Sunday, February 3, 2008

Blog Carnival: surgeXperiences #114

Welcome to this edition of surgeXperiences, a blog carnival about...guess what...surgical experiences! (By coincidence, it's Carnival Day in Brazil - Happy Carnival to those around the world celebrating!)

I've chosen the above painting by Gauguin as an organizational aid for the carnival. Where Do We Come From? What Are We? Where Are We Going? (1897–1898) was painted in Tahiti and is now at our very own Museum of Fine Arts here in Boston, as far as I know. Without further ado, let's take a stroll through the questions Gauguin poses in his title!

Where Do We Come From? A few glimpses of our training...

Bongi at Other Things Amanzi recalls how a surgeon in training was expected to tough things out.

At Bright Lights, Cold Steel, lightsnsteel gives us a vivid example of how tough that training could get.

"You gotta walk before you can fly." Don'tcha hate that? :) An orthopaedic resident reflects on how being a stellar surgeon starts with being a good assistant.

This med student's impressions at Denialism during his first week on surgery rotation generated a huge controversy at a New York Times health blog!

But of course, different students have different impressions and experiences, as Aaron the "sneaky dog" notes on his blog.

And finally, a captivating story from the training experience captured by a true "fly on the wall," the astute and observant medical videographer, Sterile Eye.

Who Are We? Meet the surgical team...

We, the surgical team, are composed of surgeons, anesthesiologists & nurse anesthetists, scrub and circulating nurses, scrub and anesthesia techs, assistants, residents, and medical students.

I loved Aggravated Doc Surg's playful post about medical words - we gotta know our stuff, we team members, but really, what IS all that gobbledygook?

Doc Surg also describes how great the enjoyment of the work of surgery can be - can we say, pancreatic cystgastrostomy, everyone?

And speaking of love of the work, Dr. Sid Schwab, one of the best surgeon-writers out there, writes about an amputation and reveals how even in the face of a tragic clinical situation, the pleasure of doing the actual work can prevail.

Hard-earned knowledge also helps us do our job well. Dr. Bates, author of Suture for a Living, gives us an informative article on an overlooked but very important body part.

Buckeye Surgeon points out how the challenges of working and making decisions in the community can differ from those of working in the hallowed halls of academe in this post about an urgent operation to remove a child's spleen.

What about the rest of the team?

Makeminetrauma over at intraopOrate introduces us to the world of the surgical first assistant and reminds us all not to assume things are as easy as they look in this post about laparoscopic gastric bypass surgery.

At Livin' Large, Unsinkable MB compares her job as a circulating nurse to that of a familiar face to those of us who grew up in the 70's...

And I couldn't resist inserting my old diatribe "Have You Hugged Your Anesthesiologist Today?" from months back, about what anesthesiologists do. Go, team!

Where Are We Going?

Some people think the growing interest in alternative medicine is a step in the right direction, while others decry the dangers that may lurk therein for unsuspecting patients. Whether or not we fear urban legends come true (anyone seen the film Awake yet?) or scoff at what we see as quackery, the alternatives will always be fair game. Psychic surgery? Is it a joke? Some people claim they've benefited from it. What about gallbladder flush? Sid Schwab weighs in with some strongly worded thoughts.

We have even more urgent and complicated challenges for us in the realm of ethics and morality. We face difficult questions, small and large, on a daily basis in the operating room. Should we suspend DNRs? How do we balance the information a family wants to know versus what they need to know? Should we even do a case in someone whose illness is clearly not salvageable? How about...should we use our expertise to participate in killing people? Terry over Counting Sheep offers a lucid post on the subject of lethal injection. And this heart-breaking, beautifully written post from Dr. Schwab about the death of a child reminds all of us that moral courage in the operating room covers not only decision-making before and during a procedure but also one's demeanor, sentiment, and behavior in its aftermath.

Then there's technology. Hundreds of years from now I bet people will look back on 20th- and 21st- century surgery as comparatively barbaric. But we're making progress. Minimally invasive techniques are all the rage. Off-pump cardiac surgery has been made possible by special stabilizing machinery. We can regenerate heart tissue, transplant faces, separate the conjoined. We are developing robotic techniques - I think I mentioned once that one of my most memorable cases involved the robotic removal of a boy's uterus. But what about robot rounds? I'm not sure removing the human factor is ALWAYS an improvement...

In fact, snazzier doesn't always mean better. Once again, a word from Sid about "bugs" in the O.R. and how a little common sense can be all the technology you really need - and how the body's capacity to repair itself can often outdo the high-tech stuff.

Last but not least, speaking of clean O.R.'s, I'd like to end the carnival with a link to this tribute about one more often-overlooked member of the team that helps the O.R. run smoothly. Thank you, Barb!

Thanks to all who submitted posts for this edition. I wish I could have used all of them! I'm taking the liberty of linking you to one last one from Sid, about scrubs, one from Aggravated Doc Surg, about how we should be careful how we read studies, and a humorous one from amanzimtoti that lightened up the mood a little. They made for good reading but I couldn't fit them into place under my Gauguin schema.

Tune in next time, February 17, when Chris from Made a Difference hosts surgeXperiences #115!

To quote one of my favorite childhood TV shows, this edition of surgeXperiences has been brought to you by the letter

"Where have we come from? Where are we going?

What is the meaning of our lives? We can’t comprehend.

So many pure souls under the blue circle of sky

Burn into ashes! But tell me, where is the smoke?"

-From the Rubaiyat by Omar Khayyam, translated by Dmitri Smirnov


Terry at Counting Sheep said...

Great edition of SurgeXperiences. Thanks for my inclusion.

I think you forgot to mention nurse anesthetists under your Who We Are "surgical team." :-)

T. said...

Oh my Lord, that is so bad! I lumped you guys in! So sorry - will fix it right now. :)

rlbates said...

Nicely done, T!

Chris said...

Wonderful presentation of wonderful entries! I can't tell you how long I got lost in the controversy over Dr. Hoofnagle's post!

Please contribute to the next edition of surgeXperiences:

Full Metal Scalpel: The Love-Hate Relationship between Surgery and War.




make mine trauma said...

Awesome T! Like the format. Thanks for the inclusion.

Anonymous said...

Excellent edition!

In addition to all the great posts, it brings about a real sense of community.

Thanks for including me!

Jeffrey said...

Great edition! Thanks all for your support thus far! Keep going and let me know if you want to host or know of a suitable host! :)

Terry at Counting Sheep said...

Thanks T! (no problem!)