Remembering Dr. Joachim Stefan Gravenstein

Dr. Jerome H. Modell joined the UF faculty in 1969 as chairman of the department of anesthesiology before retiring in December 2001. While at UF he also served as senior associate dean for clinical affairs, executive associate dean and interim dean for the College of Medicine.

Photo by Sarah Kiewel

Joachim Stefan Gravenstein, M.D., Dr. med. h.c., succumbed to a long bout with cancer and passed away on Jan. 16. Many of his colleagues and friends who knew him best stated, “The world has lost one of the most gentle, kind, considerate, unselfish, compassionate and intellectual men of all time.” Dr. Gravenstein is survived by his loving wife of 59 years, Alix; eight children, Nikolaus Gravenstein, Alix Gravenstein Pastis, Frederike Gravenstein, Dietrich Gravenstein, Stefan Gravenstein, Rupret Gravenstein, Constanza Gravenstein Goricki, and Katarina Gravenstein Brient; and sixteen grandchildren.

Dr. Gravenstein or “J. S.” or “Nik”, as he was known to his friends, was born in Berlin, on Jan. 25, 1925. After graduating with a doctor of medicine degree from the University of Bonn in 1951, he spent one year in Switzerland as an intern and then immigrated to the United States. From 1952 until 1958, he was in Boston where he completed a residency and research fellowship in anesthesiology and a second doctor of medicine degree at Harvard University School of Medicine. He was elected to membership in the highest honor society for medical students, Alpha Omega Alpha, in 1958.

Dr. Gravenstein’s career as an academic anesthesiologist began in 1958 when he was recruited by Dr. Edward Woodward, chairman of surgery, and Dr. George Harrell, dean of the College of Medicine, immediately after graduation from medical school to be the chief of anesthesiology at the new College of Medicine at the University of Florida. At age 33, he was the youngest head of an academic anesthesiology department in the United States.

Dr. Woodward told me that at the time that Nik was appointed to this position, he approached Dean Harrell and asked that anesthesiology be established as a separate department in the College of Medicine. Dr. Harrell asked Nik how many faculty members were in his new department, and Nik responded, “One.” Dr. Harrell’s response was “Come back to me again when the department has grown. I don’t believe that a one-person department is viable.” Nine years later, Nik’s division gained departmental status in the College of Medicine.

I first met Nik in the mid-1960s when I was a member of the faculty at the University of Miami School of Medicine. At that time, the University of Miami and the University of Florida co-sponsored a post-graduate seminar in Miami Beach, and I had the opportunity to meet and work with Dr. Gravenstein related to that post-graduate education meeting. It was not, however, until November 1968 when Dr. Gravenstein announced that he was leaving the University of Florida, and I was invited by the search committee to be a candidate for the chairmanship of the department he was vacating, that I really had an opportunity to know this outstanding individual. When I visited as his potential replacement, he was most gracious and invited me to his home for lunch where I met his wife, Alix, and some of their children.

Dr. Gravenstein left the University of Florida in the summer of 1969 to assume the position of professor and chair of the department of anesthesiology at Case Western Reserve University School of Medicine in Cleveland. I had the good fortune to be selected by the search committee to be his successor and arrived in July 1969. At that time, the department was very small with seven faculty members, six residents, one nurse anesthetist and four nurse anesthesia students. We were fortunate in being able to recruit a number of outstanding young faculty and residents, many of whom have since gone on to become department chairs themselves in universities throughout the country.

Ten years later, we celebrated the 20th anniversary of the department that Dr. Gravenstein started, and we invited him to return to UF to be our visiting professor for a week on that occasion. At that time, it became quite obvious to me that Nik was homesick and perhaps not enjoying administration as much as he thought he would. I approached him with the idea of his returning to UF as a graduate research professor, and we had a conversation unlike any I have had with a recruit before or after. Nik wanted to be assured that he would be able to teach medical students, residents and fellows, perform research and take care of patients. Under no circumstances did he want to be assigned any administrative responsibilities whatsoever. Further, when it came time to negotiate a contract, he told me to write whatever I thought was fair, and he accepted it verbatim, without comment and without even knowing what his salary would be.

Dr. Gravenstein remained as a graduate research professor and then subsequently as a graduate research professor emeritus in our department, continuously, until his death. Despite his advancing age and illness, Dr. Gravenstein continued to exercise his passion for teaching and research by being an active member of UF’s faculty up until approximately four weeks prior to his death. His usual routine was to be teaching residents at the anesthesia human patient simulator at 7 a.m. almost daily. Dr. Gravenstein has been a father figure and a mentor to several anesthesiology residents, fellows and faculty over the course of his career at UF. His academic career has been legendary, as he has taught literally hundreds of anesthesiologists who have gone on to successful careers, both in the private practice of anesthesiology and in academia.

Dr. Gravenstein has published more than 80 books and book chapters, as well as more than 250 refereed publications and abstracts in the medical literature during his academic career.
Dr. Gravenstein’s publications will forever be a source of education to physicians and medical students. He was also internationally known for his expertise in anesthesiology, technology, and patient safety. He has been an invited lecturer all over the United States and in more than 20 foreign countries, including France, Israel, Denmark, Sweden, Germany, Austria, The Netherlands, Switzerland, Columbia, Korea, Japan, Australia, South Africa, Guatemala, Greece, Brazil, Malaysia, Belgium, Mexico, Thailand, and Argentina. He has been the recipient of over $1 million in extramural research grant support and has patented 14 inventions while at the University of Florida.

