Saturday, April 29, 2006

Gratuitous Surgling Posting

This is how I spent last Saturday:

Ever heard 15 harps play together? It's a true treat for your ears!

Thursday, April 27, 2006

Cutting Remarks

I have been a bit remiss in posting the past few weeks. It's amazing how work seems to get in the way of blogging! Anyway, I'd like to echo the comments made by my esteemed surgical colleague to the east and make a recommendation for anyone who is interested in reading about the life of a surgeon. Dr. Sidney Schwab, a retired general surgeon, has written a book about his experiences in training in the early 190s. . The book is entitled Cutting Remarks : Insights and Recollections of a Surgeon, and is available at a variety of locations. While my copy is still en route, I did enjoy the snippets that Dr. Schwab was kind enough to send my way. In particular, it is apparent that his take on the training of a young surgeon is pretty similar to the way I have always viewed things:

Internship is about osmosis: learning by absorption, by being there. There are no classes, no curriculum, no exams. It’s the ultimate descendant of apprenticeship—highly-caffeinated, on-the-job training. Learning derives from seeing and doing, and from randomly strewn pearls of wisdom, tossed to you when appropriate to the moment.
I couldn't say it any better (and probably would say it worse!). Anyone who is interested in learning about what the "surgical life" is like would do well to pick up a copy!

Monday, April 24, 2006

Life's Little Instruction Bureaucracy

There are some difficult things in life that we all must go through, which virtually every American can identify with. Paying taxes. Getting stuck in the "15 items only" lane in the grocery store behind some oaf with a basketload of Cheetos and Cheez Whiz. Having some idiot who never quite "got" the laws of physics drive his 9 ton SUV about three inches from you rear bumper at 75 miles per hour.

I like to make sure the surglings get fully exposed to these things --- life's little lessons --- so that hopefully they will cope with them a bit better than I do. I mean, c'mon, there's a reason that dealing with the guy at the Best Buy checkout counter who asks me for the third time "do you want the extended warranty on this?" makes my blood pressure get high enough to crack walnuts with ease.

We had just such an opportunity a few weeks ago, when it was time to head to our friendly, customer service-oriented neighborhood DMV! What a learning experience for the surglings! What a great way for them to learn about the efficiencies of modern governmental bureaucracy! What a great way to blow 5 hours on a Friday!

I have reached that stage in life (most call it "the time when your ulcer starts to develop") when I have a child living in my home who can legally operate a vehicle. Not to be outdone, her little sister --- let's just say that we didn't understand that whole "ovulation" thing -- is only a year behind her. So, the day came when surgling number one needed to take her final driver's test, and surgling number two needed to take her driver's permit test. As we have entered the 21st century, and that I live in a city of a few hundred thousand people, it would be reasonable to expect that there might be a few DMV offices for us to choose from.

It would be reasonable. But it would not be reality. You see, in my fair town, there is only one DMV office that is sufficiently able to handle the complexities, the subleties, the hazards, the sheer strain of dealing with anyone under 21. So, being the good father, I traipse on down there on a Friday afternoon, arriving about 45 minutes before my wife arrives with all of the surglings in tow, having retrieved them from their respectful institutions of indoctrination. What I find is a line of people snaking out of the office a good 25 persons long, all of whom seem to be making comments along the lines of "I can't believe I've been here since 10 AM." A quick peek inside reveals another 50 people in line, along with a large sign stating that the doors will be locked at 4:30 PM, and no tests will be given after that time. Joy! Of course, according to regulations handed out with the code of Hammurabi, both SWIMBO and I had to be present, the entire time, to ensure that surgling numero 2 would be legally allowed to drive with both of us.

Fortunately, my oldest daughter has inherited the anal retentiveness that makes her father so pleasant to deal with, and had scheduled her test -- she got to go right in and stand in a shorter line, while daughter number two got to cool her heels with her parents (to her utter embarrassment) and her little brother (who delighted in her annoyance). We eventually passed over the river Styx and through the doorway, only to be treated to a collection of people one might normally only hope to encounter at the 5,786th midnight showing of the Texas Chainsaw Massacre. Look, I have seen a bigger collection of teeth in a nursery! And to a man, woman, and pregnant teenager holding her two-year-old, they had all been there the whole day.

So, we had several of what I might refer to as "teachable moments" during the next three hours.

  • "Dad, what do those funny letters tattooed on that guy's neck mean?" "Well, son, that's an ancient Chinese inscription that means 'I have hepatitis C!'"
  • "Dad, how can a teenager just now getting her driver's license have two kids and look so pregnant?" "Gee, sweetie, it might mean that she believed the notion that Britney Spears is a role model."
  • "Dad, why is it that all of these people in here are talking nonstop on their cell phones, but argue with the clerk saying they don't have the $5 needed for their document transfer?" "Well, try to think back to the Three Little Pigs, but in this case, the two idiot pigs had cell phones and the cable package with all of the HBO options instead." "OK, Dad, but what does the smart pig do?" "He pays a lot more taxes."
  • "Dad, why does that guy have his pants down so low that you can tell what brand of underwear he owns and what religion he is?" "That, son, is what is referred to as fashion. Or blatant stupidity. I'll leave the distinction to you."
Honestly, between the hand-checked permit test (it is 2006, and Microsoft has been a well known entity for a few decades), the surly gatekeeper whose entire existence consisted of badgering people about the lack of proper paperwork, and Ruprecht the trainee putting data into the 1970's era computer system, we were lucky to get done before summer arrived. All in all, though, I think the surglings learned more in that afternoon than in the entire preceding week. We reviewed the "take-home points" at dinner that night:

  • Jobs are good
  • Clothing is good, especially clothing that has been washed since the Eisenhower administration
  • Tattoos are an expression of a person's "inner spirit" -- as well as of their misunderstanding of the causes of hepatitis and the effects of aging & gravity
  • Sex really does have consequences, and those consequences can be noisy, time consuming, and cost a fortune in diapers
  • Teeth -- they're not just for show!
  • While we don't usually do this, Mom & Dad say "I told you so."

