Sunday, March 16, 2008

SurgeXperiences 117

 Updated 3/2017-- photos and all links removed as many no longer active as it was easier than checking each one.

Let's begin with a little fun. There's plenty of serious stuff for later.
Scott who writes the blog, Polite Dissent, Comics, Medicine, Politics & Fun, recently had a post on "Fourth-Dimensional Surgery". In his words, "There’s something charming about seeing “futuristic” 30th century medicine as imagined by writers in the 1960s."

Scott's piece reminded me of Buckaroo Banzai and his fight with the evil alien invaders from the 8th dimension. If only surgeons were truly as cool as Buckaroo Banzai! The man was an adventurer, a neurosurgeon, and a rock musician. Buckaroo Banzai's band of men were called the Hong Kong Cavaliers. If you have never seen the movie, you should check it out. Very campy, but fun.
Here is a video of the closing credits of The Adventures of Buckaroo Banzai Across the 8th Dimension (1984).

For more fun, check out this game featured by Sterile Eye -- a free online flash game called Amateur Surgeon.

Okay, moving on to more serious posts, and may I say to you all--some very good ones.
What happens when the popularity of new surgical procedures outpaces science? David Gorski discusses this issue over at Science-Based Medicine.
Speaking of new surgical procedures, check out this post on NOTES meets the robot by Chris over at OpNotes. Is it a procedure ahead of its time?
Dr Wes discusses the "remarkable amount of excitement about closing patent foramen ovales (PFO's) or larger atrial septal defects (ASDs) to cure intractable migraine headaches based on observational studies, and many, many companies have rushed to develop devices for this indication".

Aggravated DocSurg discusses the winning attributes of a surgeon in The "A's" Have It. "Back in the Dark Ages (i.e., when I was in training) it was said that the most important attributes a surgeon could have in order to be successful were: 1)Availability, 2) Affability, 3) Ability" [Buckaroo definitely had all three!!!] DocSurg has so much more to say!
Dr Bruce Campbell, an amazing writer, submitted this post -- Inside Out. In it he tells how he imagines the surgical procedure he is about to perform. I would also like to direct you to another of his more recent stories -- Listening to Leviticus (It was printed in JAMA here).
Dr. Alice, Cut on the Dotted Line, is an intern in a general surgery residency. I love the enthusiasm she has. It is so obvious in this post, Real Surgery -- "I realized what a wonderful day I was having".
Dr Schwab, another amazing writer, discusses being a surgical hospitalist (again) in a recent post, Different Cloth. As always, he is thought provoking.

Chris, OpNotes, presents a look at surgeons "biases and old habits" when we determine both the need for surgery and the best procedure for a given condition. " Believe us when we say it isn’t pretty."

Sterile Eye talks about Retirement. "Lately I’ve had the pleasure of working with two recently retired surgeons. It seems to me retirement can be a more drastic moment in mentor based professions like surgery." Very thoughtful post.

Not sure, then do what Bone MD does. He re-exams a patient when there is doubt about the diagnosis of septic arthritis. A good thing to do.
Ever had that Sense of Doom? The one that tells you things may go horrible wrong. ER Stories tells of a recent case involving just that -- "There is nothing worse than a patient who has that look of impending doom in their eyes. We have to learn to recognize it and act on it fast." Then he tells another story about a patient acting totally weird--"the moral is that not EVERY one is crazy".
T, Notes of an Anesthesioboist, in her post The Edge of the Precipice writes "It was the second repeat C-section of the day.........Then it started happening. That sinking feeling that something was just not quite right. Like when you're watching a film of someone climbing up a dangerous incline......"
In the same vein, Dr Val recalls her experience with the patients you don't forget. As her attending put it-- "Inexperienced residents like you are wasting hospital resources on drug seekers!" Her story is a reminder that even a "frequent flier" in the ER can have truly serious problems.

QuietusLeo, an anesthesiologist in Israel who writes a blog called The Sandman. He writes about the events involved in the soldier's care and the emotions that came with the outcome. "on call in the ICU. There was a lot of activity surrounding an injured soldier......... Despite this, I wouldn't hesitate doing it all over under the same circumstances. Because. Because another man's son might have been my son." While you are there, check out some of his other posts.
Back to Dr. Alice, who finds things Unsatisfactory "and asking for help, I gave up and called the pre-code alert." Dr. Alice, don't judge yourself so harshly. Someday you may be as good as Bongi.
Check out this series from Bongi, other things amanzi,regarding difficult codes (or resus) in his recent posts, Resus Fun and tube and cuban resus and hands tied behind my back. All very well written.

"There's a big difference between mostly dead and all dead. Now, mostly dead ... is slightly alive." --Miracle Max, The Princess Bride
Mitch Keamy, The Ether Way, discusses just that in his post, Donation after Cardiac Death: Is mostly dead slightly alive? He also gives you some trivia on the first use of the above quote by Miracle Max, pre-Princess Bride.
Buckeye in his post, Transplant Shadiness, discussed some of the same from a different point of view. Then join him as he muses about life's tough breaks being Not Acceptable. "It took me a while to gather myself for the post op family talk. It went as you would expect. Devastation. Grown men and women crying. A wife stoically trying to keep herself together. Nothing cuts like the unabashed wail of a mother grieving her son....."
Leaving that discussion behind, go with Dr Alice on a Donor Run, "A donor run is when a transplant surgeon travels to an outlying hospital to harvest organs. ....."
Random Ness has done a post on the history of medicine told with a twist of humor. "Well, my tale here is not very humorous, more like horrific. And that brings us to the PDA, which is a landmark in the history of anesthesia in the whole wide real world. PDA means Public Demonstration of Anesthesia and this happened ..."
Sterile Eye tells us the story of why a common surgical instrument is called a peang in his post, "--this beautiful surgical instrument has many names. In Scandinavia it’s simply called a “peang” (pronounced [piaŋ]). For a long time I’ve wondered why we call it that. Here’s the story "
Anatomy on the Beach is a medical student in the Caribbean. In a recent post, Functional Anatomy, he was helping with a Mock exam. "I ended up writing only two questions and not tagging anything. One of them was a complicated clinical scenario that forced them to think about the venous anastamoses important in portal hypertension."
Street Anatomy has put together a gallery of anatomical street art. "The artists who did these pieces have helped put a little bit of anatomy into the lives of everyday people." Here's an example. This is graffiti I wouldn't mind having on my office building!

