First Quilt

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

I made my first quilt while still in high school, then didn’t do much more until about twenty years ago. I did a few off and on through the years as friends had babies, but I really begin quilting twenty years ago when I opened my practice. It saved my sanity when the first weeks (and some since) were so slow, the phone didn’t seem to ring, etc.

I gave my first quilt to my best friend from high school Blyson’s daughter Amanda years ago. Amanda is graduating from high school this spring. I “hounded” Blyson into sending photos of the quilt to me.

My first quilt was made using some cottons and some cotton blends. It used some scraps left over from some clothes I had made and worn. The bee fabric was a shirt. The ginghams were used to make a blouse. The pastels had made up a block color dress along with the one of some printed fabric. The dress had dolman sleeves.

Blyson’s email states the quilt measures 42 in X 104 in, but that doesn’t compute with me. I remember the quilt being square (as I was and am) and the photo looks like it was square. It appears to measure 19 blocks horizontally and vertically. Each block (I think) is 2.5 in which means the finished quilt is 47.5 in.

I made the quilt in 1974 at age 16. Each block was cut out by hand. These days I use a rotary cutter. Don’t know if I machine pieced it or not, but I do know I did not bind it. I “finished” the edges by literally sewing the three layers together around the edges, leaving a section open to turn it. I then hand closed the section and “top-stitched” around the edges. I “tied” the corners of each square. The things I have learned since then!

I embroidered names of classmates with nicknames on the pastel squares, as well as favorite classes/activities. This one features the mechanical drawing class I took with my friend Pam (who is now a favorite teacher of English at Vilonia). The two of us sat in the back of Mr. Park’s 10th grade geometry class, the only two taking mechanical drawing.

This one features chemistry also taught by Mr. Park. Our school was so small that to have enough students, the class included both junior and senior students. This was also the case with physics. As a result I and many of my classmates feel close to the class above us (1974) and the one behind us (1976).

This one features basketball. I loved being on the basketball team. I was mostly a bench warmer, but I loved it. I even now will occasionally get out in my backyard and shoot baskets. Such great memories.

I’ve submitted this quilt as part of the Blogger’s Quilt Festival – Spring 2010.

Goldwyn’s Laws of Plastic Surgery

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.


Another thoughtful essay from Dr. Robert Goldwyn’s book “The Operative Note: Collected Editorials” (published in August 1992).  I left out the section between the third paragraph and the “plastic surgery laws”  as they were general day to day ones.

Laws of Plastic Surgery

We pitiful human beings, born not of our will, are thrust into this world, which throughout our lives we try to comprehend.  To make sense of our existence, we seek the verities; we try to formulate laws of earthly happenstance and human behavior – basic tenets akin to the laws of gravity and energy.  Take, for example, Benjamin Franklin’s fundamental:  “…in this world nothing is certain but death and taxes.”  And closer to our time is the observation of Professor Parkinson:  “Work expands so as to fill the time available for its completion.  Thus, an elderly lady of leisure can spend the entire day in writing and dispatching a postcard, another in hunting for spectacles, half an hour in search for the address….”

As valid as the law seems, it is not always true.  There are, I am sure, older retired women who would never devote more than a half hour to writing to their relatives.  So we have another law:  “Every rule has an exception (even this one).”  Whether the exception proves the rule, or the rule, the exception, I leave to that genre of professional deep thinkers, known as logicians.

The laws concerning how our world functions or malfunctions contain much wisdom in few words.  While we might add a qualifying “usually” to the statement, its soundness and acumen remain incontrovertible.  That the law does not hold for every circumstance should not disconcert us.  The impression of precision – "’a la Heisenberg – is a preoccupation of today’s mathematics and physics…….

Permit me a few “laws” of plastic surgery:

The preoperative photos that are lost are always of the patient with the best result.

The last stitch in a blepharoplasty always starts bleeding.

No insurance company ever makes a mistake in your favor.

No medical organization to which you belong ever reduces its dues.

The patient whose operation you do for visiting surgeons will have the hematoma.

VIPs are magnets for complications.

The patient with the best initial result never returns for follow-up.

The dissatisfied patient never moves away.

The older the surgeon, the less he or she perceives the need to retire.

The older plastic surgeon never thinks there is room for a younger one in town.

