The Life & Career of Kenneth Charles Appell, M.D.: A Quick Biography

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On March 23, 1923, Kenneth Appell was born in New York City on Manhattan’s Upper East Side (East 77th Street, off York Avenue); after the death of his mother, his father moved with Ken and his sister Florence into a brick two-bedroom house in Astoria, Queens (see gallery).

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In 1940-42, he attended Manhattan College in the Bronx, New York City, but his undergrad career was interrupted in 1942-46 by service in the U.S. Navy. He trained and was stationed at J.V. Newland Field at Baylor University in Waco, Texas; Lambert Field in St. Louis, Missouri; and air bases in Jacksonville and Pensacola, Florida. He subsequently flew missions in the Pacific theater of World War II.

The war over, in 1946-47 Ken Appell completed studies and graduated (second in his class) from Manhattan College. In 1947 he continued on to Georgetown University School of Medicine in Washington, DC, graduating in 1951 with that year’s Gold Medal in Pathology. During medical school, he returned to Astoria to marry fiancée Marcella Varmuza, who then moved to DC with him.

Right out of medical school, the newly minted physician did a 1951-52 rotating internship, at St. Vincent’s Hospital in New York City. That was followed in 1951-56 by a general surgery residence, then a year as research associate, at Brooklyn VA Hospital in Bay Ridge.

After being certified in 1958 as a diplomate of the ABS (American Board of Surgery), the following year Dr. Appell served as surgical coordinator at Grasslands Hospital in the Westchester County (New York) town of Valhalla. A year after that, he and his wife moved to Westchester, to the city of Port Chester.

Following two years as attending surgeon at the Bronx VA Medical Center, in 1961-62, through 1965 he became general surgery section chief and research associate at this same hospital. It was here, in 1963, that Kenneth Appell made medical history with his invention of the AV fistula (aka the radiocephalic fistula). During this period he also taught as a clinical instructor at Albert Einstein College of Medicine.

The Sixties were a busy decade indeed for this distinguished surgeon. Overlapping with his tenure at the Bronx V.A., in 1962-69 he was also visiting surgeon at Harlem Hospital in upper Manhattan, and in 1963-69 served as Chief of Surgery at Calvary Hospital in the Bronx. This non-profit insitutition affiliated with the Roman Catholic Archdiocese of New York is the United States’ only fully accredited specialty hospital providing acute and palliative care exclusively for advanced cancer patients. On top of all the above, during his last year Dr. Appell was also president of Calvary's board of directors. It was also during this period, in 1968, that he received a Veterans’ Administration commendation for advances in the field of hemodialysis -- primarily for his creation of the AV fistula.

In 1969, Dr. Appell's life changed significantly once again. He spent part of that year as a consultant in vascular sugery at the Holy Name Hospital in Teaneck, New Jersey and consultant in surgery at St. Joseph’s Hospital in the Westchester city of Yonkers. But that same year, he moved with his family (wife Marcy, son David, daughter Ann) to the part-rural/part-suburban town of Red Hook, 100 miles north of New York City in the Hudson Valley’s Dutchess County, and started practicing medicine at Northern Dutchess Hospital in nearby Rhinebeck. His first partner in practice was Dr. Bill Jameison, followed as of 1980 by Dr. Jim Wing.

Since 1969, Kenneth Appell has been an attending surgeon at Northern Dutchess, as well as Chief of Surgery for much of that time; in 1973 also became an attending surgeon at Rhinebeck’s Ferncliff Nursing Home. He continues at both institutions to this day, even in semi-retirement.

In more recent years, Kenneth Appell's invention of the AV fistula has finally begun to be somewhat better appreciated after years of unfair attribution to colleagues in the Bronx V.A.'s nephrology unit (it has sometimes, for example, been referred to as the Brescia-Cimino shunt). Landmarks in this process included a well received paper on the subject Dr. Appell delivered in 1988 at the Symposium on Vascular Access for Hemodialysis, held in Phoenix, Arizona. The pace has picked up a bit in the past three years, most notably in 2006 when José Ramón Polo, a distinguished surgeon based at Gregorio Marañón Hospital in Madrid, Spain, published a "historical vignette" article. "Kenneth Charles Appell, M.D.: The Surgeon Who Performed the First Radiocephalic Fistulas for Hemodialysis" appeared in the February issue of The American Surgeon (Vol. 72, No. 2). In November of last year, Dr. Appell presented keynote address at the tenth annual Veith Symposium on Vascular Access in New York City, and was awarded honory membership in the Vascular Access Society of the Americas.

