Surgeonsblog

Since I was a tyke too tiny to say her name, Mildred was "Moomump" to me, and the appellation stuck for the whole family thenceforward. At every stage in my life, she was the perfect aunt. When my age was in single digits, I could cajole her into giving me the presents my parents refused. I called her a few times at that age when I felt picked on by my parents, and she'd come over, subtly mending fences. In my teen years, it was Moomump who first let me drive; in her big Chrysler 300 we'd blast our way to the Oregon coast, me a fourteen-year-old, being prodded to get it over eighty. "Don't drive like an old lady," she'd say, offering me a cigarette. In my young adulthood and later, I realized how brilliant she was, and what a great source of good advice and amazing stories. Of her famous friends: artists and actors and musicians and politicians. She and my dad -- he the older by a couple of years -- grew up at the poor end of lower middle class.

So here it is, the TWENTIETH issue of SurgeXperiences. That this carnival of all things surgical has made it to this milestony moment is testimony to the perseverance of Jeffrey Loew , who birthed it quite alone and without benefit of breathing techniques . If this is how he addresses all his goals, he's sure to become the surgeon to which he aspires. It seems a significant passage. I'm honored (so I've convinced myself) that he chose (forced, cajoled, tricked, shamed) me to mark the occasion. So... There follow the entries received, In rhymes I have lately conceived. I offer to you The best I could do. It's over, so I am relieved... _______________________________________________________________ In general I'd say I'm inclinedta Avoid making holes in vaginas. The trend, though, is clear. You can read of it here . To explain, Rico's taken the timeta. __________________________________________________________ That's not the first time it's been said.

[Yeah, it's another weekend rant. Don't know why I bother anymore.] Maybe it's just me. Maybe things aren't as bad as I think they are. Perhaps a nine-trillion dollar debt isn't a threat to our country; maybe the rising cost and self-limited supply of oil doesn't bode ill. It could be that environmental degradation and global warming are just a bunch of hype; and, I suppose, our country is not facing the possibility of governmental gridlock and economic meltdown. Nor, it could be, is the war in Iraq leading us to self-destruction. I hope so. Because from where I sit, it's now or never. I really thought people would get it. To me, it seemed tautological: eighty-plus percent of the people think the US is on the wrong track. Therefore, whatever direction they think it ought to take, the one thing everyone might agree on is that the politics of the last several decades isn't working. QED. If there's one kind of change behind which everyone could get, it&

It'd be darn hard -- probably impossible -- for a one-handed person to be a surgeon. Virtually all technique we use is predicated on the use of two hands: traction, and counter-traction. Hold the scissors with one hand, use forceps in the other. (Or fingers. I love the way the fingers of my left hand seem to know exactly how to noodle the tissues around as I'm scissoring or otherwise instrumenting with my right.) It's nice to be able to switch hands, and I'd say most surgeons do, myself included. But I admit it: I'm better with my right than my left when it comes to the finer stuff. There's nothing I do with my right hand in surgery that I haven't done with my left: place a stitch, cut, grab; and, of course, we all throw knots happily with either paw. Still, if I really want to be precise, where there's no wiggle room, I use my right hand. A completely ambidextrous surgeon, though not likely to rise above the pack on that alone, has an advantage; at leas

I'll be wrapping up my presentation of SurgeXperiences soon. It'll appear this Sunday. I'll take submissions till midnite Friday, Vulcan Standard Time. Removing one expectation unit (referring to hosting, not the quality of the essays) per hour from now until then ought to end up about right.

An article in today's paper incites a post, where none had been forthcoming. It's not news, really, in the sense that it's been well-known to many: us general surgeons are a dying breed . But it threatens to become very serious. There are many reasons, the mentioning of some of which could cause ire. The usual: doctors complaining about money and work. Sex, too. It was just before I started training that California adopted a system for comparing one operation to another, payment-wise. Called the California Relative Value System (CRVS), and used or copied nationally, it purported to consider degree of difficulty, post-operative care, and, as I recall, a few other factors, in order to compare, say, a colon resection to a hernia repair; and, more interestingly, to a prostatectomy or hip replacement. Rumor had it that the general surgeon on the panel that came up with the scale was so busy he missed a lot of meetings. As a consequence, general surgery got screwed. The work of a

[The recently usual warning: there follows a weekend rant, non-medical, and, in this case, against some manifestations of religion. Coming upon the included literary quote is what re-occasioned the thought.] Among the things that most disturb me about the way some Christians view their god is the concept of eternal punishment. That a "just" (or any other adjectival attribute considered worship-worthy) god would consign, for all of forever, some people (his creations!) to such a fate is bad enough. That it could be for as meager a failing as rejecting him as one's savior despite living an otherwise exemplary life, is even worse. But worst of all is the absolute delight with which some people of that flavor of faith (including the ungrammatical zealot who made the above "artwork ") contemplate the levying of their god's retribution on all those with whom they disagree. Sticking someone in the celestial slammer for an eon or two isn't enough for these l

As the summer of my second year in med school approached, an announcement was posted (on a bulletin board I had previously made infamous, but that's another story) advertising need for a student who spoke Serbo-Croatian, to spend a summer in Yugoslavia helping on a research project. Since it was a requirement of graduation that we engage in some form of research, and since my fluency (at the time) in Russian was as close as they could come, I got the job, and off to Yugoslavia I went. There's a mysterious illness over there. In very specific spots in several Balkan countries are pockets of a devastating kidney disease, known as the Balkan Nephropathy , or the Balkan Endemic Nephropathy, BEN. In many villages lots of people have died of it, young. Because of his expertise in streptococcal kidney disease, a professor at my med school had been asked to look into that possibility, and although he'd long since disproved any connection with strep, a lab remained in a small Bosni

