tag:blogger.com,1999:blog-304994482024-03-07T01:22:47.677-08:00SurgeonsblogWherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger400125tag:blogger.com,1999:blog-30499448.post-18070725540943260272020-11-06T10:40:00.000-08:002020-11-06T11:36:26.269-08:00Sampler<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL9PpjQ5iLgVETImrI6gUKMWpV3tQ0ivjrZxQ4p4aO9WDpysDHgtNxvZBbXRf5M222SHas4Ii9CHizuonmTIZIIvoo1WYTvaM_JrAzRpXSmIOODpsN2ZWPa8ERN9JgeGKmlgHuycLaKA/s1600-h/12boxassortlg.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5122848317486066690" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL9PpjQ5iLgVETImrI6gUKMWpV3tQ0ivjrZxQ4p4aO9WDpysDHgtNxvZBbXRf5M222SHas4Ii9CHizuonmTIZIIvoo1WYTvaM_JrAzRpXSmIOODpsN2ZWPa8ERN9JgeGKmlgHuycLaKA/s400/12boxassortlg.jpg" style="cursor: pointer; display: block; margin: 0px auto 10px; text-align: center;" /></a><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-style: italic;"><br /></span></span><br />
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, it's been my goal to let people into the operating room, and into the life and thoughts of a surgeon; to share my take on some surgical conditions, and sometimes just to get a laugh.<br />
<br />
<b><span style="font-size: large;">Memorable Patients</span>:</b> I've told stories about people who made a big impression<br />
<br />
<a href="http://surgeonsblog.blogspot.com/2006/07/memorable-patients-part-one.html">here</a>, (the most stool I've ever seen in a belly)<br />
<a href="http://surgeonsblog.blogspot.com/2006/07/memorable-patients-part-two.html">here</a>, (when my partner got sick)<br />
<a href="http://surgeonsblog.blogspot.com/2006/07/memorable-patients-part-three.html">here</a>, (she killed her caregiver, and almost killed herself)<br />
<a href="http://surgeonsblog.blogspot.com/2006/07/memorable-patients-part-four.html">here</a>, (thirteen years old, and I couldn't save her)<br />
<a href="https://surgeonsblog.blogspot.com/2006/08/memorable-patients-part-five.html">here</a> (until the end, she kept bringing me food)<br />
<a href="http://surgeonsblog.blogspot.com/2006/08/memorable-patients-part-six.html">here</a>, (kidney cancer in his pancreas, and he kept on truckin')<br />
<a href="http://surgeonsblog.blogspot.com/2006/09/memorable-patients-part-seven.html">here</a>, (bleeding so fast, I could hear it)<br />
<a href="http://surgeonsblog.blogspot.com/2006/09/memorable-patients-version-seven-point.html">here</a>, (no stomach, kept eating steak)<br />
<a href="http://surgeonsblog.blogspot.com/2006/09/mammorable-patient.html">here</a>, (breast-heart connection?)<br />
<a href="http://surgeonsblog.blogspot.com/2006/12/memorable-patients-part-seven.html">here</a>, (an extreme test of faith)<br />
<a href="http://surgeonsblog.blogspot.com/2006/10/big-joe.html">and here</a>. (a screw-up in a great guy)<br />
<br />
<b><span style="font-size: large;">Series On Diseases, Organs, And Conditions:</span></b><br />
<br />
<i>Breast Cancer</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/08/breast-cancer-prologue.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2006/08/breast-cancer-some-basics.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/breast-cancer-scary-tales.html">three</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/breast-cancer-family-matters.html">four</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/breast-cancer-women_09.html">five </a>, <a href="http://surgeonsblog.blogspot.com/2007/07/old-man-and-c.html">six</a>,<br />
<a href="http://surgeonsblog.blogspot.com/2007/07/disconnect.html">and this</a><br />
oh yeah: and <a href="http://surgeonsblog.blogspot.com/2006/10/almost-famous.html">this one</a> about outpatient mastectomy<br />
<br />
<i>Appendicitis</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/09/tales-from-right-lower-quadrant.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/tales-from-right-lower-quadrant_16.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/tales-from-right-lower-quadrant-part.html">three</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/tales-from-right-lower-quadrant-part_19.html">four</a><br />
<br />
<i>Hernia</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/10/awaiting-rupture.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2006/10/rupture-part-two.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2006/10/rupture-part-three.html">three</a>, <a href="http://surgeonsblog.blogspot.com/2006/10/rupture-end-times.html">four</a><br />
<br />
<i>The Pancreas</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/12/surgeons-and-sweetbreads.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2006/12/pancreas-stuff-2.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2006/12/pancreas-stuff-3.html">three</a><br />
<br />
<i>The Gallbladder</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/03/rocks-in-bag-what-i-know-about.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/03/slippery-stones-more-about-gallbladder.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2007/03/its-galling-diagnostic-dilemmas-and.html">three</a>,<a href="http://surgeonsblog.blogspot.com/2007/04/stones-and-knives.html"> four,</a> <a href="http://surgeonsblog.blogspot.com/2008/01/flush.html">five</a><br />
<br />
<div>
<i>The Spleen</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/06/one-spleen.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/06/two-spleen.html">two</a><br />
<br />
<i>Trauma</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/06/two-spleen.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/07/traumadramarama.html">two</a><br />
<br />
<i>The Back Side</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/08/pile-o-problems.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/08/pain-in-ass_10.html">two</a><br />
<br />
<i>Diverticulitis</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/09/kens-colon.html">this</a><br />
<br />
<i>Death</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/04/on-death-one.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/04/on-death-two.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2007/04/on-death-three.html">three</a><br />
<br />
<b><span style="font-size: large;">A Peek Into The Operating Room:</span></b><br />
<br />
<i>Deconstructing An Operation</i> (wherein I tried to convey, in detail, what it's like to do an operation. Some of it is pretty good!)<br />
<a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-one-preamble.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-two-cutting-in.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-three-parting.html">three</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-four-packing.html">four</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-five-getting-to.html">five</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-six-sticky.html">six</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-seven-resection.html">seven</a>, <a href="http://surgeonsblog.blogspot.com/2007/05/operation-deconstructed-eight-coming.html">eight</a>, <a href="http://surgeonsblog.blogspot.com/2007/06/operation-deconstructed-nine-finish.html">nine</a>, <a href="http://surgeonsblog.blogspot.com/2007/06/operation-epilogue-post-op-ergo-propter.html">ten</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/06/operation-epilogue-post-op-ergo-propter.html"></a><br />
<i>What The Liver Feels Like:</i><br />
touch it <a href="http://surgeonsblog.blogspot.com/2007/02/liverly.html">here</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/02/liverly.html"></a><br />
<i>The Beauty Of Bowel:</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/01/guts-glory.html">here</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/01/guts-glory.html"></a><br />
<i>When Food Leaks Out:</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/12/you-are-what-you-eat.html">yuck</a><br />
<br />
<i>Fun With The Lung </i><br />
<a href="http://surgeonsblog.blogspot.com/2007/08/lung-way-home.html">pink and soft.</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2006/12/you-are-what-you-eat.html"></a><br />
<span style="font-style: italic;">You Are So Beautiful:</span><br />
a look <a href="http://surgeonsblog.blogspot.com/2008/02/you-are-so-beautiful.html">inside</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/you-are-so-beautiful.html"></a><br />
<span style="font-style: italic;">What Makes A Fast Surgeon:</span><a href="http://surgeonsblog.blogspot.com/2006/11/skin-to-skin.html">it's not fast hands</a>.</div>
<div>
<br />
<span style="font-style: italic;">What Cancer Looks Like:</span><a href="http://surgeonsblog.blogspot.com/2007/11/ugly-as-hell.html">ugly as hell</a><br />
<br />
<b><span style="font-size: large;">The Mind Of A Surgeon:</span></b> (no, it's not an oxymoron)<br />
<br />
<i>Playing God</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/12/god-of-operating-room.html">amen</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2006/12/god-of-operating-room.html"></a><br />
<i>Taking Trust:</i><br />
<a href="http://surgeonsblog.blogspot.com/2006/10/taking-trust.html">maybe my most controversial post</a> (except for one on prayer. You'll have to search for that one.)</div>
<div>
<br />
<i>Liking the Horrible:</i><br />
the <a href="http://surgeonsblog.blogspot.com/2007/08/confessional.html">paradox</a> that is surgery</div>
<div>
<br />
<i>When It Scared Me to Death:</i><br />
a <a href="http://surgeonsblog.blogspot.com/2006/08/baby-killer.html">sick baby</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2006/08/baby-killer.html"></a><br />
<span style="font-style: italic;">When Things Get Tough:</span><br />
the need to <a href="http://surgeonsblog.blogspot.com/2007/03/focus.html">concentrate</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/03/focus.html"></a><br />
<i>On Burnout (wordy, but heartfelt):</i><br />
<a href="http://surgeonsblog.blogspot.com/2007/03/burnout-embers.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/03/burnout-fanning-flames.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2007/03/burnout-quenching-fire.html">three</a></div>
<div>
<br /></div>
<div>
<span class="Apple-style-span" style="font-style: italic;">On Surgical Complications:</span><br />
<a href="http://surgeonsblog.blogspot.com/2007/01/its-complicated-part-one.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2007/02/its-complicated-part-two.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2007/02/its-complicated-part-three.html">three</a>.</div>
<div>
<br />
<span style="font-style: italic;">On Palliative Surgery:</span><br />
<a href="http://surgeonsblog.blogspot.com/2008/03/time-for-tears-tears-for-time.html">difficult decisions</a>.<br />
<br />
<i>Think slow:</i></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2009/08/think-slow.html">shoot from the head</a>.<br />
<br />
<span style="font-size: large; font-weight: bold;">Various Good Stuff</span><br />
<br />
<span style="font-style: italic;">Brittle Beauty (this one got mentioned in the New York Times):</span><br />
<a href="http://surgeonsblog.blogspot.com/2007/10/brittle-beauty.html">here</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/10/brittle-beauty.html"></a><br />
<span style="font-style: italic;">About Surgical Names and Anatomic Places:</span><br />
