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Showing posts from January, 2008

Bugs, redugs

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The previous post, on OR sterility, occasioned an email from a professor of surgery, who informed me of a study of which I hadn't been aware. I quote from his letter: "I wanted to draw your attention to another surgical/OR dogma that has essentially been put to rest, the wearing of the surgical mask. The Karolinska Institute (and other groups) has evaluated wound infections in two groups, one in which the OR team wore surgical masks, the other without masks. The outcome, as you might predict, was that the infection rates are the same (4.7% with vs. 3.5% without). Here is one of the references: World J Surg. 1991 May-Jun;15(3):383-7; discussion 387-8." Whereas, in this litigious society, I doubt you'll see anytime soon surgeons and scrub personnel eschewing their masks as a result of this study, I find it unsurprising; not to mention amusing and validating. Part of the inference to be drawn from my previous post is that some of what we do is not much more than

Bugs

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In commenting on my recent post about scrub clothing, Seaspray asked some good questions about operating room sterility. To give an excellent answer, I suppose I'd have to look up the latest studies. Fortunately for me, I'm quite willing to settle for anecdote and opinion, which is a heck of a lot easier. There's no doubt that maintaining sterility in the operating room is a prime directive. It's also true that, to a greater extent than might be expected, it's an illusion. That's not to say that maintaining proper technique is unimportant, or that breaks in such technique aren't to be avoided like, well, the plague. It's just that there are inconsistencies that might seem strange, but which don't seem to matter all that much, mostly. I recall a study that was reported when I was in training. I don't remember where it was done -- it could have been there, for all I know. In it, some sort of stuff was placed on the gloves of surgeons and scrub nu

Overload

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(Here's another of the posts I wrote a while back, and didn't publish, in my "why bother" phase.) Once again (it seems this keeps being reported, about annually) we have a report which states that doctors (especially surgeons) are doing a poor job of informing women about reconstruction options after mastectomy. I'm at a loss; I simply don't know what to make of it. My mind is filled with conflicting thoughts. The first thing that comes to mind is a question: is it true? And: if so, how can it be? And: if it's not true, what's up with the report? And the ones before it. And before those. I've written about what a complicated and difficult mission it is properly to explain breast cancer treatment to patients. And it's not just because the subject is complicated, with many components to treatment and options within those components; it's also that such a discussion takes place in the context of a mind near to or beyond blowing, enwrapped an

Life Saver

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In response to a post from long ago, about death, I recently received the following (in part) comment: "July '03, I was dying in a hospital bed at the moment my doctor came in to check on me. I saw his face and I knew in that moment that if I let go, he would blame himself for the rest of his life--when it absolutely wasn't his fault. I saw in his face how deeply he cared about me, and I knew I couldn't do that to him....he needed me to live so much, and I needed so much for him not to be in pain for the rest of his life over my death, that that gave me the strength and will to live, gave me the emotion to hang on that I needed, pulled me through that horrendous night." The more I think about it, the more amazing I find those words to be. I've been there. Much as I always tried to establish a relationship of trust and caring, much as I believe in the value of attitude in recovery from surgery (the writer had not, in fact, had an operation, as she told me in

A Step Forward

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(This is one of several posts I wrote in the last few weeks, but never published, for a variety of reasons.) In an ideal world (or, it could be said, a well-designed one) there'd be no cancer. Failing that, we'd have perfect treatment: one that destroyed every bit of cancer with no damage at all to normal cells and organs. That is at least imaginable at some point in the future. Even the not-too-impossibly-distant future. Meanwhile, we're stuck with imperfect treatments and we lack the ability accurately to determine who needs how much; who will get along just fine without extensive treatment (and, for that matter, who will succumb even with maximal therapy.) Recently there was news about some progress on that front. As a surgeon who dealt extensively with breast cancer, I can say one of the most frustrating categories has been the entity known as DCIS , or " ductal-carcinoma-in-situ ." It refers to the earliest possible form of breast cancer, wherein the abnorma

Scrub Club

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I've just received an email from a designer, in New York City. She's addressing the issue of surgical scrubs and related attire, and asks for my input. (I love the unexpected connections that have arisen from blogging -- and state once again that it wasn't falling out of love that led to my abloggia. Or the current hypobloggia.) I imagine her contact was a scatter-shot towards all the surgeon-bloggers she could google; still, I'm both flattered and intrigued. And it seems a good topic for a post. Writing about a thing, after all, is the best way to figure out what one thinks. Simple and entirely functional, scrubs are nonetheless among the most recognizable of uniforms, and make an easily understood statement of authority. And not a little edginess: "I work in an OR. I know things you don't, and never will (unless you read Surgeonsblog.)" Assuming the wearer is legit, which more and more is less and less the case. I think there are phases of scrub-wearing:

Flush

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It's gratifying that despite my absent posting for many weeks, this blog still gets over five hundred visits and more than a thousand page views daily. This I attribute to the fact that some of my stuff comes up on searches for medical information, which makes me feel as if, whether or not I regain my enthusiasm for bloggery, my work will have been of use. (Or maybe it's just that people like coming by when I'm not around so they don't have to worry about running into me.) Anyhow, I still get comments and questions; quite frequently on the subject of gallstones, about which I wrote a series ( one , two , three , four) of posts many months ago. A recent visitor asked some good questions about non-operative management of gallstones, and I was surprised and disappointed to discover that I hadn't really covered it in my prior series. So this is an attempt to rectify (a term which I used in a punny context -- and one which gets hits now and again, from the perverte