Cite as: Machi A. Interview with a leader in the field: Steve Oregaugh, MD. ASRA Pain Medicine News 2022;47. https://doi.org/10.52211/asra110122.043 

Steve Orebaugh, MD, has combined his love of anesthesiology and writing into a varied and interesting career. He is a professor of anesthesiology at the University of Pittsburgh School of Medicine in Pittsburgh, PA. Special Projects Associate Editor Anthony Machi, MD, associate professor in the department of anesthesiology and pain management and regional anesthesiology and acute pain medicine program director at the University of Texas Southwestern Medical Center in Dallas, recently talked to Dr. Orebaugh about his projects.

Anthony Machi: You have had a unique evolution in your career from emergency medicine (EM) to more than 20 years of service in the Navy to academic anesthesiology as well as a writer. How have these experiences shaped your creative writing endeavors?

Steve Orebaugh: I have been fortunate to experience many different places while growing up, and again during my training and early career, courtesy of the Department of Defense. I was an Air Force brat, born in Japan and lived in several different towns and bases until I was 12, when we settled in central Pennsylvania. We spent four years in Spain, and this was such a unique and wonderful time in my life, that I wrote a memoir, which I hope to have published in the future.

I am hoping, in my modest way, to call attention to the crisis and to make clear the susceptibility that all of us have to these powerful drugs—even those of us who are well informed and clearly understand the danger.

Originally, I chose EM as a specialty, with a strong interest in critical care medicine, which led me back to anesthesiology. After EM residency and a year of critical care fellowship, I joined the Navy to fulfill my scholarship obligations, spending three years at the Naval Hospital, San Diego as an emergency physician. As soon as I reported to officer training school, a war broke out in Kuwait. Soon, I was sent overseas with a small medical unit in support of the First Marine Division. We built and staffed a field hospital, a unique and challenging experience in the middle of the desert. We were quite busy when the ground war broke out, but fortunately the action came to a rapid and successful conclusion. I also wrote an account of my experiences with that unit, and the fine people that I served with. I will submit that for potential publication within the next few years.

After completing my residency in anesthesiology here in Pittsburgh, I had no success finding a position in critical care, as the economic changes in medicine in the mid-90s led to a hiring freeze. So, I found a position that was half EM, half anesthesiology for the next eight years. This led to some amusing circumstances—sometimes, I would admit a patient through the emergency department (ED) in the morning, then put on my operating room hat and go to provide their anesthetic later that evening, when I was on-call for the anesthesia service! On a few occasions, patients with follow-up problems from surgery presented to the ED to find me, their anesthesiologist, now seeing them as an emergency physician.

I had always been interested in writing, and during these early years of my career, I aspired to write professionally for publication. Because I straddled the interface between two acute-care specialties, I proposed an airway atlas to Lippincott, Williams and Wilkins. The editor was open to the idea, but soon left the company, to my chagrin. Three years later, when I’d been called up for active duty by the Navy reserve, and sent to Norfolk, VA, to provide anesthesia there for troops coming back from the Iraq war, I received a letter. The new editor had found the proposal and wanted to pursue it. This was an exciting opportunity for me. I spent the next two weeks, during which I had the unique opportunity to staff the medical department on an aircraft carrier during its maneuvers off the Atlantic coast, writing furiously to meet their timeline. This resulted in the first Airway Atlas: Tools, Tips and Techniques, a practical and well-illustrated book for trainees and acute care providers, that eventually came to a second edition, for which I served as editor. At this time, I also was engaged in writing an instructive book for patients undergoing surgery, as I was spending most of my time in ambulatory anesthesia providing (and teaching) nerve blocks for orthopedic patients. Many patients were ill-informed about regional anesthesia and were intimidated by the concept. I wrote a text called Understanding Anesthesia, an instructive treatise for patient education, published in 2006 by the Johns Hopkins University Press.

I was also seeking to explore and satisfy my creative side at that time. In about 2012 or so, I wrote a novel about an emergency physician, staffing a small, busy urban ED, not unlike the one I had worked in until I devoted my career entirely to anesthesiology. I tried to create a realistic depiction of one night in a frenetic practice and entitled it A Night in the Life. This was published a few years later by the Pocol Press, a small press in Virginia. More recently, taking note of the burgeoning opioid crisis and the toll it had taken on colleagues of mine in health care, I decided to write about an anesthesiologist falling prey to opioids, eventually losing his practice, his relationships, his profession and perhaps even himself. This resulted in my most recent publication.

Anthony Machi: Practicing anesthesiology and writing are each full time jobs. How do you carve the time to write? When and where do you find your greatest inspiration?

Steve Orebaugh: Unfortunately, I stay up later than I should many nights. My best time for writing is after the activities of the day have settled and the quiet of evening allows me to concentrate. I am inspired, like most who write, by high-quality writing. I especially appreciate classic literature, but I can enjoy more modern writing as well. A year or so ago when I read All the Light We Cannot See, I was really impressed. What a read!

Anthony Machi: What motivates you to write in general and what motivated you specifically to write your most recent novel?

Steve Orebaugh: As we all know, the nation is in the throes of a devastating epidemic—opioids are killing Americans in unprecedented numbers. While physicians are often implicated among the many causes of this scourge, little attention is paid to the potential for doctors and nurses to become addicts themselves. Anesthesiologists and nurse anesthetists, who administer opioids with great regularity, are among the most susceptible providers. As anesthesiologists, we handle and administer opioids every working day. Tragically, I have witnessed several ruined careers related to addiction among my peers and have worked with trainees whose lives have been irrevocably altered by indulgence in the controlled substances that we administer to our patients. This illustrates just how compelling the allure of these drugs is, and how, once ingested, they create within the user a voracious appetite for greater indulgence, followed inevitably by ruinous consequences. This novel is a cautionary tale, one that I hope can influence providers in many aspects of health care.

