Sunday, November 11, 2007

SurgeXperiences #108 -- Snow White and the Seven Surgeons

When I accepted the invitation from the Monash Medical Student to host this edition of SurgeXperiences, I initially thought "No problemo, dude! Only one night of call during the week leading up to it; I should be able to knock it out with time to spare." Life as a surgeon has taught me that first thoughts are often wrong, especially when it comes to my free time! Anyways, after a hectic week, here are a few categories of surgical submissions offered for your approval --- with a little Disney flare.

First up is Grumpy -- we all have a little Grumpy in us, and surgeons have a well-deserved reputation for belly-aching. It must be all of the stale coffee we drink between cases. Dr. Alice lets her grumpy side shine in How to Not Run an OR. She shares her experience in a hospital that seems to lack the understanding that the absolutely most important person in the operating room is .... the patient. Not having the proper equipment available to take care of said patient is, well, a major no-no. From Surgeonsblog comes a well-written critique of the problem we face as surgeons in terms of training new physicians, gaining appropriate experience, and obtaining credentials -- Are You Experienced? Of course, for a surgeon, nothing makes us quite so grumpy as a case gone sour -- especially one that starts off difficult and heads downhill from there, as described by Bright Lights, Cold Steel.

Next in the door is Sneezy -- quite frankly, a dwarf with a bit of a handicap when it comes to wearing a mask in the OR. Well, these posts are really nothing to sneeze about. Bongi at Other things Amanzi describes the difficulty in dealing with patients who present with advanced problems because they initially sought care from a traditional healer in an undeveloped area. And the Evil Resident has learned that sometimes people do the strangest things.....and end up with some unintended consequences. Should one sneeze about asking just who is operating on you at the local training hospital? It's all discussed at the MedFriendly Blog.

And then there's Doc, who somehow carries that moniker without ever having taken an MCAT or passed a board exam! This week, there are a few unquestionably "Doc" posts. Dr. Schwab at Surgeonsblog offers a great description of an old-fashioned open cholecystectomy in Mini-Steps. Bongi, up for reading a second time, describes a rather different experience with the same operation.

All of us who practice in the realm of medicine outside of academia are well-versed with the sometimes strained relationships we may have with the closest Miracle Center. We have mixed feelings about them, and quite certainly they feel the same. A few "Doc"-like posts in this vein come from the Buckeye Surgeon, who delves into the problem of bed shortages, and again from Dr. Schwab, whose own name for the local academic facility is The BFH --- you can draw your own conclusions from that acronym.

Where would surgeons be without our anesthesia colleagues? Sleepy, you are being paged! Dr. Keamy from a great collaborative anesthesia blog gives us some insight into the significant role a good anesthesiologist -- and a good anesthetic -- plays in the delivery of good surgical care. Not to be outdone, at Counting Sheep we hear what it's like to spend one's days always behind a mask, as an almost unseen partner in surgery. And the Anesthesioboist gives a great introduction into pain, and how to make it go away during surgery.

Bashful?? Hell, not in the OR, if you want to learn anything or get anything done. From Flatus and Stool we learn that bashfulness needs to be thrown out the window in training --- never let a little thing like social propriety get in the way of asking a patient about their bowel habits! And a healthy lack of bashfulness, and appropriate confidence, is sometimes rewarded -- just ask the Buckeye Surgeon.

There's a little bit of Dopey in all physicians as well --- if you don't get a little dopey during training, you just aren't human; some of that needs to stay with you to stay sane during practice. Dr. Campbell, an academic ENT physician who spends a considerable amount of time dealing with malignancy, had his Dopey sensors up when he spotted T-shirt on a recent patient --- this one you need to read to get a great sense of the irony we deal with frequently. And what is more "dopey" than superstitions? All surgeons --- myself included --- must admit to our own little superstitions ("appendicitis cases come in threes"), a little secret that Make Mine Trauma lets everyone in on.

Just as we are all a little Grumpy and a little Dopey, surgeons all have (hopefully) a whole lot of Happy in us as well -- after all, people actually let us operate on them, and sometimes they even ask us to!! At Suture for a Living, we learn about the little things that make us happy during a work day --- just the simple conversations that happen in the operating room. And although he was more than a bit bored by the end of the day, learning about brain surgery was quite a treat for this medical student.

What about Snow White? Well, unless somebody wants to talk about sexual reassignment surgery, I think I'll leave her for another day. Next up for SurgeXperiences is the Monash Medical Student, who will host on November 25th; get your posts lined up by the 23rd!