The initial sponge count is never correct when you are behind schedule.

The rhinoplasty patient with only a fair result is your most enthusiastic supporter.

The lengthy operative note (discharge summary) is the one that gets lost.

No surgeon ever has enough operating time.

No hospital ever has enough operating rooms or personnel.

Plastic surgeons resent a colleague in direct proportion to the aesthetic content of his appearance in the media.  Corollary:  The expert on hypospadias is never maligned.

Most surgeons lack the enzyme allowing them to praise the results of a colleague.

Most surgeons feel a twinge of pleasure at another’s complication.

Our readers doubtless have better rules of their own – and that, perhaps, is another law.

What People Think of Plastic Surgery

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Another thoughtful essay from Dr. Robert Goldwyn’s book “The Operative Note: Collected Editorials” (published in August 1992).

What People Think of Plastic Surgery

In conjunction with the publication of my book, Beyond Appearance: Reflections of a Plastic Surgeon, I recently was on a number of radio talk shows. Through the wonders of modern communication, I was fortunately able to participate in most of these sessions without having to go to the studio. To relax in bed and to have one’s voice perpetrated on the citizens of Alaska, for example gives one an inkling of how easily those in high political office can abuse their power. To what extent these talk shows influenced the sales of my book I really do not know. But what I did learn was what many people are thinking about in relation to plastic surgery specifically and medicine generally. Although I was ostensibly on these talk shows to discuss my book, it was not long before larger issues and personal surgical events took over. What follows is not intended to be a factual survey of public opinion, but simply a series of impressions.

First, the good news. Most of those who called in were very much aware of the worthwhile achievements of our specialty. Many mothers expressed their gratitude for what plastic surgery had done for their children deformed from birth or trauma. Several men reported how well our colleagues had reconstructed their faces after removal of a cancer. Some callers wanted to know what I thought would be important discoveries in our field. A few asked specifically how close we were to perfecting artificial skin and methods to forestall aging. In that regard, aesthetic aspects of our activities soon dominated the reconstructive. Not surprisingly, many women phoned in to inquire about face lift, eyelidplasty, abdominoplasty, and liposuction. Men also described their experiences with plastic surgery, with most calling about hair transplants and rhinoplasty. Those who complained about what they considered a poor outcome of their aesthetic surgery admitted that they had been warned of that possibility but still thought that they should have received a better result, especially since, in the words of one woman, “I had been charged an arm and a leg for my face.”

A common question from the talk masters and listeners was how to find a qualified plastic surgeon. Many said that advertising had confused them. Why would a good doctor advertise? If he is as talented as he claims, why shouldn’t he be busy enough? Another question was whether a plastic surgeon would admit that he or she did not do a certain procedure and refer the patient to someone qualified. A frequent query was whether we “operated on everybody.”

What I gleaned from more than 20 talk shows was that the public believes that all plastic surgeons do cosmetic surgery and that anybody who say that he or she is a cosmetic surgeon is most likely a plastic surgeon. Credentials and board certification, though they are important to us and should be to the patient, are poorly understood. Almost any diploma on the wall will do. Availability, kindness, and cost are the determinants for a large group of people. Many regard an aesthetic operation as a commodity, a luxury item to be shopped for and purchased. A sentiment of many callers was that it is not really surgery since it can be done in the office and is not covered by insurance. Several vented their resentment at having something go wrong and then being unable to get to the doctor. One caller remarked (I was keeping notes), “He was there to take my money but not my complaints. He sent the nurse out to do that. Is that what you learn in medical school?”

The longer the talk show, the more likely the surfacing of disappointment and hostility. While almost every caller treated me with respect, undiluted, high regard was not what many had for the medical profession. The public is no longer our ally, if they ever were. A crucial factor, not surprisingly, was money. If we charged nothing for our services, our patients would undoubtedly like us more, but only if the result were perfect and we were kind. In this real world, however, most of us are not saints, most of our work is not perfect, and yet we charge for it.

I did receive one unusual call: Someone championed “genetic honesty.” saying that he was against any reconstruction that changes nature’s workmanship, even the most faulty, as in the instance of a child born with a cleft lip or a craniofacial mishap. Within seconds, the phones became alive with callers who verbally murdered that nihilist. They did my work beautifully.

