Posts

Showing posts from June, 2007

It Seems Like a Year

Image
Well, as of today it's been a year since I began this blog. Months before that, "blog"was a vague concept, something I'd heard about. Probably had read a few of a political nature, but the idea of having one of my own didn't register. I stumbled upon medblogs as I began to think about ways to hawk my book on the internet. I overdid it. Got deservedly chastised for some egregiously self-promoting comments on a couple of very worthy blogs. Shameful. I still cringe, Orac . Sorry. Eventually, it dawned on me that I should just start my own blog, and I was amazed at how easy, how free it was. At first I was pretty clueless, and my cherry-popping post was some sort of terrible toe in the water. Back then, I had no idea about site meters, tagging one's posts; didn't include pictures or links. I've gotten a little more ept. Among the great things, in fact, is the ability to link. Readers of my book will have found a surfeit of footnotes: linking to relevant

Shoe/Foot (other)

Image
I wish I'd had a tape-recorder. I'd have gotten it all and sent a copy to the doctors and the nurses. If I were nasty, I'd have sent it to the hospital administrator... Having had a number of people close to me in the hospital lately, I've spent plenty of time at the bedside. It leads me to conclude that if every doctor and nurse did the same, without letting on that they were "medical," they'd change their behavior overnight. I was a visitor in a hospital just this morning, in a two person room. The roommate was a nice lady, fresh from surgical repair of a broken leg. A few months ago, she'd had breast cancer. A doctor came to see her: thin, dressed in a crispy thigh-length white coat, dark slacks, academically correct glasses. Medical guy, clearly. "Hello," he said. "How are you feeling?" "Hi. I'm ok, I ...." "I saw your scan. It doesn't show the cancer. Does it hurt when I press here on your liver?" &q

Ommmmmm......

Image
My last post seems to have sunk without a ripple, so I'm letting my mind coast for a day or two. Letting neurons fire randomly and record the blips. Downhill sledding. Clutch in, no effort. Empty the mind, see what rises...Here's a couple of memories that popped up, for no particular reason that I can palpate, using the least amount of effort possible: Training in San Francisco meant seeing a broad swath of humanity. I once operated on an ancient Chinese woman who spoke no English, and who'd been subjected in her distant youth to the practice of foot-binding. Entirely unrelated to the problem that led to my surgery, it was nevertheless memorable enough that the image is fresh in my mind, sticking amongst the otherwise decaying RNA. Her feet were a lot like this: It hurts to think about it. Here's how the Xray would, no doubt, have looked: The mind now ping-pongs to the arrival of another Chinese person, this one a male, looking to be at least a hundred years old, and n

Two Spleen...

Image
If the concept of "a little bit pregnant" isn't a useful one, it turns out it IS possible for a spleen to be "a little bit ruptured." It wasn't always the case. Not much more than a couple of decades ago, the algorithm was pretty straightforward: a) see ruptured spleen; b) remove ruptured spleen. No need for a mnemonic. Very surgical. Now, God help us, we have lots of choices. a) see ruptured spleen; b) admit to ICU; c) insert thumb in ass; d) get lots of blood tests. If operating, it's repair spleen, remove part of spleen, remove all of spleen. If removing, slice up a few pieces and stick them somewhere (actually, that's a cool concept, and I liked to do it: theory being it might take hold and provide the immunity unique to the spleen).  Some of the early work in splenic salvage for trauma was done where I trained, one of the first major designated trauma centers in the US. Here is an early article by a guy I taught a thing or two when I was chief

Warning

Image
OK, so several blogs have found this little ditty and posted their results. Here's mine: Mingle 2 - Online Dating Here's the best part: So kids, ask mommie before coming here. Oops, I said "coming." Maybe I'll just talk about tummies and bandaids. Boo-boos, I suppose, are out. Depending on punctuation.

One Spleen...

Image
The above is snapped off a page of the book that might have saved my life. Well, no. But it kept my mind off self-pity when I was in the waning months of my tour of duty in Vietnam. Rather than attending only to that part of the world which was within three feet of me, I could ponder the power of the human mind; could hope the stories therein weren't just chemical aberrations. (Likely, of course, they were.) The book is "Be Here Now," by Ram Dass, formerly Richard Alpert PhD, associate of Tim Leary at Harvard; tripper on and contemplater of LSD. A friend sent it (the book, not the pharmaceutical) to me while I was serving my time. (Cool fact: all you had to do with mail to and from Vietnam soldiers was write "free" on the corner, and it got where it was aimed. I hope that's still true for the troops and their families.) The volume is divided into three parts, one of which is actually readable. In the snippet to which I refer, Ram Dass describes his first

Cold Comfort

Image
I've never hugged a bear, but I'm glad there are bair huggers . Because there's one way in which I'm in major conflict with my patients: I like it cold in the OR. They need it warm. Like the dual-control electric blanket that may have saved my marriage, heating devices in the OR allow dichotomy; the patient can be kept toasty while the surgical folk remain cool. Cooler. Anyone who's arrived in an operating room awake enough to recall the experience is likely to have noticed it was cool as the frost on a champagne glass (some may know the rest of that one...) "Yeah, we're trying to cut down on heating bills," I'd say when a patient mentioned it. But the fact is, it's personal: it gets darn hot under surgical gowns, especially the newer water-proof ones. Add a little stress, a little anxiety, and a warm room becomes destructively uncomfortable. Nor is sweating a good thing. Dramatic and surgeon-affirming as it may be to ask the nurse to wipe one&

