A Daily Practice: Caring Beyond Self

During Black History Month this year, community members shared African-Americans who have inspired them. After Science Department Chair Fritz Goodman spoke of Dr. Caesar Andersen ‘92, medical director of hyperbaric medicine and advanced wound care of UC San Diego in Encinitas, we wanted to share Anderson’s compelling story with the rest of the community. An immigrant who survived childhood trauma, Anderson combines extraordinary intelligence, a remarkable work ethic, and a deep love of humanity. His story inspires us to live out our core value of ‘care beyond self.’

 

Born and raised in Liberia, established in 1847 by the American Colonization for Society for freed formerly enslaved people, Anderson’s family emigrated to the United States when he was eight due to civil unrest from a military coup staged by Master Sergeant Samuel Doe in 1980. The nation had a cruel, ironic trajectory in that the freed American slaves, Americo-Liberians, recreated a system of oppression they faced in the United States against the indigenous people of the land. Shut out of top positions and marginalized within the society, the native Liberians overthrew the president and suspended the nation’s constitution.

 

“I remember my neighbors’ homes and the military essentially knocking in the gates going into their homes,” Anderson said. “Fortunately, they were gone at that point. I’m sure my mom was freaking out because we probably would have been next. Random people from the street were coming in and stealing their refrigerators, stoves, anything they could get their hands on and carry. There was rampant looting.”

 

Since Anderson’s father worked in the former government, his family was also a target. As political asylees, they fled quickly to the United States to stay with an uncle, an executive in the U.N. Department of Social Affairs living in Jamaica, Queens, N.Y. They stayed with him for several months until the family could resettle in Connecticut, where his father had worked. 

 

Anderson has gone back to Liberia only once when he was 13, and he said he has mixed feelings about returning again, despite having extended family living in Liberia urging him to visit.

 

“My memories are warped,” he said. “I know it’s something I need to do [returning to Liberia], but I also know it’s going to awaken feelings that I probably subdued.” 

 

He recalled seeing the movie Hotel Rwanda, which included a particularly gruesome scene of passengers in a car traveling along a bumpy road in the fog only to discover, once the fog cleared, that they were driving over corpses. 

 

“I started crying at that moment,” Anderson said. “I remember the stories. I remember seeing bodies. I remember experiencing the piercing chaos.”

 

During the unrest, Anderson’s mother had taken him to the hospital for treatment, and while they were in the hospital, a 12-year-old child soldier was patrolling the corridor armed with a machine gun. The soldier bumped into the two and proceeded to have them hop on one foot while giggling at them.

 

“My mother urged, ‘You better do what he says,’’’ he said. “Those memories I have permanently. I’m sure that’s played a role in shaping the scene that I don’t necessarily want to run back.”

 

To soften his transition to the U.S., Anderson’s parents spun tall tales of American streets lined with chocolate and snow that you could eat. He just couldn’t wait to taste snow! Although a bright student, Anderson was reticent to speak in class and look his teachers in the eye due to the African cultural norm of respecting elders. But after his teachers expressed their concern to his mother and encouraged him to engage in class, Anderson went on to become the valedictorian in his grade school and headed to KO for high school, where he found a home and immersed himself in school life as a star on the track and cross country team, class president, and Shield and Dragon ambassador. Anderson also won the Tyler Tingley Headmaster award for the individual who best exemplified the KO motto of ‘caring beyond self.’

 

As the eldest son in an African family, Anderson joked that he had only two options for a career: medicine or engineering. After graduating from KO, he studied pre-med and biomedical engineering at Brown University and understood that, as an immigrant, his success would have to be based on meritocracy, not on well-established connections. As a medical student at Howard University, he initially intended to specialize in neurosurgery, but after his fourth-year neurosurgery medical rotation, he pivoted toward plastic surgery, a hyper-competitive field.

