Dr. Joseph Civetta spent more than 25 years at the University of Miami, where he changed the face of surgical critical care, wrote hundreds of research papers and caught a lot of fish.
He passed away on March 30 at his Islamadora home. He was 77. A private celebration of life will be held next week.
Civetta, a New York native, graduated Magna Cum Laude from Holy Cross University in Massachusetts. His daughter said that he was expected to continue his education, so instead of law like his father, he chose medicine. He got his degree (Summa Cum Laude) from Boston University School of Medicine and spent the next five years of internship and residency at Massachusetts General Hospital. He had five children with his first wife Maryellen Regis-Civetta.
“He was a very inquisitive person, and I think medicine allowed him a wonderful life of asking questions and finding answers,” said his daughter Nancy Civetta.
In 1968, served two years in the U.S. Air Force at the Keesler Air Force Base in Biloxi, Mississippi.
He returned to medicine as director of the surgical intensive care unit at Massachusetts General. Two years later, he arrived at the University of Miami Jackson Memorial Medical Center as Chief of Trauma. He led the SICU, or “living physiology laboratory,” from the start and became Chief of Surgical Critical Care in 1972.
In Miami, he spent the bulk of his career, made important discoveries in his field, and he also met his future wife, Judy. She worked as a nurse in his SICU, and as she said, “the sparks just flew.”
The couple worked together on research projects throughout their careers. Civetta was the grand thinker and Judy worked the fine details. She was smitten with his intelligence and kindness. They married in 1979 at Casa Juancho in Miami.
“I had dated so many toads, and I finally found a frog who turned into a prince,” she said.
Dr. Nicholas Namias, chief of critical care at Jackson Trauma Center, said Civetta’s enduring medical legacy is his work with positive end-expiratory pressure, also known as PEEP. Pressure from ventilators keeps patients’ lungs pressurized and open. Before Dr. Civetta, the standard practice was low levels of pressure. But patients were dying from low blood oxygen, so Civetta tried something radical.
“He was using levels of pressure people thought were crazy,” Namias said.
It worked. And his technique lives on in ICUs around the world. The other acronym of PEEP was ‘Physicians Exploring Endless Posibilities,’ Namias said. Civetta called his group of doctors the PEEP Society, and they regularly gathered to “think crazy thoughts” about how to better serve patients.
Civetta’s brand of improvisation showed up in his home life as his love of cooking deepened. His daughter Nancy said the family dubbed him “Sir Mix-A-Lot” because of his constant recipe tweaking.
She said he sought perfection in everything. If something wasn’t done “the right way, the Civetta way,” his residents and fellows were going to hear about it. And not just from him. Civetta included the nursing staff in everything he did in the ICU. Nurses even evaluated residents.
“It was about taking away the ego of one central star and focusing on a team,” Namias said.
Teamwork meant work didn’t end when it was time to go home. Doctors were expected to call in and check on all their patients. Namias, who calls himself a “total, direct descendent” of Civetta, reminds his residents that “the I is for intensive.”
He got the call about Civetta’s passing while giving one of Civetta’s favorite lectures. Just like his mentor, Namias drew the empire state building on a whiteboard with a little man diving off the top. As he falls, he passes a man leaning out the window of the 80th floor, who asks, “How’re you doing?”
“Oh, fine,” the plummeting man replies. The drawing is a metaphor for the proactive, not reactive care Civetta strove for. His residents were taught to catch patients before they got anywhere close to crashing.
But when the crash came, Civetta was ready. End-of-life care was a late interest of his.
“The goal isn’t just to preserve a beating heart, it’s to save the patient while there’s still something to save,” Namias said.
Unburdening the family member or friend of the patient was a major focus for Civetta. He taught his doctors to remind the family that they’re not making the decisions, they’re telling the doctors what the patient would have wanted.
In the realm of end-of-life care, Civetta might be best known for his definition of medical futility.
“Futility is defined as the gap between what a doctor can achieve and a patient can accept,” Namias said. And because of that, Civetta helped change policy at Jackson that lets patients choose death.
For him, that policy move was as practical as the way he wore his watch — palm side up so he could check it easier.
Civetta’s ICU disciples span the globe, manning ICUs throughout America, Canada, Japan, Israel and Thailand. Every adult trauma center in Miami-Dade, Broward and Palm Beach counties has surgeon internists trained by Civetta or one of his trainees. The only exception is the pediatric trauma center at Nicklaus Children’s Hospital.
“We are his legacy,” Namias said.
In Civetta’s honor, alumni of his trainings are gathering money to create a named lecture series on surgical critical care.
In 1997, Civetta left Jackson. Namias said it happened right around when top brass made long-sleeved shirts and ties mandatory. He said Civetta, ever the free spirit, preferred short-sleeved, open-collar shirts. In his honor, Namias said he’ll attend the celebration of life in a tie-dyed T-shirt and cargo shorts.
Anything otherwise would be “directly disobeying the boss,” he said.
After Miami, Civetta became Chairman of Surgery at the University of Connecticut UConn Health Center, Director of Surgery at Hartford Hospital and general surgery residency program director.
His time there also made him a rabid, lifelong fan of the UConn women’s basketball team. He and his granddaughter dyed their hair blue to support the team in 2014.
Civetta read voraciously. Sci-fi, spy novels and medical textbooks filled his walls, including ‘Surgery Critical Care,’ which he wrote.
His accomplishments made Civetta a giant in the surgical critical care industry. He was President of the Society of Critical Care Medicine and presided over the society’s 1981 World Congress. The society gave him a lifetime achievement award in 2005.
In 2012, he finally retired. He and Judy headed to Islamadora full-time to pursue his other passion, deep-sea fishing. Previously they spent the winters working remotely in the Keys. “He commented that being cold in the winter was an option, not a necessity,” one UConn professor told his medical students.
Nancy said her father “lived his passion to the Nth degree.” He inspired his kids to live their life fully, like he did.
“Even when he had cancer and his bones were aching, he wanted to get on one ski again,” she said.
Most of all, Nancy said, everyone who knows him will miss his conversations.
“He could see 10 chess moves down the board. He asked the kind of questions that made you reflect,” she said.
Civetta is survived by his wife, his five children, 14 grandchildren and his mini-poodle, Ozzie.