<a href="http://surgeonsblog.blogspot.com/2007/09/names-and-places-pouches-and-spaces.html">here</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/09/names-and-places-pouches-and-spaces.html"></a><br />
<span style="font-style: italic;">Ever Have A Maneuver Named After You?</span><br />
<a href="http://surgeonsblog.blogspot.com/2007/10/smooth-move.html">he did</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/10/smooth-move.html"></a><br />
<span class="Apple-style-span" style="font-style: italic;">Surgical Clips, And A Good Story:</span></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/pleasin-squeezin.html">blip, blip</a></div>
<div>
<br /></div>
<div>
<span class="Apple-style-span" style="font-style: italic;">"Alternative" Medicine And Why We Love It:</span></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/11/no-alternative.html">we're nuts</a></div>
<div>
<br /></div>
<div>
<span style="font-style: italic;">Strange Things In Strange Places:</span><a href="http://surgeonsblog.blogspot.com/2006/11/rectifying-redux.html">takes all kinds</a></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2006/11/rectifying-redux.html"></a><br />
<i>Old Folks</i>:<br />
<a href="http://surgeonsblog.blogspot.com/2009/07/oldies-but-goodies.html">They take it in stride</a>.<br />
<br />
<i>Word play</i>:<br />
<a href="http://surgeonsblog.blogspot.com/2007/09/word.html">Fun with new words</a>.<br />
<br />
<b><span style="font-size: large;">Hospital Politics, And A Memo:</span></b><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2006/09/in-earlier-post-i-made-reference-to.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/hospital-politics-infamous-memo-part.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/hospital-politics-infamous-memo-part_13.html">three</a>, <a href="http://surgeonsblog.blogspot.com/2006/09/memo-at-last.html">four</a><br />
<br />
<b><span style="font-size: large;">My Malpractice Series:</span></b> (lawyers hated it. Because of the title, it still gets hits on strange searches...)<br />
<br />
<a href="http://surgeonsblog.blogspot.com/2006/11/losing-my-virginity-part-one.html">one</a>, <a href="http://surgeonsblog.blogspot.com/2006/11/losing-my-virginity-part-two.html">two</a>, <a href="http://surgeonsblog.blogspot.com/2006/11/losing-my-virginity-final-chapter.html">three</a></div>
<div>
<br /></div>
<div>
<span style="font-size: large;"><span class="Apple-style-span" style="font-weight: bold;">Thoughts On Health Care Issues</span>:</span></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/res-ipsa-loquitur.html">Insurance Companies</a></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/ripoffs-or-reticence.html">Doctor Ripoffs?</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2007/10/bfh.html">The BFH</a></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2009/07/rationing-there-i-said-it.html">Rationing</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2009/08/stupid.html">Lying About Advance Directives</a></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/07/my-solution.html">Solutions</a></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/07/more-solutions-long-post.html">More on Solutions</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2009/08/bureaucrats.html">Bureaucrats</a></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/03/different-cloth.html">The Future</a> </div>
<div>
<br />
<a href="http://surgeonsblog.blogspot.com/2006/12/thinking-out-loud_15.html">Reflecting on Past and Future</a> (some excellent comments on this post)<br />
<br />
<span style="font-size: large; font-weight: bold;">The Personals: People In My Life</span><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/04/moomump.html">My amazing aunt</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/04/fading-memories.html">My grandpa</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/05/looking-in.html">Watching My Dad</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2007/02/dusty-trunk-and-cardboard-box.html">The Father I Could Never See</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/05/dougie.html">My Oldest Friend</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/05/jb.html">My Newest Friend</a><br />
<a href="http://surgeonsblog.blogspot.com/2008/05/dougie.html"><span style="font-weight: bold;"></span></a><a href="http://surgeonsblog.blogspot.com/2008/05/dougie.html"><br /></a></div>
<div>
<span class="Apple-style-span" style="font-size: large; font-weight: bold;">Rants:</span> (most of these are decidedly non-medical, so be warned)<br />
<br />
My <a href="http://surgeonsblog.blogspot.com/2007/09/thoughts-on-tragedy.html">first rant</a>, on the anniversary of 9/11.<br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/fck-em.html">This</a> is the only medical one</div>
<div>
<br /></div>
<div>
I guess <a href="http://surgeonsblog.blogspot.com/2007/04/war-story.html">this is a rant</a>. It's about war and what it does to the kids who fight them. Some of the comments are worth reading, too.<br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/tortured-logic.html">Torture</a><br />
<br /></div>
<div>
OK, <a href="http://surgeonsblog.blogspot.com/2008/02/doing-gods-work.html">this</a> is medical too, and "religious."<br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/sad-times.html">Politics and War</a><br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/funnyman_24.html">God is who?</a><br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/02/for-want-of-pin.html">Politics and Lapel Pins</a><br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/03/mendacity-of-dumb.html">Politics and Politics</a><br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2008/03/everythings-fine.html">Ignoring the Obvious</a><br />
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/10/american-dream.html">Immigrants and the American Dream</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/04/hell-no.html">Hell and God</a><br />
<br />
<a href="http://surgeonsblog.blogspot.com/2008/06/love-and-marriage.html">Same-Sex Marriage</a></div>
<div>
<br /></div>
<div>
<a href="http://surgeonsblog.blogspot.com/2007/07/bless-child.html">Praying for a Child</a> (this one caused a huge ruckus.)</div>
<div>
</div>
<div>
<br /></div>
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<br /></div>
Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com93tag:blogger.com,1999:blog-30499448.post-68140893525217740632009-10-06T13:03:00.000-07:002011-02-08T08:21:26.062-08:00A New Blog!!!<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFd4DeFyMIqqDCbdZYuH2WvC7inmD4jnn6YjX48E2tO1lDQb0vDrcd3ts9xXPji6DQUUTl6iXbwn3aNNqjq2US5i53mbcoOk1gUUIpegkh5QR7RxVQ6H5mGSggDM8P0e1UvbiDP2tJ5Q/s1600-h/gsnocc+seminar+002+copy.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFd4DeFyMIqqDCbdZYuH2WvC7inmD4jnn6YjX48E2tO1lDQb0vDrcd3ts9xXPji6DQUUTl6iXbwn3aNNqjq2US5i53mbcoOk1gUUIpegkh5QR7RxVQ6H5mGSggDM8P0e1UvbiDP2tJ5Q/s400/gsnocc+seminar+002+copy.jpg" alt="" id="BLOGGER_PHOTO_ID_5248198514486925282" border="0" /></a><br />Well, I've done it. I've just created a new blog, which will become the place for my rants. Surgeonsblog, if it ever revives, will revert to what it once was -- a place for insights and information about surgery and surgeons. My new blog is where I'll froth and foam.<br /><br />It's called <span style="font-style: italic; font-weight: bold;">"Cutting Through The Crap."</span><span style="font-weight: bold;"> </span>You can find it <a href="http://sidschwab.blogspot.com/">here</a>. There (and on this post), readers can comment if they so choose. I hope people will find their way to the new place; and I hope there'll eventually be reasons to return here as well.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com21tag:blogger.com,1999:blog-30499448.post-33285227031980289242009-10-05T10:43:00.000-07:002011-02-08T08:22:24.614-08:00Public Option<object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/fKWHUyq7BX8&hl=en_US&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/fKWHUyq7BX8&hl=en_US&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><br /><br />I know a guy who was in a video...Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com56tag:blogger.com,1999:blog-30499448.post-38544545513534645022009-08-27T04:38:00.000-07:002009-08-27T04:38:00.108-07:00Toons<object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/Jng4TnKqy6A&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/Jng4TnKqy6A&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object><br /><br /><br />In a comment on my previous post, <a href="http://www.slideshare.net/danroam/healthcare-napkins-all">a series of slides</a> is recommended. I like the cartoon above even better. In simplicity there can be great truths.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com20tag:blogger.com,1999:blog-30499448.post-24774391225298721882009-08-26T08:32:00.000-07:002009-08-26T10:29:46.921-07:00Retort<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvsXV9dCwPE9iIR-A-HT7TZ1wm1PzYYnCENTSUy6M-xd7pHrxmeZ493j2YMH7WvfQn8UUlgiP-4FjxDLNh6pe_RSZ_z99gEWrvZciRUBeeL2ZPbuJenWrGLAz3cCiqkoocNj1VfIt70A/s1600-h/retort.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 228px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvsXV9dCwPE9iIR-A-HT7TZ1wm1PzYYnCENTSUy6M-xd7pHrxmeZ493j2YMH7WvfQn8UUlgiP-4FjxDLNh6pe_RSZ_z99gEWrvZciRUBeeL2ZPbuJenWrGLAz3cCiqkoocNj1VfIt70A/s400/retort.jpg" alt="" id="BLOGGER_PHOTO_ID_5373370941509834402" border="0" /></a><br />Sooner or later, in any discussion of health care reform (to the extent that screaming and fear-mongering can be gotten past and actual thoughts exchanged), the issue of tort reform is raised. On that subject I'm of two or more minds. Neither a student of the various proposals nor particularly well-versed on the veracity of claims and counter claims about tortophobia adding to costs of medical care, I can only speak based on personal experience. Which is why I'm multi-minded. I've seen good and bad. I don't think I altered my practice style to avoid malpractice suits, but I can see why people would.<br /><br />The central issue is this: <span style="font-weight: bold;">there's a difference between malpractice and adverse outcomes</span>. Most certainly, the one leads to the other; but the other does not imply the one. Were that distinction properly made and encoded in the law, the rest of the issue would become moot. If malpractice suits were about bad care -- actual errors, poorly thought-out diagnoses or treatments, willful neglect of patient needs; that sort of stuff -- I'd have no problem with them.<br /><br />I was raised among lawyers. I've lived in their dens, eaten their food, learned their language. I agree with their claim that malpractice suits have, over the years, led to improvement in care, institution of protective procedures. And I absolutely agree there are bad doctors out there; lazy, lacking in judgment, in it for the money. Drinkers, drug users. Representing an overwhelmingly small minority, they nevertheless give us all a bad name; they are the cause of and the justification for the worst views the public has of us.