 

While completing his general surgery residency at UConn, Anderson learned that plastic surgeons were sending their patients with compromised flaps/grafts for hyperbaric medicine, which involves placing patients in a hyperbaric chamber where atmospheric pressure is steadily increased to 2.4 ATA while patients breathe 100% oxygen. UConn Health Center’s Hartford Hospital was one of the first institutions to build a large multi-place hyperbaric chamber. 

 

“To secure a position as a plastic surgery resident, you sometimes explore novel things in order to create a unique niche for yourself,” Anderson said. “I started rotating with a trauma/transplant surgeon, Dr. George Perdrizet, who was the head of the UConn Hyperbaric Medicine and Wound Care program. We published several papers together, which is how I ended up specializing in hyperbaric medicine coupled with wound care.” Dr. Perdrizet has been a long standing mentor and an excellent friend of Anderson’s. He later joined Anderson as Department Clinical Research Chair at UCSD in the Hyperbaric Medicine Division.

 

In the early 20th century, hyperbaric chambers were used for divers who suffered from the bends, a painful and potentially fatal condition caused by gas bubbles that develop in the blood when divers ascended too quickly. Over time, a governing body, the Undersea and Hyperbaric Medical Society (UHMS) regulated hyperbarics for specific uses that have been trialed and clinically tested with randomized, controlled studies. Anderson has published consecutive chapters in the UHMS Indications Manual regarding the management of necrotizing soft tissue infections (layman’s “flesh-eating bacterial infection”). Insurance companies cover the use of hyperbaric oxygen therapy only for the clinical indications approved by the UHMS. The treatment has recently become trendy among celebrities who seek hyperbaric treatments for cosmetic purposes at “sports spas” and “oxygen spas,” which Anderson considers fad money makers. 

 

Anderson said several years ago, a photo of Michael Jackson “sleeping” in a hyperbaric chamber trolled the internet. Very few knew that Jackson was actually receiving hyperbaric oxygen treatments to help heal thermal burn injuries he sustained during his infamous Pepsi commercial. Anderson points out, however, that fad entities use hyperbaric depths of less than 1.5 atmospheres, which is insufficient to achieve the level of healing identified in clinical studies. His facility at UC San Diego uses clinically proven dosing protocols and treats patients only with conditions approved by the UHMS. Anderson’s patients may undergo a series of daily treatments that last approximately two hours with five-minute air breaks in between periods of oxygenation.

 

Anderson explained that if a patient has a compromised skin graft or failing flap, the doctor can hyper-oxygenate the wounds to optimize the graft’s survival. “My type of surgical work is not sexy in terms of cosmetics,” he said. “I’m the fix-it guy, so if people have breast procedures that are failing or botched, they send them to me for salvage.”

 

Anderson’s treatments range from head to toe. Whether patients have had skin cancer resected from the scalp so the skull is now exposed, or they’ve had breast reconstruction, and the implant is deteriorating, or they have diabetic wounds or radiation damage, Anderson fixes it.  Some of these defects require artificial or cadaveric means for skin coverage, and he will utilize anything advanced to optimize the patient. 

 

Not all of Anderson’s patients are placed in a hyperbaric chamber, and he considers this treatment as just another tool in his arsenal to treat patients. In many cases, he uses bioengineered skin grafts and advanced surgical techniques. Although some doctors still are unfamiliar with or consider hyperbarics on the periphery of medical treatment, success in hyperbaric medicine is incontrovertible.

Anderson points to astounding turnarounds. One patient, resuscitated during a cardiac event, had emboli scatter, which occluded multiple vessels in his lower extremities causing the feet to turn black and gangrenous. After several consultations with plastic surgeons and orthopedics, the patient was told he had no other choice and needed bilateral lower limb amputation. Fortunately, his last stop before surgery was a consult with Dr. Anderson, who recommended adjunctive hyperbaric oxygen treatment coupled with meticulous surgical care.

 

“We were able to clean up and remove devitalized tissue which allowed the patient to granulate in and regenerate his foot,” Anderson said. “His toes were black, gangrenous, compromised with osteomyelitis, so he, unfortunately, lost his toes. But we salvaged everything else. Despite having tendon and bone exposed, we nurtured him back to full skin coverage. He wears Nike sneakers and walks even without the use of a cane. What was so gratifying was when he said, ‘Everyone said it was impossible for me to save my legs!’ I just want to walk into their offices and say, ‘Before you say something is impossible, you really need to consider your options.’”

