Having wrapped up the general surgery portion of my surgery rotation, I'm pretty glad that I had decided to not join any fantasy basketball leagues this year. Having been an avid fan since junior high, I decided last year to start playing again when a family member enticed me to join his uber-competitive cash-incentive laden league. I won that league, marking a successful comeback from my three year hiatus from fantasy sports. This year, however, I didn't think I'd have the time to really invest as I would like so I had to painfully decline the couple invitations this year.
These days, I find myself myself jumping on my computer to check on how my patients are doing. Instead of points, rebounds, and assists, I'm looking at vitals, progress notes, test results. Admittedly, these aren't the most exciting stats especially since we're not really shooting for extremes. Still, I'd like to think there's a certain head to head match up going on with death or even just surgical complications.
So every night I watch in anticipation and the following morning, I go see the results first hand. I realize it's probably not the wisest thing to compare patient care with fantasy sports, but the more I think about it, there's probably a good number of similarities that could be made. That's another post for another time.
Friday, November 19, 2010
Tuesday, November 16, 2010
Three things
One of the surgeons came up to me today and told me that I needed to learn three new things about every surgery I attended so that by the end of the rotation, I would have accumulated a nice fund of information from which to draw.
Today, I had only one surgery--the ventral/umbilical/incisional hernia repair. This is what I learned.
1. Repair necessitates cutting through the falciform ligament
2. Mesh should have at least 5 cm around the hole to ensure stability
3. Suturing the fascia to the mesh helps with stability and hematoma development.
I also present three things from the OR discussion relating to the implementation of new CT scans/pat downs in airports and the needless radiation exposure/invasion of privacy that this will generate.
Surgeon: I shouldn't have to subject my children to this (pat downs) just because I don't want to expose them needlessly to radiation.
OR nurse: If it wasn't the government doing this, these would qualify for sexual abuse.
OR nurse: I'll take the pat-downs over the X-ray any day. Heck, I'll even do it twice.
Scrub tech: Yeah, and while she's getting them, she'll probably forget why she's even getting them in the first place.
OR nurse: Everything I've learned I owe to you.
Nurse: my (Caucasian) friend recently got patted down at the airport while a 25-year old fellow Arab passenger got through untouched.
Indian Doctor: In that case, I'll be expecting my rectal exam when I go through one of those lines.
Nurse: Yeah, you'll be like, "Hey, that's not your hand..."
Today, I had only one surgery--the ventral/umbilical/incisional hernia repair. This is what I learned.
1. Repair necessitates cutting through the falciform ligament
2. Mesh should have at least 5 cm around the hole to ensure stability
3. Suturing the fascia to the mesh helps with stability and hematoma development.
I also present three things from the OR discussion relating to the implementation of new CT scans/pat downs in airports and the needless radiation exposure/invasion of privacy that this will generate.
Surgeon: I shouldn't have to subject my children to this (pat downs) just because I don't want to expose them needlessly to radiation.
OR nurse: If it wasn't the government doing this, these would qualify for sexual abuse.
OR nurse: I'll take the pat-downs over the X-ray any day. Heck, I'll even do it twice.
Scrub tech: Yeah, and while she's getting them, she'll probably forget why she's even getting them in the first place.
OR nurse: Everything I've learned I owe to you.
Nurse: my (Caucasian) friend recently got patted down at the airport while a 25-year old fellow Arab passenger got through untouched.
Indian Doctor: In that case, I'll be expecting my rectal exam when I go through one of those lines.
Nurse: Yeah, you'll be like, "Hey, that's not your hand..."
Saturday, November 13, 2010
Thursday morning cancer conference
It was the weekly cancer conference, and it was optional. Yes, his attending would be presenting a couple cases, but this short white coat had long grown tired of playing this game of impressing his superiors. But, he went anyway. Come to think of it, he probably only went because he was chasing an interest that he really didn’t have—and, on a deeper level, a calling he could never fully embrace.
The first case presented sounded familiar: Adenocarcinoma of the lung. Brain metastasis. Post-radiation treatment VATS pneumonectomy. PFTs had checked out pre-operatively. Patient recovered relatively well. Residual ataxia from the neurological deficits.
This was unfortunate because he painted houses. How would he make a living for himself if he could not stand on a ladder? The cardiothoracic surgeon wasn’t sure. His shoulders shrugged with a hint of sadness and sympathy. This was the story that was often left untold when a patient left the hospital—even if the surgery was a clinical success.
The painter had a name, and the short white coat sat there scrolling through the list of patients he had been generating over the last three weeks. All he remembered was watching the surgeons pull his diseased lung out between the ribs, and the painter’s face the day he was discharged to go home. He remembered that the painter had voiced concern about his job, but despite all this, the name eluded him.
