Sunday, July 26, 2009

SurgeXperiences 302

Updated 3/2-17-- all links removed as many no longer active and it was easier than checking each one.
Once again I it brings me great joy to expose you to surgery (via blog posts rather than actual) and the many experiences that go along with it.   I hope you find them interesting. (this -- photo credit—makes me want to quilt it-- photo removed 3/2017)

Let’s begin with this one by a non-surgeon who finds scars as fascinating as I do.  Dr Charles’ post Cicatrix is much more elegant than I could ever write about scars, but captures my feeling wonderfully.  Each scar has a story attached to it.  We all have one scar in common – the umbilicus – which tells of our attachment to our mothers.
“It looks like it’s healing well.” I told her. I didn’t know if it would be appropriate or not, but I decided to say it anyway. “Your scar is a story. I hope you can own it. Don’t ever be ashamed by it. It’s a testament to your strength, a mark of your courage.”
Dr Charles was inspired by this article in the NYTimes “Our Scars Tell the Stories of Our Lives” by Dana Jennings, as was Tara Parker-Pope “The Power of Scars.”  The comments attached to Parker-Pope’s are a very interesting  discussion on scars and their stories.
Moving on to the gratitude (or lack thereof) associated with the outcome of surgery, Bongi tells us about a patient with acalculous cholecystitis.
…….some time after this the neurosurgeon got a call from the family doctor from their home country. he was indignant. he wanted to know why the gallbladder had been removed in such a young male, a group that usually does not have gallbladder problems and that in the absence of gallstones. he felt it was totally unnecessary and demanded an explanation……..
QuietusLeo, the Sandman, tells us of true gratitude showed by a patient’s family in the form of a gift after taking care of a “12 year old boy needed ultrasound guided drainage of perforated appendicitis with abscess.”   The father sent a touching note along with the gift which you should go read.  The child (the patient) was less grateful, but we’ll chalk that up to his age.
I called the family to thank them for their generous gift. The son answered the phone. When I identified myself he said that I had done a poor job because he didn't see the James Bond movie. I apologized and assured him that it was much more important to be healthy again.
He then passed the phone to his father. I thanked him for the gift. He said it was only a small token of appreciation. I assured him that it was much more than that.
Can you imagine the story that goes with this?! (photo removed 3/2017)  Check it out over at M.D.O.D. (photo credit)

T, Notes of an Anesthesoboist, back from her vacation in France tells us about a call to the ER -- “you know it’s bad when”
One day I was giving someone a lunch break and wheeling her patient to the O.R. with the circulating nurse when we heard over the P.A. system,
"Any available surgeon stat to the emergency room. Any available surgeon to E.R. stat."
That stopped us in our tracks for a second. The nurse and I exchanged a look.
"Sounds pretty bad," I said.
Buckeye Surgeon talks about tough decisions as he gets ready to put in an access port for chemotherapy.
The other day I picked up the chart of a lady who needed a port and the first thing I noticed was that she was 92 years old. I must admit, my first thought was: what the hell are we doing here? She had metastatic breast cancer with lesions seen in her lungs and liver. I was all ready to march into the room and have an honest, heart to heart talk with the patient and the family about futile care and cost effectiveness etc etc.
But I composed myself. Every situation is different. I asked questions. I listened.

Bongi tells us about the difficulties of just walking away when nothing can be done surgically.   He doesn’t do as his “teacher” taught.  Go read the entire post.
"now why did i just walk away?" he asked. we all gave the usual blank stares. "because there is nothing we can do for her." he said with a chuckle. those of us who needed to be in his good books gave the obligatory half hearted laugh. i could just manage a smile that i think came out more as a grimace.
Orac, Respectful Insolence, writes about being faced with a different kind of tough decision in “iron surgeon?”  [first posted in July 2007 and reposted recently]
The other day, Sid Schwab, surgeon blogger extraordinaire, brought up a question that, I'm guessing, most nonsurgeons wonder about from time to time when contemplating how it is that we surgeons do what we do.
What about bathroom breaks?
…………….It happened to me only once, but it provided a serious dilemma. What do I do? I'm captain of the ship of the O.R., so to speak. The entire team depends on me. The patient depends on me.
And that's the key to making the correct decision……..
From WhiteCoat’s Call Room -- What’s The Diagnosis #4 – this 13 year old boy will certainly have a story to go with his scar! 

