Showing posts from May, 2008

The Question We Cannot Ask

[Some might call this another rant. I call it a serious question we ALL should be asking.] From an article about John McCain's entry into politics, in the New York Times: "After five and a half years of listening to senators’ antiwar speeches over prison camp loudspeakers, Mr. McCain came home in 1973 contemptuous of America’s elected officials, convinced Congress had betrayed the country’s fighting men by hamstringing the war effort." From innumerable McCain appearances: I'll never surrender in Iraq... Obama wants to surrender... Democrats want to wave the white flag of surrender... If we leave, the terrorists win... So let me ask a question that no one wants to ask: might five years of torture in a prison camp be expected to have an effect on one's (or some's) thinking about war? About challenging a war policy? Is it possible that one subjected to awful and inhuman and nearly unbearable conditions (for many, they were unbearable) could develop certain visc

Got Your Back

Where I trained, it was a very top-down place. At all levels, you were expected to inform the person next up the ladder before embarking on nearly anything. Which, as far as I'm concerned, is how it should be. Learn your limits: nothing is more important in being a safe surgeon. Ask for help, get advice, know the need. There were no mistakes as unforgivable as those of not following the chain of command. In "Cutting Remarks," I told the story of a fellow resident who performed an emergency tracheostomy in the Emergency Room. That it turned out to have been unnecessary was not what got him in trouble. It was that when the nurse asked if she should call the Trauma Team, he said no, he could handle it, which he did, in terms of technique. But for his failure to communicate , he was called into the Chief's office and told this: "A cat has nine lives. A surgery resident has two. You've just used one. Now get out of my office." That Chief was F. William B

Music of the Gods

This article is so dense with intriguing stuff that I hardly know where to start. Let's begin by ignoring the guy's extraordinary brilliance, with PhDs in stem cell biology and in music, before getting his MD. Ignore it, because it puts him so much in a class by himself that it must make the rest of us feel like tiny-brained sub-species. If he's superhuman, we'd be kidding ourselves to apply it to ourselves. So let's just consider the mind-music-medicine-surgery implications, starting with this: “If I don’t play [the piano, if you didn't bother to read the article!] for a couple of days ... I cannot feel things as well in surgery. My hands are not as tender with the tissue. They are not as sensitive to the feedback that the tissue gives you.” Fascinating. Is that an effect that translates to the rest of us? Or is it related to his special brain-wiring for music? If the latter, does music raise him above the level of other surgeons, or is it that it's necess

Looking In

After my recent " Family Guy " post, and a comment by the estimable bongi , I've been thinking about sharing. In the new-age sense of the term: letting people in on what you think or do or feel or other nerve-grating uses of the word. Y'know: "Thanks for sharing..." I digress. What I mean is that the esoteric world of surgery, so dramatic, and intimately knowable only to a small and generally comprehending audience, is quite isolated from those with whom we might most like to share it: family, close friends. I always wanted my son to see me do an operation (my wife did, once, when I was in training. But it was a small deal, and I wished she could have seen something more complicated). As much a part of my life as it has been, and as much as it took me away from his, I'd have loved to have had him watch it, just once. Demonstrate; explain. Perform, impress. Yet it's nearly impossible for a surgeon really to let people from the outside in on what it i

And, Of Course, There's This:

The words are by Mark Twain, a tone-poem, if you will, that he wrote but was not published, at the urging of his family, until after his death.

Memorial Day

Hillary the Horrible

[Until now, I thought I was done with my weekend rants. But once again, I find myself needing to vent. So turn away, all ye who want it not.] In my state we have a female governor and two female senators. I voted for every one of them, happily, and will again. I married a woman, and thus into a family of nine of them; my mom was one, too. I like women. I have no problem whatsoever with the idea of a woman as President of the United States. In fact, I'd love it. I even heard Hillary speak in Seattle a couple of years ago, and was impressed as hell. She'd be a great president, I thought. That was then. The campaign Hillary has run in the past couple of months has filled me with disgust. The demure dredge-it-up/deny-it-down racial stuff. The gas tax pander; Bosnia fantasy. That was minutiae, background noise. They all do that (although what was the Bosnia thing? Hallucination or lying? Either way...) But the Florida/Michigan maneuvering is pushing it. I agree the rules are stupid

Uh Oh...

Another item from the American College of Surgeons: COLLEGE OPPOSES RECOMMENDATION TO INCREASE PAYMENT TO PRIMARY CARE On Friday, May 16, the American College of Surgeons and 13 surgical specialty societies sent a letter expressing strong opposition to a Medicare Payment Advisory Commission (MedPAC) recommendation, which calls for increasing payments to primary care physicians, while cutting reimbursement for all other physician services. The payment reductions for other physician services, including major surgical procedures, would occur because the pay hike for primary care must be budget-neutral. Only two of the 17 MedPAC Commissioners....opposed the recommendation. In their correspondence to MedPAC Chair Glenn Hackbarth, JD, the College and the other surgical societies noted that primary care is not the only specialty experiencing significant challenges in today’s health care environment. The letter cites several difficulties facing surgery, including decreased reimbursement, su