 

Anderson cited 100-pound pigs that had been drained of blood and perfused with saline and placed in a hyperbaric chamber. Rather than the blood delivering oxygen to the tissue, only the oxygenated saline solution courses through the pig, keeping it alive. Once the pig is removed from the chamber, it will no longer live. “That gives you an idea of the oxygenation potency patients experience in the chamber,” he said.

 

Fortunately, contraindications and side effects from hyperbaric treatment are minimal and primarily depend on how sedentary a patient is. Sedentary patients may feel more tired after treatment because the chamber accelerates the metabolism, making some individuals feel they had a small workout. More active patients will barely notice a difference. The only absolute contraindication to treatment is an untreated collapsed lung. The most common side effect in patients is similar to ear changes that occur while flying, and most patients can equalize their ears without difficulty.

 

Though hyperbaric treatment seems to verge on the miraculous, it has limits. Some clinicians who don’t understand the treatment often refer patients too late. By the time Anderson receives these referrals, the tissue is already dying. “If they had thought about it sooner and referred these patients earlier, I could salvage them in a much more efficient manner,” he said. “Hyperbaric oxygen therapy, I always say, does not resurrect the dead. If the tissue is dead already, there’s no real role for it. But if the compromised tissue can be perfused promptly in the chamber, that’s certainly the way to go. This is not a hocus-pocus intervention. It’s been around long enough. It’s safe, low risk, and extremely effective.”

 

One of the most satisfying aspects of Anderson’s work is seeing the a-ha moments on the faces of his emergency medicine residents who have not been previously exposed to the surgical benefits of hyperbaric medicine. Initially, when seeing the dire conditions of the patients, the residents and students accept that the patient will necessarily lose a limb or never heal. Eventually, upon witnessing the efficacy of the treatment, they’re converted. “They see patient’s limbs being salvaged and see their skin regenerate,” he said. “Their light bulb goes on, and they say, ‘Oh my gosh! This is a real possibility?!’ I think that’s quite encouraging from my perspective.” 

 

Another area of fulfillment for Anderson is his ability to witness in real-time the success of the treatment. Rather than having to wait five years to see the benefits of a particular medication on a patient, Anderson can track from week to week the repopulation and regeneration of the tissue.  “I can show the proof,” he said. “It has tangible, convincing evidence that is inspiring and life-altering for people who don’t want to get amputated or have been told they will always have their skulls exposed. That’s gratifying to have such an impact.”

 

Because Anderson sees his patients regularly over the course of several months, in some cases, a close relationship forms between Anderson and his patients. He believes the reason his patients have such a high success rate is not only that they are educated about the treatment and the disease process but also that they experience the strong, positive bonds that are cultivated on their wound healing team. Anderson cites KO’s core value of “caring beyond self” as a belief system he encourages his students and residents to follow. “This motto tells you it’s not about you,” he said. “It’s not about your academic achievements per se. It’s not about which schools you attended. It’s about how you translate that. How do you interact with others to get them to a better place than where they started? That’s the model that I try to follow.”

 

“I love my job, and I’m telling you right now, even if you spend one day with me, you’ll see morbidity in a different light,” Anderson said. “I always say, for every adversity, there’s a trace of something potentially good. Some of my patients are cancer survivors. Some of my patients have very painful wounds. It’s saddening, but there’s also inspiration. You see these patients being tireless, and they show up each week fighting. As they see themselves healing, getting better, and the agony gives way and softens to smiles, it’s a beautiful thing. I tell my residents, whether we are speckled with Ivy League education or wherever we’ve been, the goal of medicine is not to divorce yourself from being as common as possible. The goal is to make meaningful connections: embracing every patient encounter as an opportunity and blessing. This is an arena where I get to do that. It’s truly a humanizing thing.”