In Memoriam: Miesczyslaw (Mike) Finster, MD

Mike was born in Lwow Poland almost a century ago. I only heard these past days how incredibly difficult his early life had been. He managed to escape the Nazis and ultimately made his way to Israel where he met Lily, whom he married a few years later.

Mike and Lily moved to Geneva, Switzerland, where Mike obtained his medical degree in 1957 before emigrating to New York. Mike completed an anesthesia residency at Columbia University (1958 to 1960), followed by a research fellowship (1960–1961). Succeeding Virginia Apgar and Frank Moya, Mike was appointed Director of Obstetric Anesthesia, a position he held for 32 years (1962–1994), before serving as acting Department Chair (1994–1995). Mike was on Faculty at Columbia for 47 years and became Professor Emeritus in 2007.

In his earliest publication, Mike reported on four cases of caudal labor analgesia resulting in the accidental injection of mepivacaine into the fetus’ scalp (Am J Obstet Gynecol, 1965). This report became a major factor in caudals being replaced by lumbar epidurals for labor analgesia. Mike started to study the pharmacokinetics and pharmacodynamics of local anesthetics in pregnancy. Mike’s research, working in his Columbia lab for three decades with Hisayo Morishima, Hilda Petersen, Paul Poppers, Alan Santos, and many others, was groundbreaking. His studies, comparing local anesthesia systemic toxicity in pregnant and nonpregnant ewes, the transplacental transfer of local anesthetics, and the maternal and fetal toxicity of anesthetics resulted in 30 publications between 1966 and 1996.

Anesthesia-related complications and ways to avoid them were certainly on Mike’s agenda.

Mike published a Letter to the Editor with Gertie Marx on the “alarmingly high incidence of difficult intubations, with consequent maternal and fetal complications, in women undergoing general anesthesia for emergency cesarean section because of fetal distress” (Anesthesiology, 1979). This alerted the world to the growing concern of failed intubations in pregnant women causing maternal deaths, and though brief, the paper proposes a stepwise approach to avoid a “CICO” situation.

Another publication reporting on the possible neurotoxic effect after epidural or inadvertent injection of subarachnoid 2-chloroprocaine (Anesth Analg, 1980) resulted in a change of drug formulation, and publication of another letter, “Chloroprocaine: safe after all!” (Anaesthesia, 1982).

Mike wrote two narrative reviews on the effects of epidural analgesia on the progress of labor and the mode of delivery (Eur J Obstet Gynecol Reprod Biol, 1995; Baillieres Clin Obstet Gynaecol, 1998). In the absence of well-conducted randomized controlled trials, Mike concluded “Studies showing that introduction of an ‘on demand’ epidural service did not increase the primary cesarean section rate are particularly instructive––Premature rupture of membranes and the choice of obstetrical service may be the most important factors affecting the course of labor and delivery.” We now have the data, and Mike was right.

Finally, in his last published paper, “The Apgar score has survived the test of time” (Anesthesiology, 2005), Mike described how Virginia Apgar developed at Columbia the famous scoring system that would “ensure observation and documentation of the true condition of each newborn during the first minute of life,” with five signs easily observed in the newborn (heart rate, respirations, muscle tone, reflex irritability, and color). It was only two years later that the acronym was created by two pediatricians to facilitate teaching of the Apgar score (appearance, pulse, grimace, activity, and respiration). The value of the score was examined in several large studies (1952–1956; 1959–1966; 1988–1998) and while it was not intended to be a measure of perinatal asphyxia, a strong correlation between the Apgar score at 5 minutes and neonatal mortality was confirmed.

It comes as no surprise that Mike served as a Consultant to the NIH Perinatal Research Branch and an Expert for the FDA Center for Drug Evaluation. He also received the ACOG Associate Fellowship Award and the Niels Lofgren Award.

Mike published 69 papers, authored 83 textbook chapters, and was invited around the world for visiting professorships. He served on the editorial board of many prestigious journals. He served as Chair of the Committee on Obstetric Anesthesia at ASA, as the Scientific Chair of NYSSA/PGA (1984–1987), and the NYSSA/PGA Chair (1987–1990). Mike presented the Emory Rovenstine A. Memorial Lecture at PGA in 1993 and received the NYSSA Distinguished Award in 2003.

Mike was a giant, a memorable teacher, a legendary leader, and an outstanding storyteller. His contributions to Society of Obstetrics and Perinatology (SOAP) include

• One of 64 Charter Members (person enrolled at the first national SOAP meeting held in Kansas City) in 1969

• President of SOAP in 1995–1996

• Fred Hehre Lecturer in 1997 (“Abandoned Techniques and Drugs in Obstetrics and Obstetric Anesthesia”)

• Recipient of the Distinguished Service Award in 2001

To innumerable SOAP members, Mike was a great source of advice and support. He was the perfect European gentleman with a witty sense of humor. One of a kind. Mike will be missed around the world, not only as an anesthesiologist who shaped "safe obstetric anesthesia," but as the brilliant, kind, and generous friend he was to so many of us.

Mike died on 9/11, surrounded by his loving family. We will keep Lily, Evelyn, and Victor, his children, and his five grandchildren, in our thoughts. Mike’s memory is forever with us and may he now rest in peace.

September 14th, 2022

Ruthi Landau, MD

Dr. Landau is the Virginia Apgar Professor of Anesthesiology and the Director of Obstetric Anesthesia at Columbia University Irving Medical Center. She is past president of the Society for Obstetric Anesthesia and Perinatology.

(This tribute originally was published in the Fall 2022 edition of the SOAP Newsletter.)