Monday, June 15, 2009

I Dream

I dream of surgery. It's in my mind, if not always on it. The fact is, I miss it. A lot. The good parts, anyway. The doing.

Even though the dreams aren't always pleasant, it's frequently disappointing to awaken to the realization that I'm no longer a surgeon. Last night, I was showing some sort of student how to repair a hernia, showing the anatomy (not exactly accurately rendered), explaining why I was doing what I was doing. The fact that it turned complicated, and that the student seemed annoyed that I was asking him to participate didn't diminish the sense of pleasure. (I think it's possible to sort of meta-dream: when I'm a dream-surgeon I feel like I contemporaneously know it's just a dream but also take pleasure in the pleasure of it. Like watching a movie, I'm simultaneously enjoying the story, the unreality, and the art of the making of it.)

There are many possible directions from the above: a plea to my fellow surgeon-bloggers not to do what I did, to find ways to prevent early burnout, so you might keep your craft active longer than I did; a discourse on the difficulties of leaving behind such an all-consuming profession; the wonderment at having achieved a measure of competence in such a thing; the extent to which leaving it behind confirms something I always said -- that surgeons in particular, and doctors in general, aren't really special. We're just people who learned some stuff. And now I'm back to that unspecial tabula, heading toward rasa.

I does convince me of one thing. I do want to resume this blog, if only to retain or regain a connection to that former self. Consider this another step, after the previous post. A stretching before the ride, a calesthenic. I'll see if I don't pull a muscle, flabby from disuse.

By the way and for the record, it's hard as hell to remain silent about the insanity of the real world. Surgery blogging is a weak set of arms, paddling toward the surface, trying not to drown in the sea of stupid which laps ever more insistently at our shores. Pretend I didn't say that.


Unknown said...

Have you thought about volunteering to teach at the UW Med School? Seattle isn't that far afield. There are several first and second year classes that have small group components. Might be a neat way to keep your hand in the game, help the youngen's get a good start, and gather some blog fodder.

rlbates said...

Made my day to see another post here. :)

Sid Schwab said...

Ross: I do think about it. What I'd really like to do is teach surgical technique and, if it were possible, to impart some acquired judgment. But that's getting into a level of academe that I'm not sure I could breach. Carlos P. is sort of a friend, or, at least, a good enough friend of a good enough friend that I keep considering contacting him. He did offer to let me play in his robotics lab, but that was for me, not for anyone else...

Jens Knudsen (Sili) said...

I think you should make that call, dr Schwab.

It's obvious that your retirement is eating you up, and if you're not careful, you'll kill yourself.

Make the call. Go for a visit.

It may not be your thing, but at least you've had a look so you'll know.

james gaulte said...

I welcome you back, if you are really decided to come back to this blog.I think our world visions are a bit different but that relates to your other blog.As retired physicians we share much: attitude, growing up medically in the same era and the increasingly out dated notion that the physician owes his primary duty to the patient.Also the general discontent with retirement.By the way I offered free teaching services to two medical schools in the area and neither chairman even acknowledged my letter even though I am tri-boarded, AOA, etc and had lots of experience. Maybe the age thing I was 68 at the time. However, the local retired docs organization did offer the opportunity to teach physical diagnosis class to nursing students and the med society to do boy scout physicals twice a year.Sigh

egomosperficio said...

sid, i echo the calls for you to teach.

there is still a ton of material regarding the process of 'burning-out' that you have yet to tap. in fact, with your literary acumen, that could easily be your next book. think of all those times there was a voice, perhaps at first a small voice, in your head questioning your desire to continue as a surgeon. or not. . . but i am sure there is a wealth of material there, and unlike the more exclusively surgical posts [awesome as they are], us 'laypeople' will be able to relate our experiences to yours.

best wishes,
ps-please come to toronto some day so we can share a coffee and you can enjoy the life of a 'socialist' country [oh, the humanity!].

Anonymous said...

Forget the Med School thing, all the kids today want is to go into some high payin subspecialty thats not covered by insurance, besides most schools don't even use cadavers any more, or if they do, they have someone else cut em up so the med students won't cut all the important structures like I did...

Gotta Surgical Question for ya...
What causes that little sucking sound you here when you enter the peritoneal cavity??? Is it shrink wrapped by God (OK, evolution)?? I mean, why should there be negative pressure in the peritoneal cavity?? How does it get there? I've asked surgeons before, but they just give me the finger...


Sid Schwab said...

Frank: the finger may be a cumulative thing, rather than a specific response.

Honestly, I don't think I've ever heard, or heard of, a sucking sound on entering the peritoneum. It's either not the case, or something for which I should be ashamed.

I have, however, seen the opposite: release of "air" under pressure when opening a belly with free air. In fact, I'm aware of the ability to produce a flame or explosion if the entry is done with cautery (which I never did): not unlike lighting a fart. Before he took my advice and began opening the peritoneum sharply, one of my partners made an impressive blue flame.

And to show some love, I looked up "normal intraabdominal pressure" and came up with this reference, which suggests it's positive.

Sid Schwab said...

Clarification: the flame thing is when entering an abdomen containing "free air" from gut perforation; colon in particular, but when my partner did it in my presence, it was gastric perf, interestingly.

One Nurse said...