The Midlife Midwife writes "In my scrapbook of memories, I have one simple memory that is still very vivid." It is more a post on the simple act of service to a fellow human being than on surgery, but sometimes that's what is needed of us.
T, in her post The Last Day, "the O.R. was not the right place for this lovely woman to spend her last moments, unconscious.......a bunch of stressed-out docs and nurses scrambling to try and help her survive. She belonged with her family, ..... encircled by love"
This need of human contact is reinforced in Dr Val's post, Social Networks Improve Postop Pain and Length of Stay. Support by family and friends sure make my job easier. I try to remember to thank them for taking care of "my patient" for me. They are truly important in outpatient surgery.
Belly Tales discusses the lack of the access to a simple procedure in many women's lives in A Walk to Beautiful. "The cure for fistulas is a simple surgical procedure, but with access to modern health care often hundreds of miles away, the cure might as well exist on another continent."
TBTAM was herself at patient recently. She had to have Moh's surgery and wrote about the experience in Mohs Nose Woes-Part I and Part II. She even posted pictures for us. Take care, TBTAM.
Lisa, over at The Cushing's Disease Journey, tells about her latest surgery and the difficulty with pain relief, nursing staff, etc. After all she went through, she ends her post "My head hurts, but in a good "healing" sort of way." Keep healing, Lisa!
Doctor David has a nice post about a teenager who had surgery -- How do you know a teenage is well? Check it out. It will make you smile (IWMYS).
Chris Oliver, another physician/patient, continues his story of his life post gastric banding with posts on his recent Skiing (it had been a few years) and Rugby experiences. Wishing you continued success, Chris!
Midwife with a Knife got a new gastroenterologist recently who discussed the possibility of surgery to treat her problem. "He might not be my ideal gastroenterologist, but it's a step up."
Check out GruntDoc's latest pic in his helmet series. "Needs no further explanation."
Get the story on these Smokin' Slippers from Dr Bruce Campbell, then read Smoke Scream by Dr Sid Schwab.

Doug Atkins gives insight to the patient experience relative to heart valve surgery (bicuspid aortic valve) on Adam's Heart Valve Surgery Blog. The blog has some good information for patients.
Charles, Trusted Advisor Assoc, has a post about two personality types of surgeons, how they treated the family/patient, and asks: "The question is: when it comes down to something like that—life and death—who do you trust? Do you go with the credentialed expert? Or the one who cares?
I suspect Rob would make the same decision again. I suspect my sister would make hers again as well.
How about you? Who(m) would you trust?"
A news link, via Dr Kevin, regarding a surgical mishap--Granny victim of colostomy confusion. Wow! It boggles my mind to think how that mistake was made!
I hope you have enjoyed this edition of SurgeXperiences. I enjoyed bringing it to you. The next edition (118) will be hosted by the guys at OpNotes on March 30th. Please, submit your posts here. The submissions should be made by March 28th.
Here is the catalog of past surgXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Hope you all have a good week. I'll leave you with some music by Buckaroo and the guys


Jeffrey said...

wow! well done ramona! if i didnt count wrongly, you gathered a total of 50 unique posts! this is surely a record! thanks!

Øystein said...

Great edition and so many excellent posts!

Thanks for including me.

Sid Schwab said...

As usual, Ramona, your writing shows amazing devotion and thoroughness. It's literally breathtaking. You put the rest of us to shame. And you produced, unsurprisingly, a great collection and narrative.

rlbates said...

Thank you all, but you guys WROTE the posts that I simply LINKED too.

Bruce said...

Thank you so much! You went above and beyond. Wonderful, thoughtful, and insightful presentation.

rlbates said...

Thank you Dr Campbell.

Dr. A said...

Great job! Strong work! I like it!

Margaret Polaneczky, MD (aka TBTAM) said...

Wow! This was a marathon of a carnival , chock full of some truly amazing posts.

Thanks for inviting me to join in.

And for putting it all together.

rlbates said...

Thanks Dr A and TBTAM! There were some really nice posts, weren't there. Made my job so easy.

Dr. Val said...

Great work, Ramona! I agree with Sid - amazingly thorough and well written. Congrats!

rlbates said...

Thank you, Dr Val.

Lisa said...

Thank you! Great posts and thx for including me. :)

Doctor David said...

Thank you so much for including me. The patient from my post continues to do well (and run up her texting bill!)

rlbates said...

Lisa, you are welcome. Hope you are well!

Dr David, so glad to hear your patient is well!

ness said...

Awesome! Reading all those 50 posts and writing a bit about each of them is a meticulous job only a dedicated plastic surgeon like you could have done. I'd say a labor of love for someone who enjoys blogging.

And I am so thrilled that you included me. Thanks!

rlbates said...

Thanks Ness! Glad you enjoyed it.