Family Guy

When I saw my brother-in-law dazedly slugging toward the house, blood streaming down his face in impressive rivulets, I sprang into action. Well, okay, not so much me as his wife, and my wife, and another of their sisters. But I did, eventually. Maybe not "sprang," exactly, but went over to have a look. And determined that on this Sunday morning, on an island, he'd need a few sutures. No problem. We had the whole cast of characters on hand. It helps, on a Sunday on an island, to have the keys to the clinic. If the one holding the keys is the head nurse and clinic manager, sister-in-law to the subject, and weekend host, so much the better. What good is a surgeon, after all, with nothing to put in his hands? So up we loaded D., pressuring appropriately the wound (rendered, it turns out, by a branch let loose by D. as he... well, I won't embarrass him...) and drove to the clinic. J. (not really a giveaway since the entire family of nine kids and two parents and, at one

Says It All

In the latest email bulletin from the American College of Surgeons: ....Practice Management Webcasts for 2008 and early 2009 include: July 9, 2008 - Negotiating Better Third-Party Contracts July 23, 2008 - Practice Valuations ... What's Your Practice Worth? Aug. 6, 2008 - Compensation Formulas of Successful Practices Aug. 20, 2008 - Effective Personnel Management Sep. 10, 2008 - Dealing with Difficult People Sep. 24, 2008 - Maximizing Patient Collections Oct. 1, 2008 - Scheduling Techniques for Improved Productivity Oct. 22, 2008 - ICD-9 Coding & ICD-9 Changes for 2009 Nov. 5, 2008 - E & M Coding ... Beyond the Basics Nov. 19, 2008 - CPT Coding & 2009 Updates Dec. 3, 2008 - Bottom-Line Budgeting for 2009 Dec. 17, 2008 - Billing Compliance: Avoiding Fraud and Abuse Jan. 14, 2009 - Creating a 2008 Management Work Plan Jan. 28, 2009 - Analyzing the Financial Health of Your Practice Feb. 11, 2009 - Medicare Update for 2009 Feb. 25, 2009 - Advanced CPT Co

Faint Praise

Syncope . Great word. SIN-co-pee. (I prefer SINK-oh-pee.) Summertime, during college, I worked on a construction crew. One job was in the woods, following behind a D-9 CAT as it pushed down trees, clearing a path for a sewer line (the job I then had building manholes killed the guy that took over for me when I returned to college. That's another story). I'd saw 'em up with a chainsaw, buck 'em up with an axe. Filling the wait time, I kept that double-bladed axe sharp as a scalpel, honing it with a broad file, the metallic hrrizzzzzz, hrrizzzzzz and the sway of my hardening shoulders convincing me I was Paul Bunyan . In one of my moments of brain-body disconnect (I also nearly produced a sagittal section of my head with the chainsaw, cutting a log lying across a gully, above me), I tried whittling with that axe, whizzing it past the fist that held my would-be chunk of wood sculpture. Gee, I thought. I could really hurt myself; and with that, I did it again, this time s


It can't have escaped notice that of late my blogging has wandered from the prime directive to inform and entertain about surgery and surgeons. So this post splits the difference. It's about friendship, and it's about a surgeon. I've mentioned him already . Not entirely by intent, in recent years I've become more of a recluse than is my nature. Time was, I had lots of friends. In college, we were a group of four guys who ate nearly every meal together, went on dates together, did funny bits up and down the Northeast Coast; and there were a few others, my freshman roommate included, that were close and with whom I've stayed in occasional touch. Med school included new pals; with one or two I have rare contact. During surgery training, my wife and I had several couples who were much more than typical friends; not all of them were medical, and the friendships intersected in all possible combinations. I knew we were lucky, and I loved it. Once I started in pract


" Ready ...." A long pause, milking it for all it was worth. " Aim ...." Blindfolded, I squirmed. I figured it was what he wanted. " FIRE!! ...." Then ...nothing. Not a surprise. This was, after all, payback. "C'mon," I said, making it sound like begging (which it was, partly.) "Just shoot me." Tick, tick. Pkkfftack. Buried right next to my spine, deep and painful. Fair enough. Otherwise, he'd have told my mom. Like many kids, it was by indifferent luck that Dougie and I survived childhood, and each other. On this particular occasion, we'd been shooting one another with a BB gun he'd borrowed from a neighbor. Unlike our Daisy s, this one had some oomph; you could pump it more than once. Because we weren't totally clueless, we'd been using protection: the shootee wore a diving mask and a raincoat, and was dashing between trees across the street from Dougie's house. The shooter, from a window in Doug


On first meeting over the years, many patients have asked me if I played football. I'm sort of a big guy and, during some cycles of my life, have actually looked in reasonable shape. The answer would be in the affirmative, with the qualifier that in general I was comparatively lousy at it. Slow. Not particularly agile; hypo-endowed with the killer instinct. (I was captain of the high school team, and was honorable mention all-city, on a team that finished dead last and never won a game. At halftime of my final game an assistant coach finally got to me: the Knute Rockne rah-rah never worked, but this guy managed to shame me. You coulda been a leader, you dogged it, etc etc, such that I got a little steamed had a noteworthy second half, made a few tackles, a sack or two, blocked a punt; so the opposing coach gave me a nod at voting time.) Probably it was my first game that did me in. I knew literally nothing about football before high school. My dad, unrealistically wanting bragging