As an aside, let me offer another fact: Nobody wrote me to become my patient. Many people did send letters asking how they could find a plastic surgeon in their area for a specific problem. I referred them to the Executive Office of the American Society of Plastic and Reconstructive Surgeons.

I did get a call, however, from someone who insisted he speak to me immediately, even though I was busy with patients. Finally, my secretary capitulated and I took the call: “Doctor Goldwyn,” the voice boomed, “I read your book, and I think it is one of the best I have ever read. Congratulations on such an achievement [by then, I was purring]. Sir, it would be an honor for me to sell you life insurance.”

So much for books and talk shows.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Gruntdoc is the host for this week’s Grand Rounds. He just celebrated his 8th Blogiversary this past week! You can read this week’s “First Non-Narcissist, Non-Personal Attention Getting Grand Rounds” edition here.

I’m pleased to host this roving blog carnival, and thrilled suitably humbled to be the first 7 time host.

Which is a terrible way to start this, the first Non-Narcissist, Non Personally Aggrandizing MedBlog Grand Rounds, and thanks for putting up with my first theme. 31 submissions from 23 submitters makes this theme viable, and well-attended.

Editor’s Pick: Where romance and medicine collide by Movin’Meat. A tale you’ll retell. Recommended by Musings of a Dinosaur.

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 4, No 22) ! You can find the schedule and the COS archives at Emergiblog. (photo credit)

Hi – welcome to this edition of Change of Shift, the nursing blog carnival.
We have a diverse group of submissions this week. Some will make you laugh, some will make you cry and some will make you think.
So, without further ado, I give you….
Change of Shift.

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TBTAM has written a post, Lung Cancer and Women, highlighting the findings of a new report on lung cancer in women has been published by the Women's Health Policy and Advocacy Program at Brigham & Women's Hospital: Out of the Shadows. Here is a short segment from the report itself

Lung cancer, once rare among women, surpassed breast cancer in 1987 to become the leading cause of cancer death among women in the United States. Today, one in four cancer deaths in U.S. women is due to lung cancer. A common misconception is that breast cancer takes the lives of more women than lung cancer, but this is not the case – more women are diagnosed annually with breast cancer, but lung cancer kills more women each year than any other malignant tumor. In 2009, it is estimated that 70,490 women in the U. S. died from this disease. Approximately $9.6 billion is spent in the U.S. each year on treatment of lung cancer.

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Thanks to @DrVes for his tweet “Blogging the end of a life: Death at 25 from CF http://goo.gl/IZsM” Check out this interesting CNN article and some of the blogs mentioned.

…. But Eva Markvoort smiled weakly.

"Hello to the world at large," she said in the video. "To my blog, to my friends, to everyone…... "My life is ending."

Markvoort had cystic fibrosis, an incurable disease that causes mucus to accumulate in the lungs….. the 25-year-old continued to chronicle life on her blog…….

Bloggers like Miles Levin, an 18-year-old who had a rare soft-tissue cancer and died in 2007, and Michelle Lynn Mayer, a 39-year-old mother who had scleroderma and died in 2008, shared their thoughts on living and dying, too……

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H/T to @scanman for his tweet “RT @FutureDocs: A Doctor and His Imaging - http://nyti.ms/bRSyjV NYT - the Ethicist on self-referral conflict of interest.”

…….. I say it’s more complicated than trust or don’t trust. And so does Katie Watson, an assistant professor in the Medical Humanities and Bioethics Program at the Feinberg School of Medicine at Northwestern University: “I trust my physicians not to be criminals who intentionally order unnecessary tests to feed their yacht habits. I also trust them to be human beings, which means they’re vulnerable to subconscious influences and incentives just like the rest of us.”………

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Threads has an article by Susan Khalje: Sewing Perfect Matchpoints on Intersecting Seams (photo credit).

It seems so straightforward – lining up and stitching intersecting seamlines (or plaids or stripes) so that they match perfectly. …. But, I’ve got a couple of methods to help you out.
I was teaching in Sacramento awhile back, and someone – a quilter – introduced me to Clover forked pins, which I’d not seen before. She credited them with allowing her to make perfect matches when stitching her quilts; she showed me her work, and the matching was indeed impeccable…..

