As I look ahead, bloggingly, it occurs to me that it would be fun to hear from readers about subjects they'd like to see addressed. Anything you'd like to hear a surgeon (this one, anyway) talk about? Because I just might.
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Sampler
Moving this post to the head of the list, I present a recently expanded sampling of what this blog has been about. Occasional rant aside, i...
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Finally I'm getting around to writing about the gallbladder. Don't know what took me so long, seeing as how, next to hernias it'... -
I finished the previous post with the sad story of my patient, illustrating diagnostic difficulties at the fringes of biliary disease. An... -
It's gratifying that despite my absent posting for many weeks, this blog still gets over five hundred visits and more than a thousand ...
37 comments:
Dr. Schwab:
I always enjoy your blog and your nice writing. It depends on your editorial line. Your line is about stories and casualties with your patients and you share your experience.
In my blog, I try to write about conditions, news and what I think it's catchy for patients and doctors (mostly original medical images). I don't write like you because it's harder to write (since my first language isn't english) a story than to list a bunch of causes of a certain disease.
I think that everything you blog is nice. It would be nice to read how you empathize with your patients, what's your trick and all that stuff.
Best of all,
Jon.
i'm kind of new to this blog. have we talked about cholecystectomies yet?
From a patient's perspective (both a suvivor of abdomenal surgery and a candidate for more in the future):
How do you approach the whole "planning and preparation" side? You had a post recently about lateness, and as someone who spent an extra unexessary two hours "NPO" recently waiting for a test, I appreciated it. I have been given to understand that a lot of patients seem to blow off that part of the instructions, which made me wonder if I was a rube for subjecting myself to the misery. During my last hospitalization, I complained to the wound nurse about being awakened in the middle of the night to have the appliance over a draining wound emptied--it wasn't draining that much, for heaven's sake, and it's such a miracle to actually fall asleep in a noisy hospital--and she apologized because she was the one who had ordered wound care every 4 hours. She figured if she put that, I'd get wound care every 8 hours, which was more reasonable. So when I find out stuff like that, I wonder even more if all of my endless days on jello and popsicles followed by endless mornings with sandpaper-mouth are really worth it. Also, I had been feeling really guilty for all the mean things I whispered at the recovery room nurses who wouldn't give me just one little mouthful of water, the heartless bitches, after the anesthesia completely wore off and I remembered that they weren't supposed to give me water. But now I wonder if they weren't, well, following some rule that the surgeon's retired mentor's grandfather came up with. Not that I don't trust surgeons or anything (yeah, right), but there was also the day my surgeon had a nasty fight with the Pain Team right in front of me. I was glad the Pain Doc won, for obvious reasons, but after all that dehydration I went through, how could anybody object to a little more epidural fluid with some painkillers in it?
This may seem like horribly confused small beer to you doctors, but I bet you could do a big public service by giving us the inside skippy on this stuff.
dr. schwab, just curious...if you are doing a surgery that you have done maybe for the hundredth time, what are you actually thinking while looking at the same say for example, appendix?
may from www.aboutanurse.com
I've had a couple of surgeries. During one, I was awake (plastic surgery on a facial scar). The surgeon seemed quite annoyed with the nurses who failed to pay attention to the blood creeping down my chin. They were more concerned with asking him if they could have plastic surgery on their c-section scars. The second surgery was on a deviated septum. I asked the doctor if that was an interesting operation, but he answered honestly that it was too common to be interesting. So my requests would be for more insight into the behavior of personnel, perhaps especially during boring, routine surgeries.
I would be just as happy to be surprised by your choices of topics; your posts are uniformly engaging, interesting, educational, and a pleasure to read. (The same goes for your book, which I fell upon before I ever learned that you had a blog.)
Thank you --
Felix Kasza.
hi doc, just popped in to see what your sweet self was up to today! later gator....bee
Just want to say I enjoy your blog and have ordered the book. It looks so interesting!