<br /><br />But, unlike the guy struggling to fix my freezer as I sit and type this (peering occasionally at what he's doing: my home improvement skills have largely osmosed from such viewings), I dealt with soft stuff. Every freezer of this type is exactly the same; the wires, the machinery, the outcome if you plug x into y. Not so of us humanoids. (I'm not saying what he does is less important; we're having to get along without freezing tonic cubes for our G and T's [a trick I highly recommend to anyone so inclined]. Or, judging by his grunts and mutterings, any easier. Just more predictable.) If he makes the correct diagnosis and replaces the parts properly, the outcome is the same for the same problem, over and again, on every like freezer. I've had some sub-optimal outcomes, despite (take my word for it, okay?) doing everything right. Not often. Not, thankfully, catastrophic. But the possibility is always there.<br /><br />I've been sued, and I've <a href="http://surgeonsblog.blogspot.com/2006/11/losing-my-virginity-part-one.html">written about it</a>. It's humiliating, frustrating, depressing, and anger-inducing. I'd say that's entirely because of my certainty that in no case was malpractice, as I understand the term, committed. On the other hand, had I ever done something (or failed to do something) in a way that fell into that category, the last thing I'd want to do would try to defend it on a witness stand, nor try to prevent the patient from being compensated. Patients need a mechanism by which they can be protected from errors, and their injuries redressed. What form that takes is a complicated subject. The current system, because it fails to separate bad outcome from errors in management, isn't the proper mechanism. It wasn't my intent, in writing this, to suggest solutions.<br /><br />My point, at last, is that I don't think tort reform, <span style="font-style: italic;">per se</span>, will have much impact on the total cost of health care. Reducing errors will. Addressing inefficiencies and variations in treatments among doctors will. To the extent that docs order tests to cover their legal asses, such behavior would be reduced, asses covered, if there were guidelines that indicated when such tests were medically necessary and when not. It's true that there were times, when deciding a course of action based on clinical judgment alone (diagnosing appendicitis without a CT scan or ultrasound is a perfect example; taking a patient with a rigid abdomen to the operating room without the delay of additional testing is another), that I felt a slight breeze on my backside. Many docs are unwilling to do it; partly out of fear, but partly, also, out of being trained in the era of judgment coming in pixels. I guess you can't legislate judgment, but guidelines would help.<br /><br />And yet it seems there's no discussing it without raising the specter of rationing and death panels. When President Obama suggests that investigating what works would save lots of money and improve care, he's exactly right. That's where the big bucks are spent, and wasted. Addressing it would solve much, including the need for tort reform.<br /><br />The political party who has argued for reducing Medicare <a href="http://tpmdc.talkingpointsmemo.com/2009/08/the-gops-long-history-of-medicare-skepticism.php?ref=fpblg">since it began</a>, whose most recent candidate ran on cutting it, has now, for pale political reasons, resorted to demagoging attempts to do just that, as fascist terror. Without diminishing service at all, huge amounts of money could be saved by doing exactly what Obama proposes. Surely there are a couple of Republican senators and representatives who know this. But, clearly, the resistance is not about effective reform. It's about politics, and defeating the party in power.<br /><br />The public be damned.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com25tag:blogger.com,1999:blog-30499448.post-90667418132409230492009-08-25T08:12:00.000-07:002009-08-25T08:21:46.284-07:00Grand Old Times<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyZIWobSlhPDMIkxB6ll1T2DIQfeer6HCjlRYPKqaJ5D59YUEUMKTqKljKQqR8aGIPH1uHkvaK18ceo8b0Gsu9CqHQLTt4MUk64dJJ-s_RGYh9_mZQBIAGcWpso_NRjSB7m20x8GiUeQ/s1600-h/132220183_255a623bd5_b.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 267px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyZIWobSlhPDMIkxB6ll1T2DIQfeer6HCjlRYPKqaJ5D59YUEUMKTqKljKQqR8aGIPH1uHkvaK18ceo8b0Gsu9CqHQLTt4MUk64dJJ-s_RGYh9_mZQBIAGcWpso_NRjSB7m20x8GiUeQ/s400/132220183_255a623bd5_b.jpg" alt="" id="BLOGGER_PHOTO_ID_5373921419570282722" border="0" /></a><br />Nice <span style="font-style: italic;">Grand Rounds</span> up over at the <a href="http://www.theexaminingroom.com/2009/08/grand-rounds/">resurrected Dr Charles</a>. His balloon is on the rise again, even as the hot air leaks soundlessly out of mine. Dr Charles has always been one of the most lyrical of medical bloggers, and it's nice that he's rediscovered his muse.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com0tag:blogger.com,1999:blog-30499448.post-29934326998254354622009-08-21T09:46:00.000-07:002009-08-24T11:32:46.067-07:00Stupid<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiylzUdVZBTF9rlHuIYpJ-B3q8g9982IX6A3AsZwj78SG_mW7bS7oJtOR4hHuuFUrrtKkxelpyumQxf253C6AABkX1-Vo5jStc-HfpG5qxSmVXTfm_EWVmpExsv_4IOpCDre7xZwsogTA/s1600-h/stupidity.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 369px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiylzUdVZBTF9rlHuIYpJ-B3q8g9982IX6A3AsZwj78SG_mW7bS7oJtOR4hHuuFUrrtKkxelpyumQxf253C6AABkX1-Vo5jStc-HfpG5qxSmVXTfm_EWVmpExsv_4IOpCDre7xZwsogTA/s400/stupidity.jpg" alt="" id="BLOGGER_PHOTO_ID_5372469959456535778" border="0" /></a><br />Uuggggghhhhh.<br /><br />Sorry.<br /><br />I feel dirty, I need a shower, I may have to kill myself. Where are the death panels when you need them?<br /><br />So Jon Stewart interviewed <a href="http://en.wikipedia.org/wiki/Betsy_McCaughey">Betsy McCaughey</a> last night, on <a href="http://www.thedailyshow.com/watch/thu-august-20-2009/betsy-mccaughey-pt--1"><span style="font-style: italic;">The Daily Show</span></a>. She's the one credited with raising alarms about the dastardly implications in the health care bill regarding end of life counseling. "Death panels," evidently, wasn't her exact term. "Disgusting," is what she said she wrote in the margins when reading it.<br /><br />There was a point to which she kept returning (in between quite amazing dramatic gestures to the audience -- the kind when a stand-up comedian goes, "Am I right? Am I right? Huh? Huh?"). Medicare reimbursement is increasingly tied to performance standards, and it's an issue about which <a href="http://surgeonsblog.blogspot.com/2007/08/new-rules.html">I've written</a> <a href="http://surgeonsblog.blogspot.com/2008/04/numbers-game.html">a bit</a>, and which, in its execution, is potentially problematic for all doctors. Nevertheless, her interpretation regarding end of life counseling was utterly, idiotically, cosmically ass backwards. Can you get it that wrong by mistake? Or must you be a willful liar? The lady, after all, was Lieutenant Governor of New York for a moment, which likely puts her in the upper four-fifths of the population in intelligence.<br /><br />Doctors, she said, will be reimbursed, in part, based on the percentage of their patients who are given end of life counseling. Okay. And, she said, it will also depend on the percentage of cases in which the wishes were carried out. It's at that point that she went off the rails so grandly that, had I not been paralyzed with disbelief, I'd have reached for the remote. And shoved it up my nose. Aiming for my brain.<br /><br />Her interpretation -- this former politico and self-styled patient advocate -- is that doctors get dinged if their patients change their minds. Really. That's what she said and, apparently, believes. (Okay, she may not believe it: she is, after all, a Republican hack trying to derail health care reform.) You sign an advance directive, that's it. No changes. Any doctor who allows changes gets penalized by THE GOVERNMENT. The lady is an idiot. And, sadly, Jon Stewart didn't call her on it.<br /><br />Here's the thing: advance directives are for the time when you can <span style="font-weight: bold;">no longer make your own decisions</span>. By definition, that means as long as you have the ability, you can change your mind any time you want. In the hospital. In the ICU. Anywhere, anytime. Advance directives are <span style="font-weight: bold; font-style: italic;">not in effect</span> until you are no longer able to express your wishes. What the bill is doing is making sure doctors follow the patients' expressed wishes when they're no longer able to express them. If a patient has said they want everything done, the doctors must do so. If they've said they don't want to be put on breathing machines, the doctors must honor that request.<br /><br />It's about following the patients' request. It's about protecting the wishes of patients. I repeat myself. But the lady blew my mind. She couldn't understand her way out of a paper bag.<br /><br />So this is where we are. This is the level of debate. In a matter as important as this, it's really appalling and disheartening to watch. It's not as if the issues aren't worth discussing. Tying reimbursement to adherence to certain standards is a tricky issue. But if we're going to have the discussion, let's have it with at least a toe still attached to the fundaments. Same with advance directives.<br /><br />As long as people like that lady get air time without proper rebuttal (in fact, as long as idiocy that deep gets air time at all), we'll never have the kinds of discussions that we need. And deserve.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com19tag:blogger.com,1999:blog-30499448.post-5296998081879526492009-08-18T10:01:00.000-07:002009-09-23T15:06:02.845-07:00Bureaucrats<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE87D5LDnckoZDvd8drH5MP1L8VgQvDotfo1h5T3gsIm9H13dAImUc1VOdS9so74I-8exniRQnTqRgltxqoUbzx5bHyAbJYsFhwRsCJCknVKUNIEWVRBKAWqvLSpkpSoDzUB4pRX9jdg/s1600-h/denied.png"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 345px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE87D5LDnckoZDvd8drH5MP1L8VgQvDotfo1h5T3gsIm9H13dAImUc1VOdS9so74I-8exniRQnTqRgltxqoUbzx5bHyAbJYsFhwRsCJCknVKUNIEWVRBKAWqvLSpkpSoDzUB4pRX9jdg/s400/denied.png" alt="" id="BLOGGER_PHOTO_ID_5371360046565833442" border="0" /></a><br />Among the many themes of dissent which have gained traction in the health care debate is the canard that <span style="font-style: italic;">we don't wont some government bureaucrat between us and our doctors</span>. Funny thing about that: the only payer entity with which I never had a problem getting authorization for care was Medicare. Here's the sort betweenness I routinely encountered from private insurers:<br /><br />In the fine print of nearly every private plan are exclusions for "pre-existing conditions." Okay. You had breast cancer, now you can't get any insurance to cover issues related to it. Fair enough, right? Guy's gotta make a buck, right? I mean, it wasn't <span style="font-weight: bold; font-style: italic;">their</span> fault you got it, right?<br /><br />But how about this: more than a couple of times I had patients with colon cancer who were denied coverage because of a previous history of.... hemorrhoids!! Yes. <span style="font-style: italic;">Hemorrhoids</span>. Similarly, people who'd had, say, a rubber band placed for hemorrhoids -- a two minute, hundred buck outpatient procedure -- could not get future insurance that would cover ANY disease of the intestinal tract. Band on your butt, screw your stomach. Exit your esophagus. Not, I suppose, that a private insurer has to have any reason for something like that: their goal, after all, is to NOT spend your premiums on your care. Message: if you have hemorrhoids, live with them, baby.