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Dr Anonymous’ BTR show guest this week will be Dr. Daniel Lewis, Family Physician, talking about his recent mission trip to Central America . The show begins at 9 pm ET.

Upcoming shows (9pm ET)

5/13: Medical Student and Video Blogger, Bryan McColgan
5/20: Larry Bauer from the Family Medicine Education Consortium

Microsurgery History

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Facial transplants, hand replants, free flaps are only possible in large part due to microsurgery.  I finally got around to reading the “History of Microsurgery” this past week (first full reference below).  The article, as well as the other two, are good reading for anyone interested in the history of microsurgery. 

The article, written by Susumu Tamai, M.D., Ph.D. (Japan) was received for publication June 14, 2007.

Microsurgery is relatively young.  Dr. Tamai breaks down the history to four periods:

• Dawning Period of Microsurgery (end of the 1950s to 1970)
• Developing Period of Microsurgery (1971 to 1980)
• Fully Matured Period of Microsurgery (1981 to 1997)
• Transition Period from Autogenous to Allogenic Transplantation and Regenerative Medicine (1998 to 2007)

As the article points out microsurgery hinged on many other medical/surgical/technology discovers.  A few of them mentioned include:

• The most significant technical breakthrough came in 1902, when Alexis Carrel reported the triangulation method of end-to-end anastomosis that is still routinely used today and for which he was later awarded the Nobel Prize in 1912.
• The introduction of anticoagulation was one of the critical developments in clinical vascular surgery. Heparin was discovered in 1916 by Jay McLean, a medical student at Johns Hopkins University, and Howell and Holt.   The ability to control blood clotting was an essential step forward in the development of microvascular surgery.
• The final innovation that laid the foundation for modern microvascular surgery was the introduction of the operating microscope by Nylen and Holmgren in the early 1920s at the Karolinska Medical School in Stockholm, Sweden. It was used successfully in ear and eye surgery at various centers in Europe.

A few key landmarks from the article:

• Jacobson and Suarez  are credited with the landmark achievement of successful microvascular anastomosis using an operating microscope in 1960….  Finally, he brought in an operating microscope used for otology and was successful. This event marked the historical beginning of microvascular surgery.
• In 1962, Malt and McKhann performed the first replantation of a completely severed arm in a 12-year-old boy in Boston.
• The year 1965 was an eventful year in the field of microsurgery. The first reported experimental free skin flap transplantation of abdominal skin based on the superficial epigastric vascular pedicle was performed in a dog by Krizek and associates.
• In November of 1967, the world’s first panel on microsurgery was held at the Annual Meeting of the American Society of Plastic and Reconstructive Surgeons in New York City. The panelists included Harry Buncke, John Cobbett, James Smith, and Susumu Tamai, with Clifford Snyder serving as moderator. This was a landmark event in the history of microsurgery.
• With increasing interest in microsurgery among orthopedic and plastic surgeons in the United States, the American Society of Reconstructive Microsurgery was founded in 1983, 11 years after the establishment of the International Society for Reconstructive Microsurgery. The members of the founding council included James Steichen, Berish Strauch, Julia Terzis, James Urbaniak, and Alan Van Beek. The first meeting was held in Las Vegas in 1985 under the presidency of Berish Strauch, with approximately 300 orthopedic and plastic surgeons attending. Since then, the meeting has been held once a year at several locations in the United States.
• The era of allotransplantation of composite tissues began with hand transplantation at the end of the twentieth century. The first procedure was performed on a 48-year-old man on September 23, 1998, in Lyon, France, by Dubernard and his team.
• After these successes, on November 27, 2005, the first facial allotransplantation, including nose, lips, and chin, was performed on a 38-year-old woman who had suffered a dog bite injury on the lower face in June of 2005.

REFERENCES

History of Microsurgery; Tamai, Susumu; Plastic & Reconstr Surgery, 124(6S):e282-e294, December 2009; doi: 10.1097/PRS.0b013e3181bf825e

Correction: History of Microsurgery; Plastic & Reconstr Surgery, 125(3):1050, March 2010; doi: 10.1097/PRS.0b013e3181d91a45
The Early History of Microsurgery; Buncke, Harry J.; Buncke, Gregory M.; Kind, Gabriel M; Plastic and Reconstructive Surgery, 98(6):1122,1123, November 1996.

