SurgeXperiences 19 - Surgery Carnival

I'd like to thank Jeffrey Leow, the Monash Medical Student down in Australia, who found my blog and invited me to host the 19 edition of SurgeXperiences, the worldwide Surgery Carnival. As anyone reading my blog can see, the practice of medicine is just one of the activities I pursue, and so I have never really wandered the blogosphere looking for medical blogs. But now, through hosting this Carnival, I've found that there are some really fascinating ones out there. It's also inspired me to write a bit more about my own medical and surgical experiences.

I designated the theme of this Carnival,"Funny Operating Room Moments," and there are quite a few of them here, but many are just entertaining posts about various facets of surgery and medicine, and, well, the human condition. I'm posting them in the order they were received. Here we go.

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One of the most fascinating surgery blogs I came across is from Israel, and belongs to The Sandman, an anesthesiologist in Tel Aviv. (The Sandman -- get it? Puts people to sleep.) I found two of his recent posts quite compelling. The first is a story of having an elderly couple in his office. Because he took the time to get to know them better, they shared with him their story of arriving in Israel after the holocaust on the ship that was at the center of the story of the historical novel, Exodus. His second post that I enjoyed shares his thoughts on the calm face that seems to often be present on people who die violent deaths. It's a graphic post, but gives a peek into the task of pronouncing a person dead. ("I now pronounce you dead.")

You can also browse through his blog and get a different perspective on the violence in that country -- as seen from the inside of an operating room. The Sandman did send a post for this Carnival, "It ain't over til' the fat lady sings" which points out the importance of making sure your patient is asleep when you think they're asleep.

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Jeffrey Leow forwarded a few links to save me time finding them, including A Lesson (Not Just a Joke) From an Orthopedic Surgeon posted at The Differential: Medscape Med Students Blogs. It’s a story by medical student Ben Bryer that describes the unexpected use of a hand drill (instead of a power drill) to fix a patient’s leg. It’s just like here in Saipan, where improvising is a way of life. In fact, there is a sign hanging on our OR wall (by the former chief of orthopedic surgery) that reads, “If you have to have everything you need to do the case, you probably shouldn’t be here.”

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All of us have experiences of non-nonchalantly almost killing someone. I almost did it when I was an intern and admitted a patient who was experiencing weakness. I tucked him in for the night, thinking we'd deal with the problem in the morning. The resident stopped by to see him an hour later and diagnoses Guillane-Barre syndrome, a rare disorder that causes paralysis and therefore stops breathing. If the resident hadn't stopped by, the patient would have been dead by midnight. It was a learning experience I never forgot. In How We Learn posted at The Differential: Medscape Med Students Blogs, Anna Burkhead describes witnessing a surgical resident's similar learning experience.

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Jeffrey also brought my attention to the post, Surgery and the Blowfish, again by Ben Bryner, who gives proof that we surgeons are way smarter than blowfish chefs. Find out why.

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Pimping. Do other professions use the word the way we do? In medicine, it refers to the endless series of questions that will come the way of a "junior" medical type, by a "senior" medical type. Most commonly, it is a hapless medical student getting pimped into oblivion by the attending physician (the "professor"). It's usually conducted on rounds or in the operating room, and it's rare that there isn't a gaggle of spectators present -- the whole medical team -- silent witnesses with downcast eyes, folder arms and beaded sweat. Pimping ends when either the pimper runs out of questions, or the pimped doesn't know the answer. And the pimper never runs out of questions. So, the session will conclude when you're wrong, which is why pimping never feels like it has a happy ending. If you have a sense of humor, you can get away with a lot, especially if you know the answer. Once during rounds when I was being pimped, the attending, while studying an EKG asked me "What is one of the clearest indications of an elevated blood potassium level?" I answered, "The word 'HIGH' next the the letter 'K' [the symbol for potassium] on the lab sheet." Jeffrey Leow directs us to How to Survive Pimping in the OR posted by Anna Burkhead, where she gives some useful tips.

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Sid Schwab, who like myself is the author of a book, has written about a tube at an unexpected orifice. For some reason, whatever the conversation may be, orifices seem to be fertile ground for a giggle. Sid's post is Snakes on a Pan, over at SurgeonsBlog.

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When people move to Saipan (the island on which I live) and work for the government, they typically rant incessantly about the problems with the system, as if problems and inefficiencies are unique to this island. I usually respond, "Dude, you haven't ever worked at a VA, have you?" Dr. Rob Oliver paints some accurate (and funny) pictures of life at a VA at his post VA Voodoo Economics - Krugman wrong on John McCain posted at Plastic Surgery 101.