He played the harmonica. He had brought in his harmonica that last day to see if he could still play it after the surgery. Indeed, he had found that he could. So strange; this was all he could remember. He played the harmonica.
The purpose of the conference was to provide a venue for oncologists, pathologists, and surgeons to discuss treatment plans, to collaborate so that future patients could be better served. At the same time, these conferences became a place to commemorate those that had passed through their care. Because for every 55 year old with adenocarcinoma of the lung and brain mets, there was a painter who painted no more—a painter who was recovering at home and playing his harmonica.
The first case presented sounded familiar: Adenocarcinoma of the lung. Brain metastasis. Post-radiation treatment VATS pneumonectomy. PFTs had checked out pre-operatively. Patient recovered relatively well. Residual ataxia from the neurological deficits.
This was unfortunate because he painted houses. How would he make a living for himself if he could not stand on a ladder? The cardiothoracic surgeon wasn’t sure. His shoulders shrugged with a hint of sadness and sympathy. This was the story that was often left untold when a patient left the hospital—even if the surgery was a clinical success.
The painter had a name, and the short white coat sat there scrolling through the list of patients he had been generating over the last three weeks. All he remembered was watching the surgeons pull his diseased lung out between the ribs, and the painter’s face the day he was discharged to go home. He remembered that the painter had voiced concern about his job, but despite all this, the name eluded him.
He played the harmonica. He had brought in his harmonica that last day to see if he could still play it after the surgery. Indeed, he had found that he could. So strange; this was all he could remember. He played the harmonica.
The purpose of the conference was to provide a venue for oncologists, pathologists, and surgeons to discuss treatment plans, to collaborate so that future patients could be better served. At the same time, these conferences became a place to commemorate those that had passed through their care. Because for every 55 year old with adenocarcinoma of the lung and brain mets, there was a painter who painted no more—a painter who was recovering at home and playing his harmonica.
Tuesday, November 2, 2010
Fences and Elbow Room
Today while waiting for a cholecystectomy, my team of one attending, two residents, and two medical students sat in the physician's lounge chatting about various subjects. My attending raised the issue of how everyone in his affluent neighborhood was putting up fences around their yards. It was silly, my attending bemused, how our relationships with our neighbors were becoming increasingly defined by such a strict sense of privacy.
Sometime later in the conversation, my attending went on to share this story.
"So I took my kids to Disneyland and my son was all up in people's butts the whole time. I had to finally pull him aside and tell him that part of what defines Americans is how we want our elbow room," He propped his elbows up accordingly to show how he symbolically demonstrated to his young toddler the concept of privacy.
"And," he continued, "for the rest of our time there, my son was walking around with his elbows like this," he repeated the gesture a second time.
Thinking back to this conversation, I realize that the hospital is the exact antithesis of the coveted privacy that Americans pursue. Here, a patient is stripped down to their most basic needs (pain, passing flatus, urinating, ambulating, and appetite). In order to receive help, he must be examined, poked, prodded, cut open, and assisted in rudimentary clothing (the hospital gown) by strangers not of the patient's choosing. He is furthermore forced to trust strangers with their most intimate details (sexual history and social history) with really no way to ensure that their confidentiality will be preserved (nurse gossip anyone?). This is both uncomfortably alarming and yet intrinsically necessary to the current health care process (because even the nurse gossip becomes a way to preserve the sanity of the participating parties).
If people were willing to subject themselves to such treatment for the sake of personal health, how different our society would be if we were willing to place ourselves in similarly compromising situations for the sake of our fellow man?
Sometime later in the conversation, my attending went on to share this story.
"So I took my kids to Disneyland and my son was all up in people's butts the whole time. I had to finally pull him aside and tell him that part of what defines Americans is how we want our elbow room," He propped his elbows up accordingly to show how he symbolically demonstrated to his young toddler the concept of privacy.
"And," he continued, "for the rest of our time there, my son was walking around with his elbows like this," he repeated the gesture a second time.
Thinking back to this conversation, I realize that the hospital is the exact antithesis of the coveted privacy that Americans pursue. Here, a patient is stripped down to their most basic needs (pain, passing flatus, urinating, ambulating, and appetite). In order to receive help, he must be examined, poked, prodded, cut open, and assisted in rudimentary clothing (the hospital gown) by strangers not of the patient's choosing. He is furthermore forced to trust strangers with their most intimate details (sexual history and social history) with really no way to ensure that their confidentiality will be preserved (nurse gossip anyone?). This is both uncomfortably alarming and yet intrinsically necessary to the current health care process (because even the nurse gossip becomes a way to preserve the sanity of the participating parties).
If people were willing to subject themselves to such treatment for the sake of personal health, how different our society would be if we were willing to place ourselves in similarly compromising situations for the sake of our fellow man?
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