SurgeXperiences 322 is Up!

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Jeffrey, Vagus Surgicalis, is the host of this edition of SurgeXperiences. Here is the beginning of this edition which you can read here. (photo credit)

Welcome to this fortnight’s SurgeXperiences, where we feature several blog articles which might be of interest to surgeons, anesthesiologists, scrub nurses, nurses, students, techs, or just about anyone who is fascinated by the surgical discipline!

Believing that I cannot better reflect what the various excellent bloggers already have in their own words, I hereby present some of our regular surg bloggers’ recent posts!

The host of the next edition (323) has not been announced, but don’t let that keep you from making your submissions. Be sure to make your submissions by the deadline: midnight on Friday, May 14th.   Be sure to submit your post via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Voice

Each spring my voice changes
As the trees, oaks and pines, begin to leaf,
Taking on qualities of Lauren Bacall’s
Or leaving me soundless.
“What?  I can’t hear you.” the caller says.
“Sorry, it’s allergies,”  I reply into the receiver, trying for more volume.

Flying Colors Baby Quilt

Flipping through some of my quilting books, I decided to make an “airplane” quilt.  I looked at all the patterns in “Flying High:  the Airplane in Quilts” by Ragi Marino, but ultimately decided to use the “Lindy” airplane block from  BH&G’s America’s Heritage Quilts.  The book states the pattern was published in the Capper’s Weekly in the 1930’s.

The baby (or child’s) quilt is machine pieced with the propellers appliqued by hand.  The planes are in primary colors -- two red, two blue, two green, and two yellow planes. The quilt is 42.5 in X 43.5 in.

The quilt is machine quilted using outline quilting and grid quilting for the plane blocks.  The plain blocks are quilted with a “propeller” and circles.

Here is a close view of one of the yellow planes.
Here is a view of the back to show the quilting.

Sun Sense

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

We are past spring breaks and headed toward the end of the school year and summer vacations.  I noticed this product in the April issue of PSP.  (photo credit)

UVSunSense is a wristband that monitors your exposure to sun.  If you and your children have trouble remembering to reapply sunscreen or to just get out of the sun, then this might be just the ticket. 

Even young children can be taught to recognize the color changes the band goes through with exposure to the sun’s UV rays.  You should use only one band a day.  After placing the band around the wrist, apply your sunscreen over your exposed skin AND the band.  The new band will turn a bright purple with exposure to the sun, indicating it has been activated. (photo credit)

 

When the band fades to light pink, it is recommended to reapply sunscreen on your body and on the band. 
When the band turns pale yellow, it is recommended to cover up or get out of the sun.
The bands are made of recycled plastic.  Recycle them after use.


Related blog posts:
Sun Protection (March 19, 2009)
Melanoma Review (February 25, 2008)
Skin Cancer—Melanoma (December 8, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Skin Cancer -- Basal Cell Carcinoma  (December 3, 2008)
Skin Cancer – Squamous Cell Carcinoma  (December 4, 2008)
Moles Should Not Be Treated by Lasers  (July 27, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)
Skin Cancer (March 24, 2010)

Can Anyone Help?

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

I continue to occasionally get comments on my facial/orbital fracture series (2008).  These days they are mostly from patients who are looking for advise.  The most recent one is from tyler has the post "Nasoethmoid Orbital Fractures"

With his permission (via email), I am posting it here and asking for help.

Hi I just came across this and I’m wondering if there’s anyone out there that can give me advice.  I suffered an orbital fracture 3 years ago resulting in double vision.  I had surgery once and it didn’t work. I still live with double vision and I’m thousands in debt.  If there’s anyone out there that could give me advice it would be greatly appreciated (charity programs, grants, anything).  My email is juoncl@gmail.com

The only suggestions I had were possibly state programs (ie Medicaid, etc), but these would be income dependent and maybe the Lion’s Club.   Though I didn’t ask and he didn’t say, I’m assuming he has no insurance because reconstructive surgery for “double vision” is something insurance would cover.

If you have any suggestions for him, please, either email him directly or leave a comment here or both.  I would love to know of any resources available.

Knowledge: What Kind and How Much?

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.


Here is a second essay from Dr. Robert Goldwyn’s book “The Operative Note:  Collected Editorials” (published in August 1992).  