<br /><br />There's more. Many patients of mine whose gallbladders I removed were informed by their insurers that they'd no longer be covered for any disease of their internal organs. A lot of territory excluded, that.<br /><br />And, as everyone knows, if you lose your insurance because you lost your job, and if you've had any sort of serious illness, you are simply <a href="http://www.adler-versand.com/shop/images/kings%20of%20nuthin-shit%20out%20of%20luck.jpg">SOL</a> finding new coverage. Imagine the frustration, as a physician trying to help, of dealing with insurance companies as they apply their exclusionary rules. Their rationing. Their death panels.<br /><br />Yet there they are, those <a href="http://farm3.static.flickr.com/2478/3792330877_eef14754db.jpg">sign wavers</a>, insisting that it's Hitleresque to demand changes in all this. For his attempts, Obama gets branded a Nazi. While the right wing screams, the left wing caves. Advance directives? Gone. Public option? Fuggeddaboutdit. Studies to find out which kinds care work and which don't? Nuh uh. Too... too... I don't know... logical?<br /><br />I repeat: Medicare, which is in my mind the best paradigm for a public plan, NEVER refused coverage for cancer (or any) care. Not even for grandma. Those government bureaucrats? Not a problem. It was, as anyone might predict, the "market forces" guys who stood between me and my patients.<br /><br />There is, of course, this little paradox: those people who hate government intervention generally are quite happy with Medicare. Those who point out it's running out of money are those most likely to recoil at suggestions that we ought to find ways of saving money in the program. The ones who think Medicare is shameful socialism would holler "they're trying to raise your taxes!!!" if anyone suggested premiums be scaled to one's financial status.<br /><br />Is there a more clear example of why we're failing as a country than the debate over health care reform, and the arguments over Medicare in particular?Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com29tag:blogger.com,1999:blog-30499448.post-74897493986714370002009-08-13T21:37:00.000-07:002009-08-13T21:38:39.590-07:00Death Panels<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2_dccINNQLKJ8jRecUPfVlwHs0M9sdv6k5A4WBhIZkJAqA8ujRe8MDdPgsJgCzih_av-u3AQHbsGpYfvSP6VX_ulX5ZMHr2CdYIjFrGzg3Ieh9aXJl2oUxZnA5_gnOzAv-bnE0ZPB/s1600-h/434px-Death.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 290px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2_dccINNQLKJ8jRecUPfVlwHs0M9sdv6k5A4WBhIZkJAqA8ujRe8MDdPgsJgCzih_av-u3AQHbsGpYfvSP6VX_ulX5ZMHr2CdYIjFrGzg3Ieh9aXJl2oUxZnA5_gnOzAv-bnE0ZPB/s400/434px-Death.jpg" alt="" id="BLOGGER_PHOTO_ID_5369673579217323122" border="0" /></a><br />Surprise! <a href="http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/">It's a Republican idea</a>.<br />.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com3tag:blogger.com,1999:blog-30499448.post-6126361352964049732009-08-12T10:08:00.000-07:002009-08-12T13:24:08.274-07:00One Small Step<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNv2VUrVa3d5rE-XkQID5ms_DMia94AFo-7dwVNIOfdTA__7YLRqWtx8PDNEos_WpNfJOwn_Ap1O6XAK-FG5PSXt3JifY_3rdu5mp7RQYScvRDgi3o1Nkzzsyws6qjvY9ETqPQf4dvJg/s1600-h/SuperStock_1555R-304084.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 350px; height: 233px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNv2VUrVa3d5rE-XkQID5ms_DMia94AFo-7dwVNIOfdTA__7YLRqWtx8PDNEos_WpNfJOwn_Ap1O6XAK-FG5PSXt3JifY_3rdu5mp7RQYScvRDgi3o1Nkzzsyws6qjvY9ETqPQf4dvJg/s400/SuperStock_1555R-304084.jpg" alt="" id="BLOGGER_PHOTO_ID_5369166657723737922" border="0" /></a><br />If anyone here reads Andrew Sullivan's blog, runs across<a href="http://andrewsullivan.theatlantic.com/the_daily_dish/2009/08/the-view-from-your-sickbed-18.html"> this post</a>, and finds anything familiar in the writing, there could be a reason... Anonymity doesn't do much for blog traffic, but any way to spread the word...<br /><br />The word, of course, is the extent to which health care reform is aimed at doing things that will be helpful. Even -- <span style="font-weight: bold; font-style: italic;">especially!</span> -- for those very people who yell and weep and carry guns to meetings, spouting verbatim the insane ravings of Glenn Beck and Sarah Palin while having not the slightest idea what they're really talking about. "Keep government out of Medicare," they say. "Socialism."<br /><br />The "socialism" trope may be the most laughable (were it actually funny): all of the proposals on the table fall over themselves to <span style="font-style: italic;">maintain</span> the death-grip insurance companies have on us. (Talk about "death panels!" What is it when insurers deny coverage?) None talks about nationalizing the health care delivery system. Not even Medicare is socialism. Single payer -- which in my mind is the only option that makes sense, and which, like Medicare is NOT socialism -- is, clearly, off the table.<br /><br />There's no possible health care reform package that will satisfy everyone; nor, given the way Congress works, one that will be free of pork-fat, undue complexity, or unexpected consequences that will need to be addressed. Still, what the various iterations seem to have in common are regulations to prevent rescission, to create portability, to remove limits on lifetime coverage, to banish denial for pre-existing conditions. Is it really possible that any of the screamers are against those reforms?<br /><br />Cost is most certainly an issue, and there is a multitude of ways to address it. Starting, from the doctors' part, with the sort of thing mentioned in that Andrew Sullivan post. Only the surface has been scratched there. And, long after I'm dead, assuming the country still exists, I predict single payer will have come to pass, and people will be glad for it. Even the gun-totin' America lovers.<br /><br />Signs at the meetings -- ignoring the ones showing Obama as Hitler, a completely ludicrous meme hatched and promoted at Fox "News" (sic) and ingested without chewing by its self-pitying listeners -- point out that Medicare is "bankrupt." While not yet true, it's a point worth considering. To the extent that it hasn't enough money, it's not the fault of Medicare, which spends far less on non-medical expenses than any private insurer. It's because of funding. It's because of the holdover idea from the Reaganomics that you can have what you want without paying taxes.<br /><br />So, what if everyone were covered by a Medicare-like program, and no one paid premiums; or if there were the sorts of premiums and co-pays associated with Medicare? Currently I pay $14K/year in premiums for me and my wife. Would I be happy to have taxes raised in another area, even, say, by $10K/year? Who wouldn't take that trade? By getting rid of the 30% skim by insurers, that math works right away. And by taking seriously -- instead of demagoging as "death panels" -- the idea of finding cost savings in more efficient care, much more than that will be saved.<br /><br />And yet, they rave and froth. Getting crazier and scarier. Arguing, in effect, for maintaining a system in which their premiums have likely more than doubled in the last ten years, which covers them sparingly, cutting them off when they need it most: sick, out of work. And they are ready to draw weapons over a plan to pay for help writing the very instructions that will keep them in charge of their care when they're unable to make decisions for themselves.<br /><br />Who'd have thought people so in need of health care reform could be whipped into a froth by people who lie so freely and make easily refutable claims? I remain unable to understand. And bereft of hope.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com26tag:blogger.com,1999:blog-30499448.post-19103422450972505502009-08-11T15:01:00.001-07:002009-08-11T15:52:15.803-07:00Local News<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD8qSvOjRY7K_LkJBiVmEEXmi1yoBn3ZMu5HAC7ikCQSIRiB59OYayxO9ut6b1OQxnFkV1m3iP3ANn0ze0D9HCTS3W3FoUNQ2sOtQ672m-v984_GZPFyFhyphenhyphenNYH-MFvPzmU-FIw82HwQ/s1600-h/SideshowBob2.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 343px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMD8qSvOjRY7K_LkJBiVmEEXmi1yoBn3ZMu5HAC7ikCQSIRiB59OYayxO9ut6b1OQxnFkV1m3iP3ANn0ze0D9HCTS3W3FoUNQ2sOtQ672m-v984_GZPFyFhyphenhyphenNYH-MFvPzmU-FIw82HwQ/s400/SideshowBob2.gif" alt="" id="BLOGGER_PHOTO_ID_5368832146932374562" border="0" /></a><br />Using local anesthesia, I always took care to do it gently, slowly, and thoroughly, and had reason to be proud of the results. Almost routinely, patients expressed their happiness and relief that the process was so... not unpleasant. I've written <a href="http://surgeonsblog.blogspot.com/2007/01/taking-my-lumps.html">a bit</a> about it <a href="http://surgeonsblog.blogspot.com/2007/01/local-hero.html">before</a>.<br /><br />So when I couldn't seem to make someone numb, it hurt. As it were. In addition to having a dissatisfied patient, it made me feel like a failure. It has always been my belief that there are some people who, for some unknown biological reason, process the drugs differently; that it's more than just a few 'fraidy cats or me having a bad day. Now, it seems, <a href="http://well.blogs.nytimes.com/2009/08/06/the-pain-of-being-a-redhead/">there's substantiation</a>. It's those darn redheads.<br /><br />It never occurred to me to check. I wish I could play back the scenes in my head, in full color. Were the unhappy ones all rubro-capited? There's much I know now that I wish I'd known a few decades ago (and not all of it is surgery-related.) And there've been a few notable redheads in my life. Until now, I've had nothing but happy memories.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com12tag:blogger.com,1999:blog-30499448.post-40974148551379998812009-08-10T10:57:00.000-07:002009-08-10T11:41:53.784-07:00Advance Directive<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY4rRby7yUm2CAivdQdc7fkUpx7cA8gQVHEmcyqorv79TdfebI5sc_nOM1TdAARUPI1yBjg_wTDMhsS-kd3PYIeZaJgrZsbQo6Hamcs484jYSlD1bSe1r7SYrvRf2D8NOhqwTHwSSErg/s1600-h/man-with-megaphone.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 395px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY4rRby7yUm2CAivdQdc7fkUpx7cA8gQVHEmcyqorv79TdfebI5sc_nOM1TdAARUPI1yBjg_wTDMhsS-kd3PYIeZaJgrZsbQo6Hamcs484jYSlD1bSe1r7SYrvRf2D8NOhqwTHwSSErg/s400/man-with-megaphone.gif" alt="" id="BLOGGER_PHOTO_ID_5368406543565654706" border="0" /></a><br />On those few occasions when a patient had an advance directive, it was terrifically helpful. To me as their surgeon, to other caregivers, to the family, and, of course, to the patient. Which is why the outrage over a plan to assist people in making them (and cover the cost of counseling) is as cynical as it is ill-founded. Cynical, because people are turning it into "they're coming to kill grandma." Unfounded, because it actually <span style="font-style: italic;">puts people in control</span>, not caregivers or government.<br /><br />My parents serve as two examples.