May-
FWIW, This is what this mid-50s general surgeon thinks about when doing my 1000th gallbladder or appendix or hernia or colon resection: Where is the next likely place I (really, the patient) could get in trouble? There is a bloodvessel/bile duct/weak area/nerve that sometimes is here and not there where it usually is, and I remember the time I/a colleague that I was assisting/a malpractice defendant that I was providing expert witness for/someone in a morbidity conference was discussing cut/damaged/otherwise zigged instead of zagged and regretted it greatly. Even “routine” operations are anything but that; I imagine that similar thought processes occur when good pilots approach their 1000th or 10,000th landing.
Dr. Schwab -
I would like to know how new surgeries are developed and how surgeons test the new techniques to determine if the outcomes are better than the outcomes from the previous methods.
As a medical student who has aspirations towards surgery I would like to know what you would look for in a residency candidate. I understand that you may not have been on a residency committee at any time (and then again you may have been), but I feel that there are certain traits and conditions that surgeons look for in future peers. Just wondering.
Thanks,
MSG
I'd like to know if you listen to music in the O.R.
I'd like to know what you think about Nissen Fundoplications. Lap vs open? success rates, failures, why recovery is so long, what happens to your stomach during this surgery? is vagus nerve damage common during it? Why do failures happen? When should a person have one? Should they have a redo or leave alone a failed surgery? How often is barretts lost in the wrap? Is the failure rate normally higher with barrett's patients vs patients without barrett's (when making the wrap to loose so biopsies can still be taken)?
How often do hiatal hernias recur after a repair as part of a nissen fundoplication?
I guess I would just like your opinion about this entire topic.
Do you always ask for the machine that goes "PING!", especially when the administrator comes around?
what is it like to tell a patient or patient family bad news after a surgery? What are the range of reactions and do you just at some point go on autopilot, do the deed and then escape to have lunch, check your email, or schedule a tee-time? I have to say that one of my most vivid memories is of my 10 yr old son's surgeon coming out to see me and giving me bad news about a poor surgical outcome/complication. Surgeon seemed sincere, but factual and disappointed to be giving me this news....even though the outcome had been discussed as a small possiblity. I can only imagine how I looked when I had to process the info he gave me. I wonder if he thought I blamed him. I wonder if he worried I might be litigious(I'm not). I wonder if he second guessed his decisions or his skill. When the tears welled up in my eyes I think he felt a little teary, too. I saw him again later. We all got through that setback...developed a bond...all in all a very intimate relationship occurrs between a peds patient, parents and surgeon. It seems like he must have a heavy burden---
These are good. I'm already thinking about some related posts. Thanks. Don't stop.
Great blog, and I just started reading it yesterday.
What about competition between surgeons, relationships with other surgeons, surgeons working together etc
Why you chose abdominal over the other specialties..
oh and, do you think you need to have any special dexterity or skill to become a surgeon?
As an 11 year "survivor" ie... the Doc. didn't kill me this time, MRSA, contracted during hardware placement in the spine. I would LOVE to see anything on chronic staph infections. Mine just pops up several times a year and as long as I as in Me, catch it in time oral antibiotics, Penicillin, fixes me up. But if I don't recognize the symptoms and it gets into my blood I am back on IV antibiotics with Synercid being the only one that will work. I was on IV antibiotics for 5 years and it also wrecked havoc on my system but that is a who other unstudied field. We all know that staph can be a complication and are willing to accept that risk but as patients we also assume that someone will fix us within a reasonable period of time without causing these long term problems.
I read your blog often and love your insight. I need to look for your book.
Hi--I'm also a blogger, my blog is The Assertive Cancer Patient, and I'd like to get your input on things patients can do to prevent mistakes from happening during surgery. Obviously, the patient is usually asleep, but ...
If you could take a look at this post on my blog and respond, I would really appreciate it.
Mistakes During Surgery:
http://www.assertivepatient.com/2006/10/mistakes_during.html
Thanks,
Jeanne
I'd like to hear about a nephrectomy or vesicoureteral reflux repair as I had both but was too young to ask a lot of questions.