Knowledge:  What Kind and How Much?

A few years ago, when my daughter was a high school sophomore, she asked me to help her prepare for a biology quiz.  She was astounded that this paterfamilias, a certified physician, was ignorant of the precise base sequence of DNA-RNA.  In self-defense, I said that most of my colleagues would probably fail her test but were good doctors nevertheless.

“but how can they take care of patients properly if they don’t know all about these important nucleic acids?” she asked.

“Surprisingly,” I replied, “they do very well.”

This incident, aside from revealing my daughter’s knowledge and my lack of it, is relevant to the greater considerations of learning – What kind and how much?  Publilius Syrus, known for his maxims in the first centery B.C., said:  “Better be ignorant of a matter than half know it.”  Many centuries later, Alexander Pope expressed the same thought in his famous “a little learning is a dangerous thing.”  Huxley’s retort was “Where is the man who has so much as to be out of danger?”  In truth, most of us are in various stages of ignorance.

A medical student asked me, “How much basic science do I have to know to be a good doctor?”  The question, which may be unanswerable, is nevertheless perennial.  Because knowledge and wisdom are not synonymous, the central query is how much of each is necessary.  Any answer must take into account the individual’s needs at a particular time.  Students regularly complain about the irrelevance of the material they must digest, and teachers constantly chide them for their lack of perspective in not realizing that what may seem useless today may be helpful tomorrow.  What to teach and what to learn have stimulated curriculum committees to produce ponderous reports that rehash everything and resolve nothing.  Rare is the year without another “definitive” statement on the aims and strategies of education.

The human being functions astonishingly well knowing comparatively little.  Global enlightenment is unnecessary.  For most people, making a living in our complex society demands narrowness not breadth.  We are job-specific.  Major league pitchers would fail a high school physics test on mass, velocity, friction, and wind currents, yet they could easily strike out every professor at the Massachusetts Institute of Technology.  So also can a doctor do considerable good for a patient with more know-how than knowledge.  Deplorable, perhaps, but true.

Let us take the example of reconstructing the breast in a 45-year-old woman who has had a mastectomy.  How many plastic surgeons could discourse on the hormones at menopause?  Could we pass a thorough examination on the  various ways of treating breast cancer:  radiation, chemotherapy, surgery?  Are we well read in the history of each of these therapies?  Do we have a picture in our minds of the histology of the most common kinds of breast cancer?  Do we know the chemical structure of silicone and how the implant is made?  During the procedure are we familiar with the anesthetic agents and their pharmacology and physiologic effects?  Do we understand the manufacturing process of the surgical blade and suture material?  And what about wound healing, not only the names of the classic stages but the biochemical and biomechanical aspects?  Certainly, it would be better if we had this knowledge.  However, even if we possessed it, we still would have to know when to operate, on whom, and how.  And what about the not-so-small matter of being a compassionate physician with psychological understanding of this unfortunate person and a feeling of permanent responsibility toward her?

This editorial is not a plea or an apologia for ignorance, not is it a eulogy to it.  It is an attempt to recognize things as they are.  Often we are hypocritical in being hypercritical.  We usually demand more knowledge from others than from ourselves.  Furthermore, within the medical sphere, if we are honest, we would admit that many errors arise not from lack of knowledge but from absence of what moralist one called “character.”  In this situation, what motivates the doctor may imperial the patient to the detriment of both.

Unfortunately, I cannot offer a solution to the problem that prompted this editorial:  Knowledge: What Kind and How Much?  What is certain, however, is that knowledge without wisdom is like a ship without a rudder.  Correct timing and the proper application of  information hopefully come with experience.  Yet, as someone observed, there is a difference between a person who has 20 years of experience and someone with 20 years of 1 year’s experience.  Let us hope, at least, for the former.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

ChronicBabe is the host for this week’s Grand Rounds.   You can read this week’s edition here.

Hey laaaaadeeeeez! It's time again for Grand Rounds, ChronicBabe style, which means we've curated a collection of posts that are completely babelicious. We hope you enjoy this gathering of doctors, nurses, patients and just regular folk who like to write about medicine. And women.

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If you don’t have access to Discovery CME channel, you can still watch Dennis Quaid’s Chasing Zero: Winning The War On Healthcare Harm  online here. 