<br /><br />Like most people (or so I assume), my dad had always said he'd never want to be kept alive by machines, and had a directive that put it in writing. Yet when he entered the hospital for what turned out to be the final time, after months of physical decline that had made his life only about the rudiments of existence, when the chips were down he opted for the ventilator. Which is an important point: <span style="font-style: italic;">nothing in his directive prevented him from changing his mind, as long as he could express it</span>. At the time, his world had shrunk entirely, barely extending beyond his skin, having formerly been a man of superior intellect, a voracious reader, adviser to governors and senators, a mayor himself, a judge. Leading up to his death, he'd become unable to get in and out of bed on his own, needed help in all forms of personal care, had not the strength nor will to talk about anything but his own decline. He was miserable. And yet he opted for entry into the critical care unit, where he remained, kept alive, for two futile weeks, until he died. Even having had an advanced directive to the contrary, his wishes at the time were honored, as they should have been. (It did, however, make it easier for everyone, when the futility was evident, to take the steps to discontinue aggressive care. An important point.)<br /><br />My mom, likely past the midway point in her descent through Alzheimer's disease, also has an advance directive. Composed with the help of her very caring doctor, who gently and carefully went through all the options, it directs that all reasonable measures be taken to prolong her life. Now well past the capacity to consider or reconsider, she gets wonderful care. With her strong heart and good genes, her body will likely live long after her mind is gone entirely.<br /><br />Whatever else they might mean, these two cases illustrate, at the very least, that making advance directives available is hardly a step down the road to euthanasia.<br /><br />They also illustrate something else: directives are not for people who retain their ability to make their own decisions. The intent is to carry out people's wishes when they're unable to express them. It's the <span style="font-weight: bold; font-style: italic;">opposite</span> of euthanasia: it's giving PEOPLE -- not governments or others of evil intent -- legal control over their own fate!! THEIR OWN FATE!!!<br /><br />The misinformation, willfully disseminated to the vulnerable by those who stand to profit from keeping things as they are, and by those whose only goal is to regain political power no matter the damage to people who need better care, is appalling. But effective. People are scared. They're becoming distrustful of the very thing that allows them to call their own shots beyond the time they otherwise can.<br /><br />It's the perfect example of how people are being tricked into agitating against the very things they need. That, and the anti-reform protester who was injured at a town meeting, who's now asking for donations. To cover the health care he lost <a href="http://www.washingtonmonthly.com/archives/individual/2009_08/019423.php">when he lost his job</a>! Simply amazing.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com8tag:blogger.com,1999:blog-30499448.post-12380348212453451622009-08-07T20:25:00.000-07:002009-08-07T20:36:25.439-07:00Scam Alert<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMbs62-YiqSb5Y0zZuLDzypgrPA92hfVHkebud39iYJAAxlx9ZTEI1uWUwa8rBs06PE13z4y5wlf7P9dc4hR6iLSBwhcPR5_rwYCW9eYl29n-LeLvxx9mkDczzJNAgHNDKYfkEgKaLmw/s1600-h/thief.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 384px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMbs62-YiqSb5Y0zZuLDzypgrPA92hfVHkebud39iYJAAxlx9ZTEI1uWUwa8rBs06PE13z4y5wlf7P9dc4hR6iLSBwhcPR5_rwYCW9eYl29n-LeLvxx9mkDczzJNAgHNDKYfkEgKaLmw/s400/thief.gif" alt="" id="BLOGGER_PHOTO_ID_5367431536070037970" border="0" /></a><br /><br /><br />For months I've been getting spam comments linking to a website called "Findrxonline." I finally took the time to look at it, and find that it requires a monthly subscription which supposedly pays them to find you low-price meds from other websites. As if you couldn't do it yourself.<br /><br />What a joke. I assume none of my readers is so dumb as to fall for it, but I thought I'd mention it anyway. An outfit that thinks leaving spam on blogs is a good business plan is surely one to avoid. There was another, recently, that responded to my complaint by apologizing. This one not only doesn't do that, but at least one of its email addresses bounces back.<br /><br />Sigh. For all the beauty of the internet, there must be, it seems, a little ugly too.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com3tag:blogger.com,1999:blog-30499448.post-49115969197759111102009-08-07T11:26:00.000-07:002013-01-30T09:01:17.674-08:00Head-Scratcher<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVCLgnT1yF9bQZPeG6yk0xrWvNycwNy1JgtGjzUpy86Dyz1G2WU4Z2qsxC8RXLVUIioWkmZIEeq5xdzjCq21zQeNcT3cCBWOvzxFy1Bi36RoPXukNz-WnSCPC4cLFkbs5KRu7WniXS7Q/s1600-h/bush-scratching-head.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5367293358450043586" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVCLgnT1yF9bQZPeG6yk0xrWvNycwNy1JgtGjzUpy86Dyz1G2WU4Z2qsxC8RXLVUIioWkmZIEeq5xdzjCq21zQeNcT3cCBWOvzxFy1Bi36RoPXukNz-WnSCPC4cLFkbs5KRu7WniXS7Q/s400/bush-scratching-head.jpg" style="cursor: pointer; display: block; height: 319px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br />
I simply don't get it.<br />
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Quite aside from the fact that the plan to disrupt health-care town-meetings is overtly to stifle honest debate on a very difficult subject, and despite the fact that there isn't even a bill yet (only a House version and several Senate versions that need reconciling), and even imagining that the anger is real and not ginned up by the distortions and outright lies of the right wing media or fomented by interest groups with a long history of ripping off the health care system for legal profit -- not to mention being fined one point seven billion dollars for fraud -- overlooking all of that: what the hell are these people so mad about?<br />
<br />
As far as I can tell, the proposals out there -- the ones that are actually in writing as opposed to the absolutely insane claims of the Rush O'Beckly axis of a$$holery -- are fairly weak-kneed attempts at maintaining the status of most of the quo. Are people really that upset about a bill which aims to prevent their care from being disallowed? Is making insurance portable, and preventing the companies from pulling the plug on coverage when you get sick really that infuriating? In what way is any of it socialism? Do any of the protesters even understand the word?<br />
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Yes, there are plenty of problems -- huge problems -- with reforming health care. Which is exactly why the stifling of discussion is so tragic. But can it really be that those screamers and yellers and shouters like things the way they are? Premiums doubling every few years? Losing coverage when they lose a job? Defacto rationing by insurers bent on keeping as much of their money as possible, not spending it on actual health care? Is that what they want? Do they really hate Medicare?<br />
<br />
What's so entirely dispiriting is the extent to which these mobs have been whipped up to argue -- once again -- against their own interests. In the most cynical of ways, for the most ignoble of reasons -- ratings, on the one hand, vis a vis the insanity that is Fox News; and pocketbook, on the other hand, vis a vis the insurers who are making billions off the dollars intended to provide medical care -- people have been spun into outrage based on a series of outright lies. Socialism. Coming to kill Grandma. It's unbelievable.<br />
<br />
Except that it isn't. Headlong and happily, we're heading off the cliff, cheered on by the very people for whom the system is working fine: making them rich indeed while millions suffer. It shouldn't be possible, it shouldn't be that easy to decieve, but most clearly, it is.<br />
<br />
The only thing I can't figure out is this: where do those guys plan to go when this country, at their urging and entirely of their making, is fully down the tubes?<br />
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<br />Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com4tag:blogger.com,1999:blog-30499448.post-27558051687095210322009-08-05T12:06:00.000-07:002009-08-05T12:08:12.189-07:00Certifiable<a href="http://kenyanbirthcertificategenerator.com/d92d5d6ac7c13743f4ff1e9b53847da5"><img src="http://kenyanbirthcertificategenerator.com/d92d5d6ac7c13743f4ff1e9b53847da5.jpg" /></a>Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com6tag:blogger.com,1999:blog-30499448.post-18672010589317933492009-08-04T02:04:00.000-07:002019-06-17T15:40:24.859-07:00Think Slow<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5tAAjncWfS1_yvZtEdIcVS_SPW7VwWJfN9qvjs4Gxr-xo5b2hK7k53mMuKachtsWDgC-KPqHhV4Q0SMdhYyGh0g08580BiKy_MT9K_Z6jFdgCM4r_ZC8J4IakLOOIXvboc42k0JPCtA/s1600-h/3532813_ede1c91c16_o.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5358101955903368594" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5tAAjncWfS1_yvZtEdIcVS_SPW7VwWJfN9qvjs4Gxr-xo5b2hK7k53mMuKachtsWDgC-KPqHhV4Q0SMdhYyGh0g08580BiKy_MT9K_Z6jFdgCM4r_ZC8J4IakLOOIXvboc42k0JPCtA/s400/3532813_ede1c91c16_o.jpg" style="cursor: pointer; display: block; height: 320px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br />
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Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists. (By way of diversion, I'll add there were only two of them at the time, and they were <b>both</b> my favorites. Practical and canny, surgical-patient-wise, they were a pleasure to work with. Over the years we developed great mutual respect and affection; to the extent that caring for critically ill and deeply challenging patients can be fun, it was.<br />
<br />
It's unique to private practice, I think, that such relationships can be so positive and mutually supportive and satisfying. I know I <span style="font-weight: bold;">have</span> said that in the academic centers, there's too much turf war and defensiveness. Was, back in the day, anyway. The discovery of such collegiality was one of the pleasures of my entry into private practice.)<br />
<br />
To make a long and dimming story short and bright, the patient was an older woman, admitted <i>in extremis</i> to the intensive care unit. Dying, evidently, of infection of indeterminate source. Clearly, she had severe pneumonia. Was there anything else? I was consulted early on, charged with ruling in or out a surgical and operable cause of her illness.<br />
<br />
Without going into details (mostly because I can't remember them), I became convinced that the lady's decline was not due to any kind of "surgical" condition. I continued to follow her three or four times daily, during which time the intensivist in charge kept working me over: she's dying; at least have a look inside to see if there's anything fixable. For those unremembered reasons, I continued to resist. At some point it became moot. If I'd been wrong and she indeed had a surgically treatable condition, she'd ultimately descended beyond her ability to recover from whatever I might do.<br />
<br />
