his training in the specialty at Brigham and Women’s Hospital and Boston Children’s Hospital (1982-85).
At this point in his training, John and his wife, Judy, had two daughters and one on the way. They had outgrown their little house and needed to find something bigger. One of the attendings at Boston Children’s had accepted a job at Cincinnati Children’s but ended up having to back out for family reasons. He told John, “You really should take a look at that position. It’s a sleeper, but it might be a good fit.”
He and Judy traveled to Cincinnati to check it out.
“The anesthesia group here was very congenial,” he says, “and the cost of housing relative to salaries was much more affordable than in Boston. But the biggest sell was the people and the work environment. We moved with the idea of staying for about five years, and here we are 38 years later.”
Back then, the Department of Anesthesia ran the Pediatric Intensive Care Unit and Respiratory Care. The Operating Room volume was growing. John’s time was principally spent in the OR and doing research. But he enjoyed his work.
“In pediatric anesthesia, you have patients who range in size from 700 grams (not quite 2 lbs) to 300 lbs. You don’t see that variation in the adult world,” he says. “The problems they show up with in surgery are not self-inflicted. They haven’t made unhealthy lifestyle choices for years or gotten behind the wheel of a car when they’ve been drinking. You have a better opportunity to change the trajectory of a disease and to make a difference on a deeper level. It helps to make your work feel more meaningful.”
Advancing the Science
When John first joined Cincinnati Children’s, the Anesthesia Department had no established research program. In 2002, when Dean Kurth came on as anesthesiologist-in-chief, he appointed John as research director.
“We came up with a strategic plan for growing the research program within the department, and now we have three high-level, full-time PhDs as principal investigators who are well-funded by the NIH,” he says.
Over the course of his career, John notes that there have been many advances that have made anesthesia safer and contributed to better outcomes, some of which have originated or been refined here.
“A lot of the drugs we once used have been replaced with better ones,” he says. “And with the technology of ultrasound, we can actually see where to place an IV instead of going by anatomical landmarks. Getting an IV in on the first stick is much less traumatic for the patient. Ultrasound based techniques have also made regional anesthesia accessible to more patients.”
John points out a unique feature of Cincinnati Children’s Anesthesia Department—the intraoperative neurophysiology program, which he helped build.
“When we’re doing a spinal fusion on a patient, we can monitor their sensory-evoked potentials and motor-evoked potentials—which are measures of the integrity of the nervous system—to make sure everything is still working. Knowing that these functions are present and stable during surgery is a real comfort to the surgeons because they know they can go ahead with the correction they planned. As long as all the signals are stable, they can be confident that the patient will wake up with everything intact.”
These advances get even more fine-tuned for surgery to remove a tumor in the brain or on the spinal cord.
“We look at the cranial nerves that control the face—the muscles around the eyes, the tongue, the swallowing reflex—and when we are doing certain at-risk maneuvers, we can tell if a nerve signal gets interrupted and make adjustments to restore it at that moment,” he says. “Before we had this technology, we had no idea when an injury that caused a post-operative deficit happened.”
Artificial intelligence (AI) also has a role to play in the realm of anesthesia.
“The operating room is very much a critical care unit,” says John. “So, when you have patients with a complicated history, it’s likely that 90% or more of the medical record is in the form of raw text notes. It’s time-consuming but essential to read it all so you can deliver the best care. I am working with my colleagues in Information Services on how to use AI to digest all the notes in a patient’s record and extract a summary that can be used to support decision-making.”
Always a Team
John is modest when asked about his accomplishments.
“I’ve always thought of myself as part of a team—I’ve been fortunate enough to be in the right place at the right time to build our research arm and other programs, so there’s always some serendipity involved,” he says. “My greatest accomplishment has been raising three relatively successful and well-adjusted kids, and that was definitely a team effort with my wife. And now I have three wonderful grandchildren.”
He’s learned to embrace change and keep an open mind.
“There will always be someone who knows more than you,” he says. “The corollary to that is, you never know who your teacher will be—it could be a patient care assistant or a family member you’ve talked with in the pre-op area. It’s important be humble and allow yourself to be vulnerable.”
As retirement gets closer, John is looking forward to spending more time with his grandchildren and getting reacquainted with his piano. He and his wife also hope to do more traveling.
On the topic of how he would like to be remembered, John says, “Just recently, I was asked what my ‘why’ is in regard to my work. My response was, ‘I am here to serve others.’ I just hope the legacy matches.”