Uveal Blues tells us about Better Vision, With a Telescope Inside the Eye for people with irreversible, advanced macular degeneration.  Check out the post for photos.
Vijay, Scan Man’s Notes, gives us a quiz using “three x-rays”
A small mental exercise for medical bloggers.
See the following three portable (bedside) chest radiographs that were taken in an ICU setting. They are in sequence.
See if you can guess the story that they tell.
What do you do when you can’t get good IV access?  Check out Dr Michelle Lin’s post  Sneak Peak "Trick of the Trade": IO line for failed IV access.  There’s even a video showing how to do the IO (intraosseous) access in adults.
Adult intraosseous needles are coming more into favor in the United States, although they have been part of standard practice in the military and Europe. Various commercial devices exist. The one we have at SF General is the EZ IO Needle. (I have no financial ties with the company.) Needle placement is surprisingly easy and takes less than 10 seconds, especially if you channel your inner Home Depot self in using the power drill.
Orac does a much better job than I did discussing “Overdiagnosis of breast cancer due to mammography” and it’s implications.  It’s a must read for all of us.

M.D.O.D talks about a surgical tragedy in the recent news in two posts – here and here where he attempts to explain how the tragedy might have happened.
Surgeon hands intern trochar. Intern, stepping up on small stool puts all her weight behind it and hubs it. Descending aorta pierced, Surgeon apoplectic, blood fills abdomen, patient's legs get blue, Vascular Surgeon scared shitless, knows it's a hopeless case, tries to punt, no one receiving, then finally gets an accepting somewhere else. Rest of story plays out.

H/T to PSP (Plastic Surgery Practice) for the link to this news article from India --  Rare surgery helps re-implant foot's thumb to write with hand.  Technically the foot does not have a thumb, so it should read “rare surgery uses foot’s big toe to give right hand a thumb.”  Still it is a nice procedure.

H/T to Barbara, Medical  Quack, who shared an update on the  German Man with Double Arm Transplant.  You can see a video of the man here.

IntraopOrate was recently an ENT patient.  Here’s the first part, read her post for the outcome.
I've been having some unpleasant pressure in my right ear and a couple of episodes of vertigo over the last six days. Today I had an appointment with my ENT Dr. He entered the exam room, we shook hands, he looked at my throat, looked up my nose (but doc, it's my ear that troubles me!) looked in my right ear and while rolling across to look in my left ear, he said "We're gonna have to get that hair out of there."

Dr Alice, 3rd year surgical resident, talks about some of the “sand traps” attending set for residents.
Answering to one attending is difficult enough. Answering to three or four at the same time, about the same patients, is extremely tricky (I’m not going to try to explain the structure of this group of attendings……..

From twitter
  • medpiano  RT @jonmikel: HUGE TUMOR: Radical right nephrectomy <<ENORME! (CT is image before and on wall behind)
  • jeffreyleow RT @jonmikel: GIANT inguinal hernia:
  • jeffreyleow RT @ColumbiaSurgery: What You Must Know about Flesh Eating Bacteria and Superbugs from Dr. Oz.
and for fun/education
  • DrCris  I'm blue. Non-surgeons get to guess what procedure I have just done. 
  • DrCris  I like "smurf appendicectomy" but @twelveeyes hit the winner with sentinel node biopsy (for breast cancer)

MedPage Today reports that female surgeons report high job satisfaction.  I do love my work.

I agree with this news from fellow plastic surgeon, Dr Rob Oliver Jr -- Nip/Tuck gets "nipped" by FX - thank you God! 

And on that note, I wish you a wonderful day!  Enjoy the reading.   Remember if you would like to be the host  in the future, please contact Jeffrey who runs the show here.


Jeffrey said...

great edition!! thanks for hosting!

Johann The Dog said...

Oh my those x-rays remind me of my broken paw xray and all those xrays of pups with stuff in their stomachs.

I have some scars, but Mum and I are sure to remember that they may be a part of me, but they don't define me. She says that's important fur a dog :)

Thanks for the Barkday wishes for my sis Gracie!!!! We're off to do agility practice today, can't wait!

T. said...

FANTASTIC edition, Ramona. Thanks so much for counting me in!

Unknown said...

As usual, great edition!

drcharles said...

A great compilation, thank you for the mention. This is a great way of introducing people to the surgeon's world, and reminding those of us who only rotated through it of the many fascinating things you all do :)

Jeffrey Parks MD FACS said...

hell of a job