A made-for-TV documentary, 55 minutes long and entitled Chasing Zero: Winning the War on Healthcare Harm, is being shown four times globally beginning April 2010 on the main Discovery Channel. After it has aired, a commercial-free DVD will be produced and distributed for free to all U.S. hospitals by TMIT, and will be sent to the chairmen of the governance boards and their CEOs. A second hour of content composed of digital short stories and concept messages will be added to the DVD.

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Drew, Pallimed, writes about Surgical 'Buy-In' and the Surgical Contract 

Critical Care Medicine has a fascinating qualitative study about surgeons and end of life care which speaks directly to this, and similar, situation.  It's an excellent paper for the teaching file, particularly for fellows who don't have surgical backgrounds (which I assume is most, but thankfully not all, HPM fellows these days). 

The paper presents a small qualitative study of 10 physicians (mostly surgeons; a few non-surgeons who do extensive work in SICUs) …. and attitudes towards advance directives, ……..

This paragraph of Drew’s post struck a chord with me:

I have a distinct memory of one of my attendings, early on in my palliative fellowship, talking with me about surgeons.  …….  My attending told me something like 'Surgeons have a bond with their patients that is much stronger than internists. If you cut someone open, it changes your relationship with the patient in a way that internists just don't have.'  I thought to myself at the time that that was really weird.  Surgeons are cold heartless scalpel jockeys - how could they have a bond deeper than my patient-centered, humanistic, whole-person approach?  Well like a good fellow I remembered what he said, and slowly came to realize he was right…..

Perhaps it was because I had just read Bongi’s post significant moments or because I am a surgeon who felt sorrow for my mother’s surgeon last May even while grieving for her.

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The world’s first FULL face transplant has been done by surgeons in Spain.  Helen Briggs, BBC News writes about it:  Full face transplant 'success'

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Nice interview in the May 2010 issue of Reader’s Digest by Amy Wallace:  Michael J. Fox’s Recipe for Happiness.  The following is from the related RD article An Accidental Education: Exclusive Excerpt from Michael J. Fox's New Book 

At first I went into denial. …..

I realized that the only choice not available to me was whether or not I had Parkinson's.  Everything else was up to me. By choosing to learn more about the disease, I made better choices about how to treat it. This slowed the progress and made me feel better physically. …...

So let me make this suggestion. Don't spend a lot of time imagining the worst-case scenario. It rarely goes down as you imagine it will, and if by some fluke it does, you will have lived it twice. When things do go bad, don't run, don't hide. It will take time, but you'll find that even the gravest problems are finite, and your choices are infinite.

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My friend Gizabeth Shyder, Methodical Madness, wrote a lovely post Basketball in which she tells a patient to put him at ease during a needle biopsy:

I could tell it hurt by the expression on his face….

I prepared the second needle,... Decided to tell a story while I was doing the fine needle aspirate …..

"I was recruited hard by my high school basketball coach, because of my height. I was pretty shy in high school, so I resisted him for a long time. I realize in retrospect he probably looked at me and had big dreams of making a star."………….

As I pulled the needle out of his skin I noticed his eyes were all crinkled up and there were tears forming at the corners. I worried that I had hurt him, but he started laughing uncontrollably.
"That is the funniest basketball story I have heard in a long time."
I smiled, pleased I was able to entertain him.

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Sophie, Blocks & Swaps & Pattern Tips, gives a tutorial on this marvelous bag:   Summer Tote from Orphan Blocks

Do you have orphan blocks–blocks you made and loved but for which you have no project in mind? Then you might consider making a useful, beautiful tote bag of your own.

This bag is approximately 12 inches high and 16 inches wide (at the top edge). The bottom is 8 inches square. It is constructed from 6-inch pieced quilt blocks and squares of fabric.   It is based on Gay's So Sew Easy Schlep Bag pattern, which you can download from the linked page on her Sentimental Stitches site. My  Summer Tote differs in the following ways:………….

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There is no guest listed for this week’s  Dr Anonymous’ BTR show as of this morning.  

Upcoming shows

5/6: Dr. Daniel Lewis, Family Physician, Talking about recent mission trip to Central America
5/13: Medical Student and Video Blogger, Bryan McColgan
5/20: Larry Bauer from the Family Medicine Education Consortium