Young, and not much established in the community, I didn't find it at all easy. The phrase lobbed to me more than a few times was, "It's time to fish or cut bait." I was well aware that if I was wrong it could be awful: for the patient, of course, but very likely for me, too.<br />
<br />
Not a good enough reason. It's not unreasonable sometimes, when all else fails, to "have a look." Before the ready availability of quite accurate non-operative testing, such an undertaking (as it were) was not entirely rare. In this case, certain as I was, I simply didn't want to do it. Not absent from my thinking was the realization that if I did operate against my better judgment, and found nothing to fix, I would have become, in a very real sense, her executioner.<br />
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If anyone has the answer to such dilemmas -- which, I might say, we still face despite our imaging capabilities -- I'd be happy to hear it. Meanwhile, in the case at hand, the unfortunate lady died.<br />
<br />
With more than a little dread, I awaited the autopsy findings, and came to have a look when it happened. (There's another subject: autopsies are done increasingly rarely nowadays. This case is an excellent example of why they are still needed.) I'm happy (if that's the right word) to report that it confirmed my conclusion that she did not have any pathological process going on in her belly.<br />
<br />
There's really no lesson to the story, other than sort of confirming my belief that more mistakes are made in operating too hastily than in giving things time to sort out -- assuming there IS time. But the real point is that for the next twenty years of an extraordinarily productive and rewarding relationship between myself and the intensivist, the phrase <span style="font-style: italic;">fish or cut bait</span> was used uncountable times. With varying meanings, depending on who said it, where, and why.</div>
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Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com8tag:blogger.com,1999:blog-30499448.post-2715466626895037062009-07-29T01:51:00.000-07:002018-03-13T20:45:35.329-07:00Kung Fu Surgeon<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo8HqpmnqtgnxwS96R9XliVNvSQjGWdz91j2JNDP7F8fUQpQevfL74IQLMJ13BtnZRG-HJYjtBYHajd0-u4sxFZMz5YnMyVUD_t3hvoPyAAu4CwDCOZYeK3z32IKF5nO5Y4iPILND0tA/s1600-h/kung-fu-master-po-and-caine.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" border="0" height="352" id="BLOGGER_PHOTO_ID_5362998532277868514" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo8HqpmnqtgnxwS96R9XliVNvSQjGWdz91j2JNDP7F8fUQpQevfL74IQLMJ13BtnZRG-HJYjtBYHajd0-u4sxFZMz5YnMyVUD_t3hvoPyAAu4CwDCOZYeK3z32IKF5nO5Y4iPILND0tA/s400/kung-fu-master-po-and-caine.jpg" style="display: block; height: 220px; margin: 0px auto 10px; text-align: center; width: 400px;" width="640" /></a>Somewhere in my home is a letter I received from a Shaolin priest, one of five (so I was told) grand masters of the martial art of kung fu on the planet. The letter is embossed with the gold seal of the temple of which he was the head honcho. With its beautiful calligraphy and that timeless seal, I've thought of having it framed.<br />
<br />
The temple is in another country. The master came to me, that I -- and only I -- might operate upon him. (To put it a little more dramatically than circumstances might warrant.) According to the man who sent him, he taught only a select few, and demonstrated his skills only in private. The referring person, who had been a student of kung fu (but not of the master), described to me the man's ability to toss a group of attackers <a href="http://onemansblog.com/wp-content/uploads/2009/03/tossing-fish-at-pike-place-market.jpg">like fish</a>, and other unearthly wonders. The priest was in his seventies.<br />
<br />
I'm not sure what I expected. An aura? Rays of light? Surely, were I to give satisfactory care, I'd be granted some sort of special status, maybe presented with a holy relic, invited to the temple for a secret ceremony, rooted in ages past. I admit I let myself imagine special things.<br />
<br />
He arrived in my office dressed like a Florida retiree. Looking age-appropriately fit, but neither athletic nor powerful, he was of no more than medium stature. Less surprised than embarrassed for my silliness, I immediately discarded my dream and proceeded into my usual doctor/patient partnership, treated him like everyone else, operated in due course, saw to his recovery, and he returned to his homeland.<br />
<br />
The letter, which compared my art and skill favorably to his, arrived with a package. Really, the elegance of the letter was more than enough. Once again, I entertained a brief fantasy of what might be in the box.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVU1x1VBqFPX7P2sSZd60BTifnhZU3t9LDhesOp3qApbWVR8tRPsyYPENRAUj04bf-2WLlrFi4cl1qN-sx9QD-BmOrJQfymWY3briJHPDghmWw3DUynI1nsCjg88yco16SIlcCOCDYYQ/s1600-h/fueller.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5363633713488735186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVU1x1VBqFPX7P2sSZd60BTifnhZU3t9LDhesOp3qApbWVR8tRPsyYPENRAUj04bf-2WLlrFi4cl1qN-sx9QD-BmOrJQfymWY3briJHPDghmWw3DUynI1nsCjg88yco16SIlcCOCDYYQ/s400/fueller.jpg" style="cursor: pointer; display: block; height: 319px; margin: 0px auto 10px; text-align: center; width: 286px;" /></a><br />
<br />
It was a Mont Blanc fountain pen.<br />
<br />
I'm not sure I'd heard of them before that. Very expensive, for a pen. A nice gesture, no doubt, but of not much use to me. A little too showy, it was also impossible to use for writing orders at the hospital, because you need to push hard enough for several copies. Nor was I interested in lugging around a bottle of ink on rounds. I confess to being disappointed. It seemed so impractical, so materialistic, so... unlike a Shaolin priest. Not that I had any information other than <a href="http://en.wikipedia.org/wiki/Kung_Fu_%28TV_series%29">a TV show</a>.<br />
<br />
In its elegant box, the pen sat on my bedside table for a decade or so, along with its <a href="https://www.amazon.com/Mont-Blanc-Bottle-Oyster-105186/dp/B003LR4262">exotic ink bottle</a>. Then I wrote a book, got it published, gave a few readings, did some book signings. Wow, it eventually occurred to me. It's karma, or whatever Shaolin priest kung fu masters believe in. He forsaw it, it was perfect, meaning revealed. I took it to the next signing. With its elegant gold nib, its meaty heft, its characteristic emblem, the soft lines of ink it imparted to the page, perfect for a signature and a few well-chosen words. The mark of a writer of distinction.<br />
<br />
After reading from and commenting on the book (I will humbly say my readings were always a hit: I'm enough of a ham to enjoy it and get plenty of laughs -- the first time I did one, it was at a fairly fancy book fair in Portland, called "<a href="https://literary-arts.org/what-we-do/wordstock/">Wordstock</a>." My reading, in a small room, was at the same time as Gore Vidal's, in a much larger one. "This is my first reading of my first book," I told the audience. "So I'm really looking forward to hearing what I have to say.") I sat at a table and proceeded to sign books for people, bringing out the newly-glorious pen, studiously acting as if it were as normal as breathing.<br />
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It leaked all over my hands, and wildly smudged the first book I signed.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com14tag:blogger.com,1999:blog-30499448.post-61260596877420830272009-07-27T01:03:00.000-07:002009-07-27T15:30:54.539-07:00Rationing. There. I Said It.<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLZInRQ7o5RF7e7VUChPW5kvLD1J0BcfARDWKmVre-GF2FAjnbY4lD_npSUhnSfCxjMYuHJZiKNfCV-qyA1yv79RojA9uqYdH7_G2WdOJBFhQVtOz1hv3e8qElZ-Y0-8U99FdRsV7qhQ/s1600-h/artsweek1-2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 296px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLZInRQ7o5RF7e7VUChPW5kvLD1J0BcfARDWKmVre-GF2FAjnbY4lD_npSUhnSfCxjMYuHJZiKNfCV-qyA1yv79RojA9uqYdH7_G2WdOJBFhQVtOz1hv3e8qElZ-Y0-8U99FdRsV7qhQ/s400/artsweek1-2.jpg" alt="" id="BLOGGER_PHOTO_ID_5361828494667302082" border="0" /></a><br /><br />Thirty percent of Medicare money, it's said, is spent in the last month (or is it six months?) of recipients' life. It shouldn't be surprising: people who die are generally sick. Sick people -- especially ones that die -- require more care than healthy people, or people who survive an illness. But it gets to the most thorny of issues when tackling health care costs. And it's a perfect example of why real reform is next to impossible: our politicians are too venal and stupid, special interests are too powerful, media are too superficial, the issue it too freighted with grayness, and the public is too easily distracted for there to be a meaningful discussion.<br /><br />Notwithstanding the truths just enunciated, I have a few things to say. A proposal, too.<br /><br />Absent having all the money in the world to spend on health care, I think it's fair to say that everyone is in favor of rationing. If all we had was a million bucks, would anyone choose to spend it on ten demented ninety year olds with advanced cancer and a 5% chance of recovery, instead of ten ten year olds with leukemia, with an 80% chance of recovery? So, <a href="http://www.anecdotage.com/index.php?aid=11508">like the old joke</a>, we're not really arguing about rationing; we're haggling over details. Not to mention the fact that rationing, so loudly decried by the Foxoid among us as possible under "Obamacare" (whatever that is) is already happening with private insurance: of the dozens of plans offered by each of the twelve hundred insurers, how many cover all things for all people with all conditions under all circumstances? <a href="http://baselinescenario.com/2009/07/27/health-insurance-innovation/">How many people</a> get dropped after an illness, or refused in the first place? Wouldn't it be better to have such decisions made in a system open to public and medical input? (Along those lines, <a href="http://www.dailykos.com/storyonly/2009/7/25/756972/-Dear-Mr.-President">here's </a>a pretty good, and humorous, commentary on the reality we currently face, still defended most arduously by the nay-sayers of the right-wing persuasion.)<br /><br />End of life care presents us with some of the most difficult decisions we make, as families, as patients, as physicians. Likewise the related situation of "futile care." In neither case are there clear criteria to guide us. The exact same operation -- say, bowel resection for perforation -- would certainly be futile in that ninety year old (let's add some heart and kidney disease to make it easier), and entirely reasonable in a thirty year old, even if that person presented in septic shock. In the latter case I wouldn't hesitate for a second. In the former, I would try (and have, many times) to present for consideration the option of providing comfort care only. I won't psychoanalyze myself, but I hated doing operations wherein I felt there was virtually no hope of survival. (Need I mention that I made more money when I did operate than when I didn't? Yet I tried like hell not to, by presenting as candidly and openly as possible what I thought the situation was.) Not every surgeon would have done so.