Office-Based Surgery and How It Came To Be

My Journey with Amy Daggett, RN, ANP

Recently I was asked to write an article about office-based surgery for a leading medical journal.

FBThe process of writing caused me to reflect on 30 years in practice and how I was inspired by a wonderful mentor in Syracuse, New York that I happened to hear about during my intern year; Dr. A. Jefferson Penfield. Even in 1973 Dr. Penfield was doing what many would consider “cutting edge” today – laparoscopies in his office. He was a gentle man with a soothing and reassuring voice and reminded me of my own family doctor when I was a young boy.

Fast forward to October 1, 1986 when I opened the doors to my private office on White Spruce Boulevard. In those days I had a full time office manager, Debbie—she did the billing, cleaned and sterilized instruments answered the phone, made appointments and balanced the books. We had a part time nurse and that was it! Our office had 1000 square feet, but it was mine and my home away from home. I did the vacuuming after hours, dusted and polished furniture. I was 35 years old with a healthy combination of fear, energy and common sense.

Two months later, in December, it was clear that we were going to grow and I felt we needed a full time medical assistant. Debbie had an acquaintance who worked at the Big Tree Inn in Mt. Morris and a couple of days later introduced me to Amy.

dagget-scan0005-186x283My father, Israel, always told me to never judge a book by its cover and I always did my best to heed his advice.

Amy was subdued, quiet and at times just looked frightened. She had attended SUNY Geneseo for a year or two and took some time off—I suppose just to figure out what direction to take. In other words, Amy wasn’t the genius clinician you know her to be today—at least not in 1986.

Amy didn’t talk much, back then. She was all of 21 and her only experience in a doctor’s office was as a patient. She was quick on her feet, which wasn’t all that important because we weren’t that busy at first. But it did leave the two of us with a lot of time to talk about the practice, teach her some principles of medicine and surgery and how we were going to do it differently. After the third month, I discovered that Amy wasn’t really mute and that she had an incredible recall for dates, names and details; just about anything important. She also had something most of my peers didn’t have—common sense. She learned that it was good to ask questions and challenge me—in fact it was encouraged–and that I wouldn’t always have answers.

One of the advantages of starting with someone young, who hasn’t yet been to nursing school, is that you don’t have to “un-teach” them some of what they’ve learned as “gospel.” The occasional registered nurses we worked with in those days were more a hindrance than a help often explaining to me that I couldn’t do what I was already showing them could be done—surgery in an office that they’d never seen outside a hospital O.R.

In the first few months of the practice Amy and I were doing laparoscopy, office sterilizations, hysteroscopy (looking inside the uterus for women with heavy menstrual bleeding) and pregnancy terminations in a humane way. Believe it or not, before 1986 there wasn’t a single office in all of Upstate New York that would provide intravenous sedatives and narcotics for pain control for women undergoing any kind of office procedure—whether it be a D and C, an IUD, or an abortion. And while I don’t believe every woman needs pain control, I’ve always felt that every woman should have it available to her on request.

A few more years went by and it was time to get Amy some “street creds”—a nursing license.

Amy graduated at the top of her class from MCC’s School of Nursing in 1990 and within the next few years would write some ground-breaking papers with me on minimally invasive surgery. The two of us performed the first successful endometrial ablation in Western NY in 1988 when Highland Hospital agreed to purchase a “YAG Laser” to the tune of 130,000 dollars! There weren’t many in the country and we were privileged to have access to one. We worked with other people’s ideas before deciding we had a better approach in mind.

In August of 1991 Amy and I were scrubbed in for an interesting case on a woman who was at high risk for uterine cancer. We knew that we had to be aggressive to prevent the disease and though I’m not sure who said what, I’m pretty sure it was Amy’s idea that produced our first true “invention” known today as EMR (endomyometrial resection). We published this technique in the leading journal in our field, Obstetrics and Gynecology, and there were many papers, invited lectures that took us all over the country.

After our old landlord refused to renew our lease at our White Spruce office—a story for another time—we decided to build our own facility on South Clinton Avenue. We broke ground in February 1999—4 months after Dr. Barnett Slepian was shot to death in his Buffalo home. It was an awful time for Amy and me and I wouldn’t have blamed her for leaving altogether. Unfortunately, the middle and late 1990s saw a lot of abortion-related violence and I’d be lying if I said I wasn’t scared for quite a while. But Amy stuck it out with me and never missed a beat.

Amy’s skills had far exceeded her pay-grade. She was no ordinary registered nurse and so she went back to school—while working full time and being a mother—and completed her Bachelor of Science degree at the University of Rochester in 2004 (graduating suma cum laude) and her Nurse Practitioner Degree in 2006. For those who may not be familiar, suma cum laude is the highest of academic honors.

In 2007 we began a lengthy process of becoming an accredited office based surgery center.

Thanks to Amy, Allison (our other nurse practitioner) and our entire staff always focused on this common goal we were able to achieve it. Our application “sailed through” and we passed our inspection on our very first attempt.

So Amy and I have been together for 23 years. I have spent more time with her than anyone in my life—including my parents, brother and children. She still trucks to and from Mount Morris everyday and I doubt she’s missed a day of work except for having her daughter. Keep in mind that until 10 years ago we worked 6 days a week!

We’ve watched each other grow up and she’s watched me grow old! She helped me celebrate my 40th birthday and later this year she’ll help me celebrate my 60th (as we say, ‘God-willing’). We’ve known triumphs and defeats. We’ve watched our office grow, welcomed children into the world and we’ve laid some dear friends to rest. It really is like a marriage, but we go home to our spouses to argue after dark!

She knows when I’m having an “off” day and makes sure I stay on course and I try to be there for her and say something intelligent when she has a problem she needs help with. It’s getting tougher to find things she doesn’t already know. And we’ve been together long enough that when gives me a certain “look” I know that she’s seen something I haven’t. We truly are an inseparable team and trust me when I tell you that my life would have been very different and much worse without her. So I’m thankful for the blessing of Amy in my life and like most people we’ve grown to love and cherish we don’t tell them often enough.

Here’s to you, Amy! It’s been a great run so far and to paraphrase Robert Frost, “we have miles to go before we sleep.”

Amy and I took a sabbatical from teaching and writing but we’re poised to do quite a bit of it in the next few years. In medicine you can either innovate or publish but you can’t do both at the same time. We’ve accomplished many wonderful things together in 23 years and it’s our time to share what we’ve learned with the rest of the medical community. After all, it’s spring.