For additional specifics on and images of Kenneth Charles Appell's life and career, please see the accompanying photo gallery.

Working with Dr. Kenneth Appell: An Interview with Nurse Jaime Dillenger

In a five-minute interview taped in August 2008, operating room nurse Jaime Dillenger describes her professional association with Kenneth Appell, dating back to 1982 (transcript follows).

"My name is Jaime Dillenger; I worked with Dr. Appell for 20 years in the O.R. at Northern Dutchess Hospital. Dr. Appell was the best surgeon I have ever worked with in my entire life. And having worked in an O.R. for almost 30 years, I’ve worked with a lot of surgeons. He was a wonderful teacher. When I went to work in the O.R. I had no O.R. experience, and he taught me many, many different things. Um, he was very respectful with tissue and excellent with anatomy, and he was a great teacher, and I always loved working with him.

I started in the O.R. in 1982. I’d worked in the E.R., so I knew him from the Emergency Room when I was in nursing school. And then I worked from 1982 till 2000 in the OR itself. And, you know, he became like my father, and you know, like I said, he was wonderful to work with, he was kind to the staff. You always felt that no matter how bad your case was, he would get you through. Even if it was an emergency, you didn’t see him getting ruffled or yell at you because something wasn’t going right, you know what I mean? It was like, there was always a purpose: okay, this is not a good thing, but, okay, we’ll fix it. Whatever the situation was, you just knew you were safe, you know what I mean? He would take care of the situation and he would get you through it and everything would be okay. He didn’t lose his cool, he didn’t yell at you, he didn’t scream at you – at anybody – you know what I mean? It was, “okay, this is what we need to do, and we will do it.” You knew the seriousness of the situation but you would remain calm because he was calm. I’m sure inside we were all panic-stricken (laughs), but like I said, you remained calm because he was. You knew he knew what he was going to do next. [With some other surgeons] you can definitely see that, “this is bad and I’m really not sure what to do.” And even if he thought that, you didn’t know he was thinking, “ oh, boy, this is a sinking ship.” You never, ever had that feeling with him. I’ve worked with a lot of surgeons, and you don’t always have that feeling that it’s going to be okay, that we’re going to work this out and everything’s going to be fine. You don’t have that all the time.

[I also became friends with him and his wife outside work,] especially after I divorced and after my dad died. When I was building the house, they would go every Sunday after church to check on the progress of the house and see how things were going. He would come to work on Monday and he would say, “I was out to Kansas yesterday” – my house borders on Kansas Road – “Marcy and I went to Kansas after church!” (laughs)

I remember one night working through an aneurysm with him and Dr. Wing, like, all night. And we finished at, like, four or five o’clock in the morning. I went to take a shower and he went into the lounge on the couch. And then I went in afterwards and made coffee for him, and he’s laying on the couch with a blanket and a pillow… (chuckles)

It was just so enjoyable to work with him. He would do anything – and especially in later years, when he was not doing as much surgery but helping Dr. Wing more – you know, he’d come back in the room, he’d be mopping the floor, he’d be helping you make the bed, you know what I mean, he’d be sitting in the lounge. Like I said, he was just an absolute pleasure to work with. He really was."

James Wing, MD Talks About Partner and Mentor Kenneth Appell

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In this six-minute interview taped August 6, 2008 at his home in Rhinebeck, NY, general surgeon Jim Wing discusses his twenty-year partnership with Dr. Ken Appell. Following is the transcript of that interview:

My name is Jim Wing, and I’m a general surgeon in Rhinebeck, and I’ve been associated with Dr. Appell for the last 20 years. I remember – I’ll start from the beginning, before it was the beginning for me and my association with him. I had just finished my residency and was – actually, I was at a teaching hospital and I’d stayed there for a couple of years afterwards and I was looking for a place to go to work after that. My sister lived in Rhinebeck, which was the initial impetus to come up here. And I looked at who the surgeons were in town here, and Dr. Appell was one and Dr. Jameson was another one. So I inquired of both of them just what the availability of, or their interest in having a partner would be at that point. Dr. Appell was actually quite interested at the time, so it was quite lucky for me.