<br /><br />I was always scrupulous about cost in my practice, from the little things to the big ones. Saving a few bucks on every case by not demanding different suture for every step when it made no difference: it adds up. So does thinking twice before heading down the road to futility. But it's neither universal, nor easy to know the signposts. Ought there to be some guidelines at the end of life, or should it be up to serendipity? I don't want to take judgment out of the equation; but not everyone has the same capacity for it. Which is part of the problem.<br /><br />I can't back this up with any data, but when their grandma was dying, it seemed to be those who'd been with her the most who were the most able to let go. It was the out-of-town shirt-tail relative who blew in at the last minute who seemed to demand that "everything" be done. In those circumstances when it was insisted I go for the one/million shot, I've wondered if the same decision would be made were the family responsible for the cost.<br /><br />So here's my proposal, in the context of the brouhaha over the idea of studying what works, and not paying for what doesn't: let's lay the money on the table. If a family wants to go ahead with an operation or other intervention, for which the odds of success are very long, or which is judged ineffective based on research (let's not get into details for now), here's the deal: if it works, Medicare (or is it Obamacare?) pays. If it fails, the family pays. Cash (credit card?) up front. Takers?<br /><br />I see this health care "debate" as the quintessential test of our democracy. The need for reform is clear; the trajectory is, without doubt, toward disaster if changes aren't made. And yet, here we are, bogged down in disingenuous rhetoric, in overt efforts to stop it for purely political reasons. Trading amendments and concessions to various profiteers like bubble gum cards. Watering down the most serious proposals like potted plants. Media covering it lazily (all of them), sensationally (most of them), or entirely falsely and politically (you know who.) Advertisements and talking points designed to <a href="http://videocafe.crooksandliars.com/heather/reality-check-shona-holmes-holmes-brain-tu">frighten, inflame, misinform</a>. Citizens unwilling to think about it carefully. Faced with a crying need and a failed future that is not seriously in doubt, we seem unable to have serious debate, to argue on the merits, to legislate the sorts of changes that are needed. How can other countries have done it, and not us? And what does it say about our political system?<br /><br />Can a nation of half-educated people, unable or unwilling critically to evaluate data; a media industry degenerated into selling soap over meaningful reporting -- and, worse, owned, operated, and scripted by people with overt political agendas; legislators elected for their dogmatism above all, the less serious the better; political parties more interested in power games than doing right -- can such a political system meet real and serious and undeniably needed challenges, or not? We'll know pretty soon. In fact, I'd say we already do.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com12tag:blogger.com,1999:blog-30499448.post-28681709731597586572009-07-23T18:54:00.000-07:002019-05-13T19:34:55.154-07:00Campfire Blues<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnc0nGjKtT2V72Fu90eENPXYfj78Fkc5y4Y1tTdagT0hMDuDvHAtyqoc8oIMJHzPkKeRT4URZIOUntZfsV-lOfYVZpharnPeUSLyvG6casw61IIbYcRBU8u7psMS7kl-CeB1_IKwK4ew/s1600-h/400px-Racquetball_ball.svg.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5360695874390089970" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnc0nGjKtT2V72Fu90eENPXYfj78Fkc5y4Y1tTdagT0hMDuDvHAtyqoc8oIMJHzPkKeRT4URZIOUntZfsV-lOfYVZpharnPeUSLyvG6casw61IIbYcRBU8u7psMS7kl-CeB1_IKwK4ew/s400/400px-Racquetball_ball.svg.png" style="cursor: pointer; display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a>As I once understood it, it's the <a href="http://en.wikipedia.org/wiki/Pampiniform_plexus">pampiniform plexus</a>, the veins around the testis, the prolonged congestion of which during unrequited (as it were) sexual stimulation, that is responsible for an unpleasant <a href="http://health.discovery.com/centers/sex/sexpedia/blueballs.html">pain syndrome</a> particularly prominent in adolescent males. This is a medical blog. Blogs are, by definition, personal. So, here's a post about something vaguely medical, and highly personal. Suffering from topic deficit, I've sunk to this. But it's a good story. In short, I may be the only person known to have passed out from a case of, well, you know... <br />
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It was at summer camp, a co-ed religious camp, which makes it even better. A high school freshman, by any standards, even in those innocent times, I was inexperienced. And there was a girl, a <a href="http://www.youtube.com/watch?v=N2CyQ7Eslg4">California girl</a>, wiser than me by light years. One cool night found us together, in the woods, for quite a while. I will say no more; but you can easily infer how it <b>didn't</b> end.</div>
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Despite being what might be called distracted, we heard the call to the evening campfire. As we made our way back, I became aware of discomfort. Increasing discomfort. Significant, unfamiliar, impedimentizing discomfort. Double discomfort, throbbing, heated, encompassingly discomfiting uncomfortable discomfort.</div>
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The evening ritual involved encircling the fire, all the campers and counselors crossing arms and holding hands, some nice words to end the day, and singing. <i><a href="http://www.youtube.com/watch?v=tfEBhsFG_T0">Henay matovu manayim...</a> </i>a mantra, hypnotizing, over and over, the words guttural, <i>shevet achim gam yachad,</i> soothing, repetitious, chocolaty, warm, pulsing, rising <i>heeNAY</i>... achim... yachad... The ch not like "chop" but kha, no English sound, a throaty sound, the letter X in Russian. Lozengy, physical. Percussive, drummy. Pounding.</div>
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Swaying back and forth, all together, the warm night, the song in minor key, repeating, the swaying the throbbing the singing, taking over, obliterating, the pain, rising, the throbbing, spreading to torso, to head, the forehead the cold forehead the singing pounding thrumming pain melding <i>manayim</i> throbbing <i>matovu</i> pounding drumming pain swaying swaying buckling swaying... the vague sense of someone falling, who?, people murmuring.</div>
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Looking up at faces looking down. Was it only concern, or was there knowing amusement? I'm okay, I insisted, wondering if there was... evidence. I'm fine, just got dizzy from the heat of the fire, or some other excuse. I didn't -- and don't -- think there was any way for them to have known. Somehow, I managed to convince them I didn't need to go to the infirmary.Walking slowly, I made it back to the bunk. Under observation, even if I knew the cure, there was no opportunity.<br />
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The pain was gone in the morning. Wonder if that was the beginning of my journey away from religion...<br />
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Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com9tag:blogger.com,1999:blog-30499448.post-63714588527767066932009-07-18T08:25:00.000-07:002009-07-22T11:49:28.238-07:00Note To "Andrew"<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYjdwThUa9Zqr5XnACTsZCNJuMj-3Fnv4MdbYb_Q5_fnYi60ZpBopWObdKiQIL0cryozV8WRT00SZsd3GNl4_M5TF0tYf39w41mG-QokvncziRU-y1H2orCS1F_38Z4-3jn43wR8btAg/s1600-h/thefinger.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 292px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYjdwThUa9Zqr5XnACTsZCNJuMj-3Fnv4MdbYb_Q5_fnYi60ZpBopWObdKiQIL0cryozV8WRT00SZsd3GNl4_M5TF0tYf39w41mG-QokvncziRU-y1H2orCS1F_38Z4-3jn43wR8btAg/s400/thefinger.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5359822212788139490" /></a><br /><br />You, sir, are the scummiest of the scum that is blog spammers I've ever seen. You discredit yourself and the "business" you "represent."<br /><br />Meanwhile, to anyone who might be thinking of satellite TV: I'd strongly advise against an outfit that calls itself "directstarTV." If its advertising methods mean anything, it's a total scam.<br /><br />[<b>Update, 7/22</b>: I emailed the business, and today I received a reply which included the following:<br /><br /><blockquote><i>Thank you for informing us of this issue. We’d like to offer our apologies for these incessant and unnecessary blog posts you received from a former affiliate of our company. Please know that DirectStarTV does not support such marketing tactics. As of July 22, 2009, this affiliate has been terminated and ordered to cease and desist immediately.</i><span style="font-style:italic;"></span></blockquote><br /><br />So I feel a little better about them.]Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com12tag:blogger.com,1999:blog-30499448.post-9253395609985668442009-07-11T08:52:00.000-07:002009-07-11T08:55:12.109-07:00Truthteller<object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/Mv1FwOCNoZ8&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/Mv1FwOCNoZ8&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="344" width="425"></embed></object><br /><br />If I can't write, there's no reason not to post things that write themselves.<br /><br />The interviewee is Wendell Potter, former head of corporate communication for CIGNA, one of the largest health insurers. He left after twenty years, in order to work for health care reform.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com29tag:blogger.com,1999:blog-30499448.post-19849189778741514212009-07-08T16:45:00.000-07:002009-07-08T19:20:24.697-07:00False Start<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0fjR5lDsgL1LR_XpTcOuHMsTzvSaKTB7DNjxP13JpwhIsQKhxnlU9SzxmUkujxRauCJqStgo9DJp_4JAwb0iWHzIEPzbc3fnIEqwfHaWwgMqJeFmTVPalnKY-JP6nl5QHyUHAIHX-5g/s1600-h/Men_s_60m_hurdles_false_start.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0fjR5lDsgL1LR_XpTcOuHMsTzvSaKTB7DNjxP13JpwhIsQKhxnlU9SzxmUkujxRauCJqStgo9DJp_4JAwb0iWHzIEPzbc3fnIEqwfHaWwgMqJeFmTVPalnKY-JP6nl5QHyUHAIHX-5g/s400/Men_s_60m_hurdles_false_start.jpg" alt="" id="BLOGGER_PHOTO_ID_5351292721049516898" border="0" /></a><br />I've tried, but I don't seem to have it. Much as I'd like to return to the sort of writing I was doing earlier in <span style="font-style: italic;">Surgeonsblog</span>, it's not happening. It's as if I'm in a darkened house with many rooms, but all the doors are locked. In a <span style="font-style: italic;">deja vu</span> sort of way, I know there is stuff behind the doors, but it's inaccessible. Familiar, yet out of reach.<br /><br />Re-reading old posts, I feel envious of the person who was able to write them, and of the good I feel it did, not to mention the wider world it created for me. But now I'm an interloper in my own life. It feels unnatural. Or, at least, unavailable.<br /><br />So we'll see. I'm rummaging around in my brain, but so far it's like showing up for an <a href="http://www.bloggingvegas.com/Easter%20Egg%20Hunt.jpg">Easter Egg Hunt</a>. A <a href="http://www.historyofredding.com/DSCN1790.jpg">day late</a>.<br /><br />To anyone who may have wandered here for the first time, I invite you to check out the "<a href="http://surgeonsblog.blogspot.com/2007/11/sampler.html">Sampler</a>" post, for a sense of direction. Meanwhile, I'll keep trying.<br />.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com26tag:blogger.com,1999:blog-30499448.post-36865412289037193792009-07-02T11:48:00.000-07:002018-04-21T20:52:55.363-07:00Oldies But Goodies<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis-BBOtv3xkmHnS1eO1L5miziBiKqqcoJIFgSMFpEHS1cZlaXgddVRV7vjTw8H6Jdy0-OZ-OhSvUymWtYfe_yUDM69oWfu74bo2vxs1Ni_Qm6-0Fh0C8_e22V6k6CyKYOKYHleiR4WpQ/s1600-h/jukebox-722780-main_Full.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5353943770412992306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis-BBOtv3xkmHnS1eO1L5miziBiKqqcoJIFgSMFpEHS1cZlaXgddVRV7vjTw8H6Jdy0-OZ-OhSvUymWtYfe_yUDM69oWfu74bo2vxs1Ni_Qm6-0Fh0C8_e22V6k6CyKYOKYHleiR4WpQ/s400/jukebox-722780-main_Full.jpg" style="cursor: pointer; display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 265px;" /></a><br />