Anthony Machi: The subject matter of opioid addiction of healthcare providers and specifically anesthesiologists has been somewhat taboo in the past. Was it difficult to tackle this taboo in your writing, and how did you overcome this to share the story?

Steve Orebaugh: I think in the past, we in medicine have been somewhat reluctant to admit our faults or bare our imperfections. But we’ve seen how hiding such things has adversely impacted other professions. Since the destruction wrought by opioid abuse and addiction has become so apparent in society at large, it seems reasonable, and perhaps even desirable, to address this within our own ranks, in a public way. It wasn’t difficult to address this while writing, but I have been surprised, and a bit disappointed, by some of the responses that I have received from our own journals when submitting excerpts of the novel for consideration in their “human element” sections.

Anthony Machi: How did you decide what type of perspective to share for your characters?

Steve Orebaugh: In this particular story, it was hard not to draw off my own experiences as an anesthesiologist. There’s a lot of me in the main character, though I am thankful that opioid abuse has never touched my own life. I tried to imagine how a physician (or other provider) in a position of responsibility and accomplishment, with high self-regard, could ever be drawn into addiction, even knowing the dangers that the drugs posed. I hope that I created a believable scenario, though I admit I struggled to make it realistic.

Anthony Machi: Do you have a specific audience in mind as you write? If so, who would that be?

Steve Orebaugh: The audience for this particular story was intended to be health care workers in general, and acute care providers more specifically, as our practices involve administration of opioids almost daily. I wanted to warn young providers about how insidious opioid drugs are, and how vulnerable we are to these influences, especially if we take that first step to compromise our principles.

Anthony Machi: Given your professional career, do the stories that you share touch more than a professional importance? What does it mean to you?

Steve Orebaugh: Well, I am in the autumn of my anesthesiology career. I hope to go to a part-time position within a few years, and full retirement a few years after that. I think it’s important to keep your mind active, and I anticipate doing that in a variety of ways as I wind down from medicine. Writing will be an important part of that. I find that writing is a fun and fulfilling process. If I can publish a book every few years and appeal to a modest audience with each one, that will be very enjoyable for me.

Anthony Machi: In addition to revealing individual stories, your writing elucidates systemic failures within healthcare and society that enable the addiction and personal destruction of the characters. What do you aim to achieve with this exposure?

Steve Orebaugh: The opioid crisis touches every corner of our society. I am hoping, in my modest way, to call attention to the crisis and to make clear the susceptibility that all of us have to these powerful drugs—even those of us who are well informed and clearly understand the danger. If I can make just a few people think twice before taking unnecessary opioids, perhaps averting a dangerous habit or addiction, that would be very satisfying for me.

Anthony Machi: Do you seek follow up from this exposure? If yes, how?

Steve Orebaugh: I was contacted by one of the executive officers of a society that monitors health care opioid use and offers education and assistance. I didn’t even know it existed! They asked me to speak and offered me a booth to sell my books at their annual conference this fall. This was a real honor for me. I hope this will allow me to amplify and promulgate my message.

Anthony Machi: Which writers influence you as an author and why? Do you have a favorite author? If yes, who, and which works are your favorites?

Steve Orebaugh: My favorite authors are Dickens, Conrad, Hugo, and St. Exupery. I’m impressed by their memorable characters, their careful plot development, and their delightful use of the language. It’s important to have something to aspire to!

I’ve read some of their books repeatedly, trying to understand how such renowned writers design their characters and stories. I suppose that Conrad’s Heart of Darkness is my true favorite. He pulls the reader deep into the jungle…you really live the story. To have that ability to touch someone amazes me.

Anthony Machi: How do you define success?

Steve Orebaugh: Satisfaction in life: personal, familial, professional. Easy to say, but it’s a lifelong pursuit!

Anthony Machi: How much of your success would you attribute to hard work and how much would you attribute to luck or other circumstances?

Steve Orebaugh: Well, at this point I would shy away from calling my writing “successful.” I’m just starting, and I have a lot to learn about both writing and marketing books. I am sure there is an element of both hard work and “right place, right time” for anyone who becomes truly successful.

Anthony Machi: What do you love about being an anesthesiologist, and what do you love about being a writer?

Steve Orebaugh: Taking care of patients is a great gift. I can’t imagine having spent my life in any other pursuit. Writing is very different. It allows me to share a part of my inner self with readers-if this captures their interest, and they approve, that is very satisfying.

Anthony Machi: What is up next for you? Are you already working on another novel?

Steve Orebaugh: Always. I have a memoir that I’m editing, as I noted above, as well as a book that is an account of the time I spent with the Marines as a Navy Medical Officer during Operation Desert Storm. And I am fascinated by Civil War medicine. I’m writing a novel about a Confederate surgeon coping with some very demanding circumstances in the aftermath of a great battle. Unfortunately, all this progresses at a snail’s pace. My first novel was published six years ago, and it took me almost five years to get the next one to the publication stage. COVID delayed the whole process by over a year, unfortunately. I hope to be able to offer a new book every two to three years, especially as I come to have more time during my later years.