Kate: although I did a few nephrectomies and ureteral operations in my training, in my practice I let the urologists do them. So I'm afraid it's not an area I'm familiar enough with to post based on personal experince. I do know that the mainstay of reflux repair is cutting the ureter off of the bladder and reinserting it via a tunnel through the muscle. It's simple, and effective. here is a pretty good website for info
Dr. Schwab
I'm an MD/PhD student wanting to go into surgery. I have been discourage by many surgeons and other types of doctors. Their reasonings are usually..."you won't have time to do both", "it's nicer to be IMED doc and do research...", etc, etc.
What do you think about this?
I would like to hear more of your experiences from the service. Your VD post had me in stitches.
I am also particularly interested in what you consider a challenge and how you prepare for it?
I have no doubt that any story about surgery itself would be interesting, as would any story about interesting past patients. My particular interest at the moment, especially from a seasoned surgeon is what is the usual interplay is between surgeon and anesthesiologist. I know not all surgeons look at them as lesser physicians, but some of them do. I'd love to hear stories where they've helped you out intraoperatively more than just the standard management of the pt.
Relationships between surgeons and surgical pathologists/radiologists?
like... 'WTF is this lump of unoriented tissue you sent me?' haha
Hi Dr. Schwab,
This is a little outside your regular writing, but the thing most on my mind these days is the business of medicine and how it is learned. Many doctors writing blogs will, every couple of months, remind their readers about the problems that they have with this aspect of health care and how amazed they are at the ignorance of today's medical graduates about these topics. Well I do not want to be one of them.
So while I think about postponing my education to get an MBA to go along with my MD (I have goals of running a successful practice) I'd like to know your thoughts about how you came to understand the business of health care, of running a practice, and your advice for those looking for the information BEFORE they find themselves over their heads.
Thanks for considering it, topher.
I was reading your back posts and came across this one for requests, and I might have an interesting one for you!:) I have six children, two of which were born with dextracardia with situs inversus and kartagener's syndrome. When my first child was born, the first with situs inversus, she was on the operating table when someone said that the x-ray was backwards. Both of my kids with situs inversus wear medical alert bracelets now for peace of mind.
Last week my kids met an NBA player who has situs inversus, who did say that he had a lot of congestion (from PCD?), as well as someone who had to retire from basketball because he had an enlarged heart and had heart surgery (something to do with his valves), which was what they thought was wrong with my kids before someone realized the x-ray was backwards and they had situs inversus. I wondered if in one of your posts you could explain what that heart condition would be that requires heart surgery if the person doesn't have situs inversus? Also, I wondered if you had ever personally operated on someone with situs inversus? Some of the statistics say its as frequent as 1 in 8000 people, while some say 1 in 20,000 people (and we haven't met a doc who seemed to know much about it). Thanks!
I have operated on a person with situs inversus; it was known in advance. It was like looking in a mirror: sort of disorienting, but fun.
As I'm sure you know, there's an incidence of congenital heart conditions with situs inversus, higher in certain variations than in pure reversal. It could be several things: the most severe situation (transposition of the great vessels) would have been discovered at birth. It could have been valvular disease. And, of course, it's possible that the heart condition was simply coincidental with situs inversus.
Dr. Schwab,
Thank you very much for that invormation, I very much appreciate it. If this works, here's a link to my kids' situs inversus NBA basketball party...
http://sports.yahoo.com/nba/photo?slug=getty-71796500ds002_wizardwolves_2_46_16_pm&prov=getty
I'm a second year surgical resident on the East Coast and recently stumbled onto your blog. I've really enjoyed your posts. I've always wanted to be a surgeon, but after two years of pretty tough, long (yes, long, even in the "80" hr work week which I violate every week) training, I'm feeling somewhat hopeless - my fiance (graduated med schol the same year as me) will be an ED attending in 2 yrs while I'm looking at 7 more (2 yrs research, then 3 more gen surg, then fellowship), friends in other specialties are looking at bigger salaries while I work twice as hard as them, scope of practice narrower as IR, GI, cardiology continue to move in, and the lack of surgical mentors are several reasons why I'm really struggling. You've mentioned anesthesia, rads, etc in previous posts as areas that should be pursued but I really feel that our patients need excellent surgeons and I still want to be one of them. I've never been a complainer but these last two years have really been a kick in the gut. Do you really wish you would have pursued another field?