An <a href="http://www.nytimes.com/2009/07/02/opinion/02leipzig.html">article in today's NY Times</a> got me reminiscing about operating on old folks. While it's true there is inherently increased surgical risk in their care, my list of favorite patients is heavily populated with the elderly.<br />
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Like the ninety-six year old who lived with a very cumbersome hernia because he'd been told repairing it would be too risky. He had some friends over for a <a href="http://medical-supplies-equipment-company.com/files/images/product/LUM-527.jpg">truss</a>-burning party after I fixed it under local anesthesia. Or the WWII vet, rejected by other surgeons for his age and (only slightly) less than perfect heart, who told me I'd replaced <a href="http://bymyart.files.wordpress.com/2008/07/douglas-macarthur.jpg">Douglas MacArthur</a> as his hero after I cured his debilitating reflux esophagitis. The many many older women who took their breast cancer in stride; the sturdy lady who fought tooth and nail, literally walked out on me, when I first told her she needed a colostomy but who finally acceded and insisted on seeing me bi-annually forever afterwards, bringing treats from her garden every time.<br />
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The oldest I ever operated on was a Russian immigrant from a town in the Ural Mountains where they live half way to forever. He was 102, which was lower than his temperature, caused by a gallstone stuck in his bile duct. His family assured me he was sharp as saber and strong as <a href="http://upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Various_Bottles_of_Slivovitz.jpg/450px-Various_Bottles_of_Slivovitz.jpg">slivovitz</a>. Two weeks later, he was back working his garden.<br />
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It was always my impression that older people were more matter-of-fact about their illnesses, and I found it almost universally true that they were less troubled with post-operative pain. Maybe it was physiological; maybe because they were more sensitive to narcotics. But I always thought it was simply because they'd made it through the better part of a hard life and pain just wasn't that big of a deal any more.<br />
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For an older person, the default mode was trust (the "sturdy" lady excepted. Sort of.) They listened when I talked. "Do what you think is best, Doctor," they said, which was like flopping into a comfy chair, after a day of walking on nails. It's impossible to care for the gray-haired and not think of grandparents, not to relax a little, to feel respect.<br />
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Okay, in the intensive care unit, not so much. Called there to consult, finding an ancient-looking person, tubes in natural and unnatural orifices, knowing survival odds are in inverse relation to those tubes, one is faced with often impossible questions having unknowable answers. To do what is reasonable; certainly no less, but hopefully no more. And humane. But that's another matter, with not just immediate but global implications (health care costs!). I was talking about the sort of relationship that begins in the office, or maybe a regular hospital bed. Relaxed. Time to get to know each other.<br />
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The NYT article points out some ways in which the geriatric population differs from the younger. (It also makes the very good point that whereas all med students do time in pediatrics, obstetrics, etc, there's no requirement for geriatrics. Older folks aren't just wrinkly.) It's certainly true in terms of length of recovery time, healing issues, complications from accompanying disease.<br />
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I wish there were objective ways to measure risk, to predict outcomes. Absent that, I always found a couple of reliable -- if unscientific -- predictors: people do like they look. An eighty year old who looks fifty will recover like a fifty year old; a fifty year old who looks eighty will recover like eighty. And, no matter what age, anyone who walks a mile or two every day will do just fine.Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com17tag:blogger.com,1999:blog-30499448.post-55207539685682974792009-07-01T11:26:00.000-07:002009-07-01T12:01:11.538-07:00Not Guilty<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZZAgTuUlN81YzXz_BNZpZIuRLqPMfRkhyByt2bf_yY9ItEQPhGpAYKkSSbZsGrTuGNj8FUIF3btRnAg1uY9RQLBsV0RD_bwR5ZkuTb1r2SxnKvhsS9P19LOmsrsQ_4IhTy463BSHn1Q/s1600-h/951003.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 323px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZZAgTuUlN81YzXz_BNZpZIuRLqPMfRkhyByt2bf_yY9ItEQPhGpAYKkSSbZsGrTuGNj8FUIF3btRnAg1uY9RQLBsV0RD_bwR5ZkuTb1r2SxnKvhsS9P19LOmsrsQ_4IhTy463BSHn1Q/s400/951003.jpg" alt="" id="BLOGGER_PHOTO_ID_5353561840436212946" border="0" /></a><br /><br />I haven't <a href="http://www.winterbourne.freeuk.com/semaphore.gif">heard directly</a> from Blogger yet, but I note the <a href="http://wholesale.piratemerch.com/images/surrender_red_flag.jpg">red-flag warning</a> is removed from my <a href="http://www.riverwinds.biz/Turbine%20Control%20Panel.JPG">dashboard</a>. Guess the <a href="http://www.everythingweird.com/images/computer-geek_48.jpg">human reviewer</a> was convinced this isn't a <a href="http://webrunnerdomains.com/blog/wp-content/uploads/2007/10/spam_21.jpg">spam blog</a>.<br /><br />Ironically, I've just <a href="http://cache.daylife.com/imageserve/0cKk70vg0h8i6/340x.jpg">deleted</a> a spam comment from the previous post: it's one I get sort of frequently which links to an online <a href="http://www.cartoonstock.com/newscartoons/cartoonists/rmc/lowres/rmcn35l.jpg">drug seller</a>. Annoying. I've <a href="http://nicekicks.com/images/santa-cruz-screaming-hand-logo.jpg">contacted</a> them and they <a href="http://www.jossip.com/wp/docs/2009/04/liar.jpg">deny doing it</a>. Now they <a href="http://coloradoright.files.wordpress.com/2008/12/monkey_fingers_in_ears.jpg">don't return</a> my emails.<br /><br />Excessive links, indeed!Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com6tag:blogger.com,1999:blog-30499448.post-29741665808994839052009-06-30T09:26:00.000-07:002009-06-30T09:37:04.853-07:00Insult<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh96CsLr8fadrzL5H0KKWj_1E5pX3K9Qgiowoyfx_DccqW7_jpPpW-Gv2t2aQHBltN9c8iQWQZa9nEIJiJLUVcA5k1SgRig_HGtFGbz7oeHcNjsvDlGfw615Q-3sC4qSMCVji436JEhbw/s1600-h/1158046108_b4131845ac.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh96CsLr8fadrzL5H0KKWj_1E5pX3K9Qgiowoyfx_DccqW7_jpPpW-Gv2t2aQHBltN9c8iQWQZa9nEIJiJLUVcA5k1SgRig_HGtFGbz7oeHcNjsvDlGfw615Q-3sC4qSMCVji436JEhbw/s400/1158046108_b4131845ac.jpg" alt="" id="BLOGGER_PHOTO_ID_5353160009457827522" border="0" /></a><br /><span class="Apple-style-span" style="font-family:Georgia,-webkit-fantasy;">This morning in my email was the following message: </span><div><span class="Apple-style-span" style=";font-family:monospace;font-size:medium;" ><blockquote>Hello,<br /><br />Your blog at: <a href="http://surgeonsblog.blogspot.com/">http://surgeonsblog.blogspot.com/</a> has been identified as a potential spam blog. To correct this, please request a review by filling out the form at [link deleted by me.]<br /><br />Your blog will be deleted in 20 days if it isn't reviewed, and your readers will see a warning page during this time. After we receive your request, we'll review your blog and unlock it within two business days. Once we have reviewed and determined your blog is not spam, the blog will be unlocked and the message in your Blogger dashboard will no longer be displayed. If this blog doesn't belong to you, you don't have to do anything, and any other blogs you may have won't be affected.<br /><br />We find spam by using an automated classifier. Automatic spam detection is inherently fuzzy, and occasionally a blog like yours is flagged incorrectly. We sincerely apologize for this error. By using this kind of system, however, we can dedicate more storage, bandwidth, and engineering resources to bloggers like you instead of to spammers. For more information, please see Blogger Help: <a href="http://help.blogger.com/bin/answer.py?answer=42577">http://help.blogger.com/bin/answer.py?answer=42577</a><br /><br />Thank you for your understanding and for your help with our spam-fighting efforts.<br /><br />Sincerely,<br /><br />The Blogger Team<br /><br />P.S. Just one more reminder: Unless you request a review, your blog will be deleted in 20 days. </blockquote></span><span class="Apple-style-span" style="font-family:Georgia,-webkit-fantasy;">But the real insult was in following the link to explanations, finding this (emphasis mine): </span><div><span class="Apple-style-span" style=";font-family:monospace;font-size:medium;" > <blockquote>As with many powerful tools, blogging services can be both used and abused. The ease of creating and updating webpages with Blogger has made it particularly prone to a form of behavior known as link spamming. Blogs engaged in this behavior are called spam blogs, and can be recognized by their <span style="font-weight: bold; font-style: italic;">irrelevant, repetitive, or nonsensical text, along with a large number of links</span>, usually all pointing to a single site<br /></blockquote></span></div><br /><span class="Apple-style-span" style=";font-family:monospace;font-size:medium;" >So much for my assertions that this blog has been of value, or, at least, once was.<br /><br />I should add that in order to perform any action in posting, I now have to do a word verification. The distortion of the letters is so extreme that I can barely read them. So you might not actually be seeing this. I await the judgment of the blogger overlords. Meanwhile, I'll have the words in my brain: </span><span class="Apple-style-span" style=";font-family:monospace;font-size:medium;" ><span style="font-weight: bold; font-style: italic;">irrelevant, repetitive, nonsensical. </span><span>Alas, it is I.<br /></span></span><span class="Apple-style-span" style=";font-family:monospace;font-size:medium;" ><blockquote><span class="Apple-style-span" style=";font-family:Georgia,-webkit-fantasy;font-size:16;" ><blockquote></blockquote><br /></span></blockquote></span></div>Sid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.com13