G’day and welcome to SurgeXperiences 318!
SurgeXperiences is a fortnightly blog carnival bringing together posts from the best and brightest of the surgical blogosphere.
Today it comes to you from the home of the sandgroper, right on the edge the Indian Ocean. As first-time hosts of a blog carnival, the Life in the Fast Lane team are rapt, stoked even, to have the opportunity to support the blogging community by serving up what we reckon will be an absolutely ripper edition of SurgeXperiences. No doubt about it, SurgeXperiences 318 showcases some fair dinkum bonzer bloggers, covering the entire gamut of surgical experience - the patient, the knife and the bench…
Perth and the Swan River, Western Australia
The Patient
Why start with the patient?
Well, here’s one reason for starters:
“The most important person in the operating room is the patient.”
— Russell John Howard (1875–1942)
and here’s another:
“The most important result of any surgical operation is a live patient.”
— Charles H. Mayo (1865–1939)
Now, let’s get stuck in…
Blogger: Steve Catoe
Children requiring corrective surgery for cardiac malformations undergo a terrible ordeal, as do their families. As an ICU doctor standing by the bedside of one of these little cardiac warriors you hope against hope that the end result makes the battle worth the fight. Steve Catoe was born in 1966… with tricuspid atresia. This meant that the right-side of his heart didn’t pump at all well. In his post Heart Moms and Heart Dads, on his intrepidly titled blog Adventures of a Funky Heart!, he tells a truly heartfelt and inspiring tale. He tells how his own parents defeated medical nihilism before facing an even greater challenge. While Steve was still just a newborn his condition became critical – his parents’ only hope was to travel through driving snow to deliver their dying baby to the miracle workers at Johns Hopkins in Baltimore.
Yes, the battle was worth it.
“For us an operation is an incident in the day’s work, but for our patients it may be, and no doubt it often is, the sternest and most dreaded of all trials, for the mysteries of life and death surround it, and it must be faced alone.”
— Berkeley Moynihan (1865–1936)
Blogger: Jamie Ivey
Jamie Ivey writes at Dreaming Big Dreams. Her post about her little son Deacon facing the trials of recurrent surgeries for (what we suspect is) juvenile-onset recurrent respiratory papillomatosis (JO-RRP) is a touching insight into what her, Deacon and their entire family are going through. Deacon is a little champion, from a family of champions, no two ways about it.
When undergoing surgery: “Console yourself with the reflection that you are giving the doctor pleasure and that he is getting paid for it.”
— Mark Twain (1835–1910)
The guiding light of modern surgery was Theodor Billroth (1829-1894) (centre) in Vienna. He was a masterful technician, teacher and scientist. He passed the torch to William Stuart Halsted who took the Austro-German method to Johns Hopkins...
Knife
And now for the knife:
“With a knife, pair of scissors, a few clamps, a few fingers, and a suture, you can do anything.”
— Anonymous
blogger: bongi
although none of us have ever met a nice south african, we’d all like to meet bongi. bongi is a truly general surgeon working in the south african province of mpumalanga, which is somewhere to the far west of our sunburned shores. in a post titled focus, bongi shares an anecdote from his student days showing how specialists sometimes fail to see the wood for the trees. as emergency docs we can relate to this – after all, as robert heinlein once told us, specialization is for insects.
in another post, law and order, bongi paints us a picture of the random lawlessness of modern south africa. his tale of how not to stop traffic reminds one of the litfl team of his time in a rural zambia and the fully loaded bus that blew a tyre on the road between lusaka and chipata. the passengers knew something was amiss when the bus driver lept out of a window seconds before impact! the unfortunate chap had to feign unconsciousness to avoid being lynched. weeks later the surgeons were still reassembling the shattered bodies of the survivors.
“Is there any way you can be of help in this operation, besides leaving the room?”
— definitely Michael E. DeBakey (1908–2008)
Blogger: SA Anaesthetist
SA Anaesthetist is one of bongi’s countrymen, but he works on the other side of the ‘blood-brain barrier‘. In Little Things, we get a gasman’s perspective on the little things. In particular, we learn about the two approaches to the gas induction of children: ‘guerilla style’, and ‘gorilla style’. We also find out that, yes, little things really do matter…
You recognize a surgeon or an ob-gyn because he has blood on his shoes, a urologist because he has urine on his, and an anesthetist because on his you see spots of spilled coffee.’
— Bernard Cristalli
Blogger: rlbates
Given that a few members of the LitFL team could probably do with a face transplant, we read with great (and almost unhealthy) interest of the developments in facial transplantation described by blogging dynamo rlbates at her most aptly titled blog Suture for a Living. These amazing operations offer the afflicted the hope of a miraculous resurrection from premature social demise. Unfortunately for us – about 2000 km away from the next major city – it helps if the patients live locally as extensive follow up is required. Oh well…
“It is better if the patient goes to the plastic surgeon after an operation, with a large scar, than to the pathologist with a small one.”
— Denis M. Arkhipov
Blogger: Dr DJ
Dr DJ is a surgeon-writer who lives in the mad-cap marvel of a city that is Mumbai. His first contribution to this week’s SurgeXperiences is titled Are You Branded? He discusses the case of a man from the Middle East who bears the always startling stigmata of scarification (or as Dr DJ suggests, ‘scaryfication’).