I can relate to everything you just said. It brings back my thoughts at the time. I agree with you that we'll need all the excellent surgeons we can get, and I hope you'll stick it out. I think the thoughts you are thinking are nearly universal at one point or another in training. I remember lying on a rock above a swimming hole up in the Sierra Mountains on the first weekend off I'd had in several weeks, while a second year resident. Thinking it was the happiest I'd been in months, wondering what's wrong with having a job you love a little less (anesthesia was on my mind) if it allows you to do more of the other things you love. In the end, obviously, I did stick it out.
What I love about surgery remains, and will remain no matter what else goes on: the unique relationship with patients, the awesome act of being allowed to operate. The bullshit around it keeps building, and I don't know where it'll end. But there's some bullshit everywhere. I don't regret my choice; I only regret (to some degree) that I let myself work way too hard, and burnt out. You can be an excellent surgeon and still manage a little time for yourself. Do it!
PS: you might enjoy my book!! It's cheap, now.
Dr. Schwab,
Hello, I had a few requests, if you don't mind. I just got another beautiful anatomy book and it had a mention of "surgical glue," and I was reminded that I was fascinated by that when I took my toddler to the ER a few years ago, after she fell and slammed her head onto the edge of a coffee table. She had a gash above her eye and the doc used "superglue" to fix her. I asked more about it and he said that surgeons used it in battle in Vietnam but it wasn't FDA approved or something so they couldn't use it anymore. You've had a few posts about being a military surgeon, so I wondered if you used this and if its commonly used in surgery in America now? Why don't we hear much about it? (In the medical shows they always use stitches.) Thanks.
My second request is that I wondered what its like to resuscitate someone? You've done wonderfully personal posts that show the emotional aspects of being a surgeon, and so I wondered what a surgeon's thoughts were on resuscitation? Is it more frequently successful than infrequently successful?
Dr. Sid: Thanks so much for your openness in your blogs. Refreshing. I'm 60 and going to get surgery on "Inguinal Hernia". I meet with the surgeon next week. Is there a question or two that would be good to ask him to verify his experience without minimizing him in any way?.
Thanks
"Glad to be here"
Glad: yours and questions like it are fair ones, and, sadly, in all my years I've never come up with an adequate answer. Usually it's more like, how do I know if I'm seeing a good surgeon? To which I typically answer, assuming you trust your primary doc, you should trust that s/he would send you to someone in whom they have confidence.
As to specifics, vis a vis hernia surgery or any other, I've never been convinced that raw numbers mean much. You could ask if the surgeon prefers open or laparoscopic repair, and why. If laparoscopic, you could ask about relative rates of recurrence. You could ask if the surgeon uses mesh in repair, and why or why not. (It's nearly universal, now, that it is used.) You can ask how many repairs s/he has done, and recurrence rates, but, as I said, I'm not sure what to make of the numbers, for various reasons.
All in all, if the surgeon seems open to questions, takes time to explain things thoroughly, satisfies your questions without sending vibes of irritation, I'd say those are good signs.
Hi Dr Schwab,
I chanced upon your entry about gallbladder flush while scouring the internet on gallbladder stones (I have a couple of small ones in my gallbladder) and enjoyed that post so much that I saved your blog into my favourite.
I read other the stories in the sampler and like them enough to go out and search for your book in our local book store, found it, bought it and finished reading it. And love it, too. By the way, I am located in Singapore (it's a little country in SouthEast Asia).
I am now reading through your older posts. It appears that you have no newer medical posts in this blog after 2009?
I hope you can continue writing.
Best Wishes to you!
Thanks, and I'm glad you found the blog.
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