Residency at the University of Cincinnati

During residency, there were no faculty members physically present in the emergency department.  Dr. Janiak recalled seeing an attending physician in the ED only once during his three years of training. Most of his mentoring came from senior residents in other specialties. Some were generous teachers; others less so. The absence of structure left room for innovation and self-reliance.

There was no playbook. Learning happened in real time and often under extreme pressure.

During his intern-year surgery rotation, the chief resident sought Dr. Janiak’s help during a Whipple procedure. In a thick southern drawl, the resident promised Dr. Janiak he was about to witness the best operation in the world. Suddenly, Dr. Janiak found himself nowhere near the surgical site holding a retractor for hours. When the resident turned his head to take a sip of juice, Dr. Janiak dropped the retractor and quietly fled the operating room, never to return.

He also recalled a tornado striking an RV park outside of Cincinnati. Victims flooded the ED. Dr. Janiak spent nearly 20 hours suturing.

Later in residency, Dr. Janiak was given a small office in the emergency department, which became a gathering place for house staff across the hospital where a refrigerator, occasionally stocked with adult beverages, helped the hours pass. One Saturday, Dr. Janiak hosted members of the Pittsburgh Steelers who were in town for a game.  Dr. Janiak made sure they were well hydrated and smiled gleefully the next day when his beloved Cincinnati Bengals won easily.

There were also painful lessons. A senior internal medicine resident wanted to demonstrate the dramatic effect of a newly released drug, Lasix, and inadvertently administered more than 200 mg; The patient died moments later. Dr. Janiak never forgot it. From that point forward, he double-checked every medication dose, a habit that lasted throughout his career.

Another patient, an obese adolescent taking a new weight loss medication, arrived agitated, grabbing at objects and hiding under the stretcher.  Dr. Janiak filed a Food and Drug Administration adverse drug report. Within a week, a pharmaceutical company representative took him to an extravagant dinner and asked whether he really wanted to submit the report.  Dr. Janiak made it clear that he did. The experience reinforced his belief that advocating for patients sometimes requires pushing back against powerful interests.

At the end of his pioneering residency, emergency medicine still lacked board certification. With no alternative, Dr. Janiak became certified in family medicine. In 1980, he was grandfathered into the American Board of Emergency Medicine (ABEM), finally receiving formal recognition for a specialty he had helped create.