As Alzheimer's disease relentlessly robs my mother of her memories, and me of her, I think of opportunity lost. Youth, rightfully, is centered on itself. It's a rare young person (and I wasn't one of them) who recognizes the wellspring of history and of connection that resides in the minds of one's elders; by the time we do, it's often too late. I wasn't entirely tardy with my parents; I pried some stories loose before they were gone forever. But about my grandparents I have many questions, and, now, no way to find the answers. It's hard to flesh out the details in family lore. But there are some good stories. I only knew one grandfather beyond my childhood. Born in Russia around 1890, he went to Moscow as a teenager, where he got some sort of degree from an agricultural school (he kept it, must have brought it on the boat, and I saw it once.) While there, so the story goes, he caught wind of the revolutionary whispers and brought them back to his villag

For anyone interested in taking the time, here 's a lengthy post by a person actually present when Obama spoke his scurrilous San Francisan words. In context, as I said in my rant , they are the thoughtful words of a person interested in the big picture, and uninterested in politics as usual. But given the effort (and willingness) required to see it (William "the war will be easy" Kristol concludes he's a Marxist), no minds are likely to be changed. Can't hurt to try.

By appealing to my baser instincts, namely susceptibility to flattery, Jeffrey Leow has cajoled or tricked me into agreeing to host the next SurgeXperiences . So consider this a call for submissions (in the other sense, as opposed to how I submitted to Jeffrey's third or fourth entreaty.) Here is an official announcement (ripped off and slightly modified from Suture for a Living ): "SurgeXperiences is a blog carnival about surgically-related blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit. The next edition will be on April 27th. The deadline for submissions will be April 25th. Please submit your posts here ." Having complained previously about themed blog carnivals (while acknowledging that people have a perfect right to do it however they choose), I'm making no suggestions other than getting your entries in on time. Unless an unprecedented deluge leads to more than I can handle, I plan to link 'em

[Another weekend political rant. Stay away. It's all downhill from here.] How many people would agree that the Republicans have been brilliant at getting the average person to vote against his or her own interests? (Hint: I would.) Knowing that their actual agenda of giveaways to the wealthy wouldn't fly on its own, they've managed to get people to think that this country will live or die over gay marriage and gun laws. So along comes a politician who points this out, and it becomes 24-hour news, drowning out the fact that the president admits, finally, that he authorized torture; wiping off the public consciousness the deficits, the war, the health care problems. Barack Obama said something that takes more than two seconds to explain, and the media and his opposing politicians go crazy. I'm not sure about John McCain, but I do think Hillary Clinton is smart enough to understand what he said. The talking heads on radio and TV? Part stupidity and part cynicism. But Hilla

In the military they graded you on everything, and you graded those of rank below yours. Drafted out of training at the end of my internship, before flying off to Vietnam I headed to San Antonio to learn what makes a Flight Surgeon (after a brief stop in Bellingham Washington to get married; the timing, one could argue, was poor, if optimistic, but it seems to have worked out.) During the sojourn at Brooks AFB, in addition to sinus blocks, decompression chambers, water-survival, altitude sickness, G-suits , and the self-injection of antidotes to toxic gas, we were taught the way the evaluation game was played. Specifically, we were instructed what not to do. Careers can be unmade by those forms. Listing all manner of attributes, to be rated in numbers running from 'one' (for performance worse than would be done by a cold corpse) to 'ten' (ostensibly for attributes seen only in the divinely touched, but in practice doled out like drinks at the Officers' Club), the f

In today's New York Times there's an article that addresses something I've argued for a long time: the way to control costs of health care is to look at how and why costs and practices differ, and to adopt the best practices. Now this article in particular is about the costs of end-of-life care, which is tricky. Even better, though, as a point of discussion, because it's been shown that a huge amount of the health care dollar is spent in the last months of life. Were this area looked at -- really looked at -- we'd have a paradigm in which to figure out what we really want from our health care money. About 30% of Medicare money is spent in the last year of life . Of that, 40% is spent in the last month. It's not surprising, of course: you tend to be sick before you die. So one would hope. Still, it would seem that in the variations described in the NYT article, there's much to be learned. Is it the same care being delivered more efficiently? Is it philosoph

Stand the process, that is. Will Rogers said he wasn't a member of any organized political party, he was a Democrat. Man, oh man, was he right. [This is a political rant, but one that's unlikely to offend many, if any.] At the Washington State caucus in February, I was elected delegate to the next level; the meeting was today. At that earlier gathering, despite the frustrating disorganization and very poor choice of venue, I decided I'd like to keep moving on up -- from the local level, to the district level, to the county and maybe even to the state level. Get a long shot at going to the national convention. Gave a little speech, got selected. But today, I bailed. "Democracy is messy," said Donald Rumsfeld. His words were uttered while Iraqis were looting their country in the first signs of the lawlessness that was to follow our invasion. In that, and maybe only that, Rummy was right. (Of course, the example he chose was, in fact, anarchy, not democracy. That

We are fortunate to live in a house perched on the edge of Puget Sound, on a high bank, looking north. Whidbey Island is in our view, as is Mount Baker, and the waters leading toward Deception Pass . Craning our necks a little, we can also see the Olympic Mountains. Winter or Summer, clear or storming, the view constantly changes. Sometimes the waters are flat and reflect the clouds (as in the title picture of this blog); sometimes winds blast down from the North, pushing waves and froth in our direction, and driving boats to struggle their way back to harbor. Tugs go by. We can hear them. Sometimes it's Navy ships, including an aircraft carrier once or twice a year; decked with planes and sailors in their whites. There's a pair of big red and white tugs, double-ended and always brilliantly clean, of the large ocean-going type that I see often. Many more, including one or two that are so tiny as to seem useless -- except that they aren't -- chuggle the waters, too. One is l