I’ll tell a small tale out of school, I guess. I don’t think I ever told Dr. Appell this, but I remember coming up here and I’m sure – or actually I know – he looked me up and I looked him up, and we checked each other out. And one of the things I noticed was, ah, he’s 65, I said, how much longer can he really practice at this point. So I’ll be going up there and I’m sure that at some point soon after that he’ll want to retire. Well, he’s still helping me to this day. As a matter of fact, he helped me just two days ago in the operating room, and he’s still an excellent surgeon, and I’m glad to have him with me in the operating room.

So anyway, I came up here, and he, as I said, I was just inquiring as to whether he had any space or was interested in a partner. He was quite interested at the time, and in fact after we met and talked a little bit the first time, and I came back a second time, he offered to have me come in as a partner with him. And it’s been the happiest association ever since then, for the past 20 years, because I came up in July of 1988 and it’s now July or August of 2008, so that’s 20 years ago, and it’s been a wonderful association.

When I was coming up here and just looking Dr. Appell up and checking him out, I found out that he in fact was the person involved in what came to be known as the Brescia-Cimino shunt and should have been known as the Appell shunt, which is a radiocephalic fistula for dialysis for patients who are having kidney problems. He in fact was the surgeon involved in that study and was the one who did the actual legwork and the surgical work involved in the study, which is now a classic fistula for patients who have renal failure. And it’s been around for a long time – I remember doing it as a resident. We don’t do them at this hospital up here anymore because we don’t have dialysis capability. But I know Dr. Appell when he first came up here would go down to Poughkeepsie and perform the shunt down there. And I did it a number of times in Long Island where I was a resident and afterwards attending for a short while.

So that was very eye-opening to me, to realize that I was coming up to work with somebody who really was quite famous, and to this day is quite famous for that. That this is one of the things that will go down in surgical history as a real milestone, and something to be looked back upon. Um, it’s really ground-breaking, because it allows patients who do have chronic renal failure to have dialysis, and it’s a very functional shunt. So I was quite thrilled and quite impressed to be able to join someone of such magnitude.

And, um, sometimes surgeons are not the, uh, easiest people to get along with. I mean, we become know for our egos, and just because of the nature of the work that we do it can be quite stressful. But I have to tell you that I’ve never worked with, um, someone who is, uh, such a gentleman, and (chokes up slightly) uh… That I mean in two ways… he is truly a gentleman in terms of, um, his interactions with other people, and he’s truly a gentle man. I think in 20 years I don’t think I ever saw him really lose his temper and really, uh, get angry at anybody to the extent that surgeons are known for. Certainly we all have our moments when things don’t go right for us, and I was involved in him in that, because the operating room is a stressful place. But, um, he never, never lost his temper. I mean, he was very even-keeled – there were moments when things would go, uh, hoary, and we would need, you know, some help or, uh, it just wasn’t a pleasant situation. But he was never unpleasant in any situation that I can recall.

So it’s been, like I said, for 20 years, it’s just been a wonderful, wonderful, uh, partnership. And, um, he’s been a great mentor for me – I mean, I had some experience, but I was still a young surgeon at that point, and I picked up and fine-tuned my own surgical abilities, you know, because I was able to work alongside Dr. Appell and watch the things that he did, and incorporate some of the things that he did in my own practice of surgery. So it’s really been a fruitful existence for me, a fruitful relationship, and I’ve gained and progressed in my own surgical knowledge and my own surgical abilities because of being with him. Um, and as I’ve said I’m happy to know he’s still, um, able to come in and assist me, uh, in the operating room now, because he’s still a quite excellent surgeon – and I really, I really say that from the bottom of my heart. And I’m happy to know him and to have had the pleasure of working with him for many, many years.