Thursday, April 20, 2006

Laugh-a while you can, monkey-boy

Overbooked office days. Long surgery schedules running into the late evening. OR Turnover times that border on glacial, with UAFAT* tacked on to boot. Lots of call. Sick patients needing a bit of extra time and hand-holding. Surglings going every which way, and now with the extra worry that comes with the eldest surgling now in proud possession of a driver's license. I'm bushed! When I got out of bed this morning, instead of the gray-haired guy with bags under his eyes looking back at me from the mirror, it came as no surprise that I saw Dr. Emilio Lizardo staring back at me!

Must. Drink. Wine. Tonight!

*Usual Anesthesia F*** Around Time

Wednesday, April 12, 2006

Dog Lab Memories

The dog lab is where I first heard the siren song of surgery. I well remember the great interest the budding surgeons in my medical school class had in our dog labs during our first and second years ---- and, in retrospect, the disinterest of those who chose a nonoperative specialty! It was truly an excellent experience for me, with physiology "on display" in a manner that allowed exceedingly inexperienced hands to put some of our learning into practice. Even though I had little personal experience with him, the uncrowned king of the dog lab at my medical school was the burn surgeon and physiologist extraordinaire Charlie Baxter, M.D. The late Dr. Baxter is well known for other exploits, but he clearly valued the dog lab experience for medical students. Later on, during a research year in residency, I had plenty more dog and pig lab experience, doing work with laparoscopic and thoracoscopic techniques, teaching courses, etc. I definitely preferred the dog lab --- ever had to intubate a pig? Ugh.

Ask SWIMBO --- I love my dog! DogSurg and I are fairly inseparable (mainly because he won't leave my side when I go home). Now, I'm not going to get into the whole "dog labs are evil," PETA-esque thing; if you are interested, just Google "dog lab" medical school to find our just how cruel I really am. But a recent event reminded me of just how much we in health care, not to mention society, have gained from the experiments of a few surgical pioneers in what were then fairly rudimentary dog labs.

I know that it is dangerous for me to crank up the few remaining synapses in my head, but the death of Dr. Norman Shumway got me thinking. Most folks outside of medicine probably don't know much about Dr. Shumway, and I'm certainly no authority on his career. We should remember him, however, as a true American pioneer, who garnered a bit less acclaim than one might expect because he "came in second place" to this guy:
Dr. Christiaan Barnard, of South Africa, performed the first heart transplant in December of 1967, pulling a Sputnik so to speak, after Dr. Shumway's team at Stanford had announced plans to do the same. By the time a donor and recipient became available, Dr. Barnard had performed three such procedures; one survived 18 months. The first American heart transplant recipient was this gentleman:
Mike Kasperak, a 54-year-old steel worker, lived 14 days postop. Dr. Shumway had run headlong into the unseen glass wall of heart transplantation -- the operation was relatively easy, in comparison to many of the concurrent advances in heart surgery that were being made at the time, but the patients succumbed to organ rejection. According to the Times Online, "by 1971 there had been 170 operations, and 146 patients were dead....Heart surgeons despaired, and called for a moratorium."

This is where the mettle of a man is tested, over and over. Where the quality of persistence in the face of failure is viewed contemporaneously as lunacy, and retrospectively with admiration --- but in neither instance with the understanding of the sheer enormity of the work involved to get continuously better results.

And this is where those who don't understand the importance of animal experimentation in medicine should probably stop reading. Dog and other animal labs were essential to the development of the operation itself; the development of minimally invasive cardiac biopsies to survey for rejection; the development of antirejection medications, such as cyclosporine, which are critical for transplant recipients; etc.

Dr. Shumway's career was a rich one, and certainly not limited to cardiac transplantation. It is a shame that more people don't know who he was and what he accomplished. While it is largely unspoken, his legacy lives in the hearts (as well as kidneys, livers, lungs, etc.) of thousands of transplant recipients across the world today.

And just to get your PETA panties in a wad, just remember that none of this was possible without the simple tools available to us in the dog lab. Maybe the PETA folks should ask the people on this waiting list what they think about it all.

Tuesday, April 04, 2006

Back in the Saddle

Reentry, as they say, is a bitch. Coming back from vacation is always hard for me -- I am greeted by a pile of paperwork, messages to be returned, forms to be signed, lingering patient questions that need to be resolved, and an overfull clinic. Oh, well, I suppose the alternative would not be terribly pleasant! At least I can remember here I was last week, hitting the slopes with the surglings while the fetching Mrs. DocSurg did a little relaxing.
And before you ask, yes, I do wear a helmet when skiing. I am not the world's best skier, and have been known to take a spill or two while doing the Texas two-stick ice-slick mambo!