In addition to Dr. Gravenstein’s accomplishments as a professor on UF’s faculty, he was a co-founder and an original member of the Board of Trustees of the Anesthesia Patient Safety Foundation (APSF), which has led the way in improving anesthesia safety to the point that when Dr. Gravenstein began his career in 1958, the unexplained death rate from anesthesia nationwide was estimated to be 1 in 2,000, whereas at the present time, it is estimated to approximate 1 in 200,000; a 100-fold increase in safety. Current widespread efforts to improve patient safety in the American health-care system can be traced back to the Anesthesia Patient Safety Foundation, and there, to Dr. Gravenstein. The success of the APSF has been applauded by the federal government in leading the way for safety in medicine in the United States. Instrumental in this increased safety initiative was the establishment of routine sophisticated monitoring of patients under anesthesia, which was championed by Dr. Gravenstein.

Dr. Gravenstein was a co-founder of the Society for Technology in Anesthesia, which established the J. S. Gravenstein Award for Lifetime Achievement in the area of technology in anesthesia in 1999. He also was a founding editor of the Journal of Clinical Monitoring and has served as one of its editors for the past 24 years. To honor Dr. Gravenstein for his accomplishments, the “Joachim S. Gravenstein Endowed Professorship” was established at UF in 1996. Dr. Gravenstein received the Anesthesia Patient Safety Foundation Distinguished Achievement Award in 2002 and the University of Florida College of Medicine Lifetime Academic Achievement Award in 2005.


Photo by Sarah Kiewel

Dr. Gravenstein further has been called the “Father of Medical Simulation” by many of his colleagues, both locally and internationally. Since the early 1980s, he has led a team of physicians and engineers at the University of Florida in inventing what was originally called the “Gainesville Anesthesia Simulator,” and now has been distributed all over the world as the “Human Patient Simulator.” This unique teaching tool combines computer and medical science and permits one to simulate human response to changes that occur during anesthesia and other life-threatening conditions so that the student can learn how to recognize and handle these problems without jeopardizing a patient’s safety or life. Although originally the purpose of this apparatus was to expose anesthesiologists to critical incidents that occurred infrequently so that they would recognize them and be able to treat them in their patients, it now is used as a routine teaching tool for all types of healthcare professionals, including medical students, residents in a variety of medical specialties, emergency medical technicians, fire and rescue personnel, nurses and veterinary medical students, to name a few. Dr. Gravenstein and his colleagues have received numerous national awards at scientific meetings for their work in this area. As a tribute to him and his colleagues, this unique invention is now widely used throughout the world.

The beginnings of the simulator effort at the University of Florida were quite unusual and demonstrated Dr. Gravenstein’s ingenuity at obtaining resources and putting together effective teams of scientists. He recruited Dr. Jan Bennekin, then the chairman of the Department of Biomedical Engineering at Eindhoven University in The Netherlands, to spend a sabbatical with him in Gainesville. Dr. Gravenstein also recruited some of our brightest residents and fellows, including Dr. Michael Good, who currently is the Interim Dean of the College of Medicine, to work together with engineering students from both The Netherlands and the University of Florida to develop the simulator. Unfortunately, space was at a premium at UF’s College of Medicine at that time because many of the current buildings had not been built yet. A couple of years prior to this effort, the Florida Clinical Practice Association of the College of Medicine purchased some land with a clump of trees where the 1329 Building now sits. On that piece of property was a house that was occupied by undergraduate students who took very poor care of it. When Dr. Gravenstein was made aware of this property, his response was “The little house on the corner would make a wonderful home for the new ‘Gainesville Anesthesia Simulator’.” Our department then rented the building from the FCPA, and the simulator core group now had a place to realize their dream and develop this unique invention.

Dr. Gravenstein created the I. Heermann Foundation in honor of his mother, which funds original research of faculty and fellows at UF and has provided the initial funding for persons who have gone on to be very successful. He also created the anesthesia course for engineers and marketers, which has educated over 600 people from industry and government about the operating room environment. Many products now used in the operating room were influenced by this experience.

In recent years, Dr. Gravenstein also developed an interest in learning why some patients who receive anesthesia and surgery, particularly the elderly, appear to have problems with mental function postoperatively. This has led several scientists in multiple institutions to study post-operative cognitive dysfunction to further improve the safety of anesthesia.

Perhaps the most outstanding example of Dr. Gravenstein’s kindness and humility was demonstrated approximately two years ago when he gave his wife, then of 57 years, a lifetime achievement award similar to the one the College of Medicine gave to him in 2005. He gathered all the children and their families together for a black-tie event to celebrate her. At that time he stated, “I thought if anybody deserves an achievement award it’s my wife, because after she is retired from being mother and wife, her achievements will still be running around,” he said. “(Children are) a continuation, rather than something that is quickly forgotten.”

It was, indeed, a sad day when this Legend passed. However, his gentleness, compassion, kindness, humility and unique way of advancing education and scientific research will never be forgotten.

As I reflect on my relationship with Nik, I cannot recall a single day in the 29 years that we were colleagues and 13 years of which I was his department chairman where we ever had a disagreement about anything or when he was not 100 percent supportive of my efforts as his chair and colleague. He truly was a remarkable friend and colleague. I have been blessed with having many mentors, colleagues and friends over the past 50 years of my professional career, but never anyone greater than Dr. J.S. Gravenstein.

Greatness in One Man!
by Dr. Shirley Graves Modell

There’s an empty chair at the table,
And it shall never again be filled,
The man who sat there is irreplaceable,
His greatness in our memory is sealed.

A giant of a man walked this earth,
Innovation, intellect, charity and love,
Words so inadequate to describe his worth,
The source of his value comes from above.

Today we say goodbye to our friend,
Tears fill our eyes as our hearts cry,
For we wished there to be no end,
But now we say that final goodbye.

We lock him in our memories,
For today his soul moves on,
We cherish our days together,
For we know he was just on loan.

Goodbye, Dear Dr. JS, our friend, our mentor.