Although I have just found this blog, I have enjoyed spending some time reading it and getting to know you a little.
I am glad that you are back in the land of blog! I will follow and continue to read as you continue to write.

Ellen Kimball said...

One Nurse, I welcome you, as a woman and a professional. I'm a retired radio personality who might have gone into biology and medicine if the fates had been different. As it was, all the men on the radio stations wanted to talk with sports personalities; I talked with all the medical authors and gained a wealth of knowledge.

I salute all of you dedicated medical people and wish your course in life in 2009 were easier for you all.

Anonymous said...

Jeez, Ellen, can't you see the Men-Folk are talking about important SURGICAL Topics!!!??? Go vacuum something... and..not to be Rude, but you were a LATE NITE DJ!!! a paychecks a paycheck, but its not like you had Harvard, Stanford, and Johns Hopkins beatin down your door...
OK Sid, you pushed me to do some research...well actually I just googled it...Normal Intra-abdominal pressure ranges from SUBATMOSPHERIC to 14-15 mmHG...I guess you mostly operate on sick people...


SeaSpray said...
This comment has been removed by the author.
Ellen Kimball said...

Frank Drackman, I put your full alias/name and comment up on Twitter, y'know the one where you said, "Jeez, Ellen, do you ever SHUT UP?"

You should see the responses! They were terrific! I should send you some in a fireproof container.

I am down to one option here at Surgeonsblog:

1) Ignore you while you criticize me and my participation on other people's blogs.

I already have tried the other two, which are/were:

1) Go to your blog and try to reason with you. I have tried to do that in an intelligent and logical way.

2) Keep you from littering my blog.

Sid, if you need medical credentials to post here, you'll let me know, right?

Let's see. I have a first cousin male cardiologist in Miami Beach, FL now retired in SC. Also, I was briefly married to a cardiologist now a diet doctor from White Plains, NY. As of 2006, he was still practicing parttime in NYC. So am I acceptable via lineage or marriage?

Frank, thanks for sharing and have a good night.


SeaSpray said...

I always loved that show..I Dream of Jeanie" .. very funny.

SeaSpray said...

*Giggling* I know this is a serious post, but when I read "I have, however, seen the opposite: release of "air" under pressure when opening a belly with free air. "... i first wondered if it made noise... and then thought if it did and that were me..I'd be embarrassed... I guess though that could be a good argument for versed.

But then I imagined the body flying off the table and around the room like a deflating balloon and the OR staff ducking to avoid being slammed. LOL! I realize no one else may be amused... but it is funny when you make yourself laugh. :) Ahem..okay serious SeaSpray back now... I agree with everyone else. It's great your back and you should look into other opportunities where you can impart your skills to others so quality is passed on.

I think sometimes dreams are just dreams... but I think they also can be teaching, guiding, prompting, warning or affirming us.

I find it interesting that you are often dreaming of surgery.

Is there a common theme? Teaching? That theme might be pointing you in a direction, a path to take. You are teaching in your dream. Perhaps as the others SHOULD look into that.

I know you were semi-retired and so now you've taken the plunge. It must be so odd feeling to have trained so long and worked so hard with such dedication... and then to just not do surgery any longer. You must've had an adjustment period... or when you were burned out..were you just ready to stop.. but now rested..find you miss it more.

You've shared in your previous posts how exhilarating, challenging and sacred surgery has been for you. You've shared the depth of your dedication to your profession and your patients and based on what you have written... (especially Oct 2006 -Taking Trust post-yes I still remember it)I would trust you as my surgeon and believe I was in good hands. (We just couldn't talk politics prior to surgery ;)I just think it would be awesome if you could impart the love, the sacredness you have for surgery along with your surgical skills and importance of well as how to prevent burnout to other students.

Age is just a number. Pursue what you want to... or take it easy... whatever your heart desires is the way to go.

Oh..and I definitely think..with the way you write... you SHOULD do another book.

Sam Spade said...

That type of dream is called a lucid dream.

Ellen Kimball said...

Sam Spade, thank you so much for helping me to find the painting of Hypnos and Thanatos at Wikipedia in the description of a LUCID DREAM. I saw that painting once in a print, and until now have never known its name.

You ARE a sleuth!


Gary M. Levin said...

Sid, it is great so see (or read) you back at the OR table....I have heard that your 'ghost' is often present in the OR making suggestions to the younguns. The only surgeon I know of who operated into his 80s was Debakey, and then he had a cadre of 'helpers' working them up, opening up, closing....etc. I advise you not to go back to the medical center and teach.. My experience was the same went I 'voluntered to teach". We are a bit like Rodney Dangerfield (I don't get no respect")
Besides the 'young physicians' like to screen their patients with an EMR. (except for Buckeye, who is my kinda surgeon.
Frank, I haven't figured you out yet, are you a pussy cat or a tiger? Anyway, Sid you are a mentsch

medrecgal said...

Now I'm glad I didn't take you off my blogroll...this is the stuff I was hoping to come back for! Glad to see you're still kicking around the blogosphere after what seemed like a terrifically long absence. Though I never managed to get even vaguely close to medical school (I could write a huge series of my own posts about that if I sat down and really thought about it), I still derive great pleasure in reading the stories of others who've been in the trenches of medicine and surgery. Welcome back!