Seeking Cover

Image
Fully clad in black, she walked the hall toward my office carrying a cane but not using it, accompanied by a daughter and grand-daughter, the latter to be her translator, the former her guide. Clouded over and looking like ivory, her eyes were blind; her face worn and wrinkled, weary and severe; yet her posture was erect and her dignity so profound that I felt as if I were in a regal presence. Her family treated her with deferential honor, and it was clear that I was expected to do so as well. It wasn't hard. If I didn't, it seemed, I might be struck by lightning. This part of the Pacific Northwest is a melting pot. Forty-seven languages are spoken in our school district. Every day, give or take, a new ethnic deli or exotic restaurant opens; I salivate thinking about them. My patient population included many with whom communication was difficult, if fascinating. (My middling Russian, po moyemu nye plokho , comes in handy.) This lady, it was made apparent, was to be referred t

Details, Details

Image
Having posted most recently about those bad -- if lovely -- drug and equipment reps (also known as "detail" reps), wouldn't you know I'd work with one today? It reminds me there's another side of the coin. There was a scandal a few years ago when it was made known that salespeople for orthopedic prosthetics (hips, I think it was) were actually doing major parts of some operations -- fitting and inserting the joints because the surgeons weren't familiar with them. I never have, and never would allow such a thing (nor is it allowed anywhere, anymore), but there are times I've welcomed such detail folk into the OR. Most of them know their products very well, and when there's some sort of new wrinkle, it's nice to have them around. Here's the likely scenario: Joe's Surgical Supply and Auto Shop comes up with a variation on a stapling device. Or an electrocautery unit, an adhesive dressing. They contact the hospital, or surgery center, and gai

Bag Man

Image
There's a recent post by Orac about the "'swag" given to docs by drug companies at medical meetings. It reminds me that when I was in med school, my class was -- far as I know -- the first ever to refuse the personalized black bags traditionally given to students by Eli Lilly Company. I was of two minds . My consciousness was a little late in the raising. It hadn't yet occurred to me back then that there were issues with taking goodies from those guys. We were also in the midst of the Vietnam war, and my class was active in protests. I attended a meeting in which a moratorium on classes was being planned, for the purpose of war protest, and the dean -- a bullet-headed guy much admired by all -- burst in and, in his most gravelly of the graveliest of voices said "What we need is a moratorium on bullshit." So it was a transitional time; but things were beginning to dawn on me. (By graduation, I was one of only a few wearing a " peace-sign " armb

I Never Meta Blogger...

Image
Just for the record, as I'm about ready once again to take up the gauntlet, let me describe the thought process, as I understand it, that led me temporarily up to dry: I was raised among political junkies, and have always been one. My dad was on the Portland school board for three terms, was on the Oregon Supreme Court, the Court of Appeals, and headed a quite important commission to address race and education during the sixties, another to revise the Oregon constitution. In retirement, he was mayor of Cannon Beach. My aunt was on the Portland City Council, the planning commission, and the port commission. My brother was a US Senate page, rubs shoulders now with a number of politicos. Table-talk was always about Big Issues when I was growing up. Governors, Senators, Congressmen and Congresswomen came to dinner (and, I assure you, it decidedly wasn't about money!) (Phone call when I was a kid: "Is Herb there?" "Who shall I say is calling?" "It's

Get Ready

Image

Update

Image

I'm Sure It's Temporary

Image

Operation; Epilogue: post op ergo propter op

Image
A reader suggested that after finishing my long-winded description of an operation, it would be interesting to see how it all would look in a typical operative report ("op note.") I like it! It is said -- and I happen to agree wholeheartedly -- that op notes ought to be dictated immediately, else the content stales likes a bagel. I was pretty fanatical about doing so; nothing bugs me more (OK, lots of things bug me more) than being told by medical records that I'm delinquent on a dictation. ANY dictation; but particularly op reports, because I always did them instantly. Usually I'd write with a flourish that I HAD dictated and give the date. It was not entirely rare that they insisted it wasn't anywhere, so I'd go to my office and find the copy that I'd already received , and tell them if they'd send me a self-addressed stamped envelope and a dime, I'd copy and send it. But that's neither here nor there. (Usually, though, it WAS there.) To me

Operation, Deconstructed. Nine: finish line

Image
Truth be told, sewing up holds no magic for me, other than the fact that in some cases it's a time to breathe a sigh of relief. (A main attraction of neck surgery is that once the fun's over, closing happens in the blink of an eye.) Still, it's not a time to stop paying attention. As in all aspects of an operation, there are dangers, and there are ways to screw it up. On the other hand, keeping your eye on the ball doesn't preclude a little relaxation. With very little encouragement (most often, without any at all) I'm liable to launch into my repertoire of Gilbert and Sullivan or Rogers and Hammerstein. I can do most of the parts in "HMS Pinafore," and a truly show-stopping " Pore Jud is Daid ," keeping it up until the circulator, sighing with force that could break bricks, marches over and turns up the radio. The anesthesiologist has a tough job: ideally, the abdominal muscles are fully relaxed (paralyzed) for closure, because it keeps the pati