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Dr. Oliver also presents Dumb laws and smart laws re. plastic surgery. It regards legislation in California that will require medical clearance for all plastic surgery patients. Believe it or not, I get medical clearance for all my cataract patients, mostly because here on the island, you can rarely get a straight story about someone's medical problems. I send them all to see their internist, and we find some interesting things (like blood sugars in the 400's, just walkin' around). It's best in my opinion to leave medical decisions up to doctors, not legislators. We get medical clearance when we think it's necessary. And we're generally a careful group of folks, particularly in America where a lawyer with a briefcase is only a stopped heart (or an inconvenient rash) away. Thank-you, Dr. Oliver.

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All stereotypes are based on some element of reality. In medicine, we all know the stereotype of the orthopedic surgeon ("As strong as an ox, and twice as smart.") Dr. Val Jones shares some excerpts from a talk by an orthopedic surgeon, which I honestly found refreshing. I like these guys. They're the surfer dudes of medicine. Check out her post at Revolution Health.

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"I was filming a nipple reconstruction..." Thus begins a "Tale of Two... " um, no, I'm not going to say it... thus begins a tale by Norwegian surgical videographer, The Sterile Eye, who presents Yo mammae! That sentence is sure to become a classic in medical blogging literature. I give Sterile Eye the "Call me Ishmael" Award (which I just created) for week's best opening sentence of a Carnival post.

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Dr. R Bates, a plastic surgeon and quilter in Arkansas (who, by the way, is married to a wonderful man) is author of Suture for a Living. She explains the surgeon's "druthers" card, in her post appropriately named, Druthers. Her post, She's a Beautiful Girl! , which comes complete with it's own music video (is that Dr. Bates on the drums?) tells the touching story of a young girl who gains new self-image as a result of Dr. Bates skill. It's a reminder to all of us to pause and recognize how some of the little, "insignificant" things we do can so greatly affect the lives of others. Thank-you, Dr. Bates.

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South Africa's Bongi has some great posts at his site, Other Things Amanzi. If you're one of my regular readers who gets cheerfully grossed out by my "gory eye pictures," you're gonna love Bongi's writing. Here is a "taste" from his post, Fettuchini:

the patient came in after being involved in a car accident. he had an acute abdomen, but was otherwise stable. x-rays confirmed free air in the abdomen. easy call. the patient went to theater. we opened the abdomen. it was full of intestinal content. not too surprising. and then...lying in this soup, free in the abdomen we found a meter long tape worm! i'm not embarrassed to say i gagged. i threw it in a kidney dish where it entertained us with its peristaltic movements.

Bongi's hilarious post on operating in various states of undress deserves reading: Fashion Statements.

And what's worse than poop? Well, according to Bongi, it's poop that has gone rancid. Yep, rancid poop happens, and if you want to read about how it happens, and how to remain a macho surgeon in the midst of its indescribable fragrance, read this entertaining post, Tough Surgeon.

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Surgery has lots of "laws" -- dicta (that's apparently the plural of dictum) that give pithy bits of knowledge and wisdom. Many of them are specific to a particular institution. At the University of Kentucky where I went to medical school, there were "Five Laws of Surgery." I remember two of them: A bump in a breast belongs in a bottle; and Surgery, like sex, should be slow and gentle, and requires good exposure. (You're welcome to share your own opinion on whether or not good exposure is really required.) Bongi writes about this law of surgery: Eat when you can, sleep when you can, and don't f@*% with the pancreas. If you ever need advice on getting some sleep when little time is available, you can read this chilling post: Other Things Amanzi: Wakeup Call. Thanks, Bongi, I enjoyed your posts and I'm bestowing upon you a coveted Marianas Eye Funniest Medical Blogger of the Week Award.

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Doc Ness, an anesthesiologist not far from me, writes about the experience of being in the operating room, not as a doctor, but as a patient. Most of us will have to face the other side of the table sooner or later. You can read about Doc Ness' experience at random ness.

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And that's all folks. Thanks for stopping by. And buy my book, World Peace, a Blind Wife, and Gecko Tails. It's available on Amazon. (Yes, I know it's shameless self-promotions, but hey, I have four kids to put through college and Oprah hasn't called yet.) I hope you enjoy reading this Carnival as much as I enjoyed putting it together. I look forward to your comments and to regularly visiting your blogs.

The next edition of SurgeXperiences will be hosted by Dr. Sidney Schwab and will presented on April 27.