In a second post, the Nightmare of 26/11, he shares the verbatim account of an anesthetic colleague’s experience of a dark, dark day in India’s recent history. Islamic terrorists killed at least 173 people in the 2008 Mumbai attacks. How could such a horrific tragedy take place at the Taj Mahal Palace hotel? We remember the iconic building and its the air-conditioned lobby as a perfect place for sweat-soaked medical student backpackers to briefly shelter from the Mumbai sun.
“He who wishes to be a surgeon should go to war.”
— Hippocrates (460–377 BC)
Blogger: Leon Gussow
It is not often that surgeons and toxicologists cross paths – but if they do, it might be because there’s a ‘body packer’ in the house. Body packers smuggle illicit drugs across borders by swallowing them in inert packets. Understandably, problems occur if the packets obstruct the intestines, or if they burst – which is a potentially lethal toxicological emergency. From the surgeons perspective it can be difficult to know when to go in – can they be treated conservatively or is an ‘if in doubt, cut it out’ policy the way to go? In Cocaine mules: what to do with body packers, tox guru Leon Gussow (who, given his triumph in UCEM‘s ‘Staghorn Challenge‘ may actually be a closet urologist) reviews a paper that tries to answer this question. Although suspecting that the author’s conclusions are indeed correct, Leon explains why the paper left him shaking his head in frustration.
If you arrive in the ER and don’t know what to do, start putting in tubes until somebody arrives who knows.
— Rip Pfeiffer
Blogger: Michelle Lin
Emergency medicine educator extraordinaire Michelle Lin blogs prolifically at Academic Life in Emergency Medicine and is well known for her series of Tricks of the Trade. This week she shares a simple but great tip for irrigating scalp wounds.
‘A true surgeon is never fearless. He fears for his patients, he fears for his shortcomings, his own mistakes, but he never fears for himself or his professional reputation.’
— Samuel J. Mixter (1880–1958)
... from Halsted the torch was passed to Harvey Cushing (1869-1939), William Osler's friend and Pulitzer Prize-winning biographer. Cushing epitomized the surgeon archetype - tall, confident and outwardly unflappable, yet capable of reducing people to tears in the operating room. He developed the first anesthetic chart, introduced non-invasive blood pressure measurement to the United States and is the founding father of neurosurgery. (Photo from Harvard Medical Library in the Francis A. Countway Library of Medicine)
Bench
Bench? Yeah, bench.
Research, knowledge, that kind of thing… the laboratory bench. Some, however, have questioned its relevance to the practicing surgeon:
The operating room is the surgeon’s laboratory.
— William Stewart Halsted (1852–1922)
Blogger: Dr Isis
Dr Isis, she of On Becoming a Domestic and Laboratory Goddess…, provides a double service with her post The Controversy of Surgically Closing Your Foramen Ovale (the foramen ovale is an oval window providing a conduit between the left and right atria of the fetal heart). Firstly, Dr Isis helpfully warns of the danger of performing a google search for ‘pearl necklace’ in a crowded airport. Secondly, she lucidly describes why the foramen ovale needs to be open in the submarine world of the fetus, why it closes when the newborn breathes air, and what happens if it fails to close. As clinicians we are taught to think of a patent foramen ovale (aka PFO – but not the type of PFO we usually see in the ED) whenever a young person suffers from a stroke. This is because a PFO can transmit a blood clot from the venous system through the heart, bypassing that natural filter we call the lungs, and on to the brain. So, the obvious question remains: if you have a PFO should you get it surgically closed? Well, maybe… Dr Isis discusses the controversies surrounding PFO closure given the absence of convincing evidence. Is this a case of ‘procedure gone wild’: ‘do it because we can’ (and it earns money)? In surgery, as in medicine, we do well to remember the Fatman’s 13th Law of the House of God: do as much nothing as possible.
“A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues.”
— Theodor Billroth (1829-1894)
Blogger: GrrlScientist
GrrlScientist from Living the Scientific Life (Scientist, Interrupted) has announced the birth of new general science blog carnival twitter feed that sends out links for a variety of science, environment, nature and medicine-based blog carnivals. The feed is called SciNatBlogs and has its own email address where blog owners/hosts can send the URLs for their most recently published blog carnival so it can be tweeted to the public.
“It is too bad that we cannot cut the patient in half in order to compare two regimens of treatment.”
— Béla Schick (1877–1967)
Michael DeBakey (1908-2008) although best known to most medical students for his forceps, pioneered many techniques in cardiovascular surgery - including the repair of aortic dissections, the carotid endarterectomy and cardiac bypass surgery. He worked until the day he died at 99 years of age.
Closing up
A car mechanic said argumentatively to his client, a cardiac surgeon: “So Doc, look at this work. I also take valves out, grind ’em, put in new parts, and when I finish this baby will purr like a kitten. So how come you get the big bucks, when you and me are doing basically the same work?” The surgeon replied: “Try doing your work with the engine running.”
— legend has it the surgeon was Michael DeBakey (1908–2008)
Sadly that’s all the Life in the Fast Lane team has for you as we watch the sun set on the 318th edition of SurgeXperiences. Be sure to keep your eyes peeled for the announcement of the host of edition 319 (due in two weeks time), and remember to submit your posts here.
Thanks for reading this far!
Just another bloody Perth sunset...
About Chris Nickson
