Scalpel’s Edge

SurgeXperiences 205: Evidence

// August 31st, 2008 // 13 Comments » // Links

Welcome to SurgeXperience 205.  I was impressed by the variety of posts I received, and many fit the theme of “Evidence” . I have enjoyed reading through this content and I hope you do, too.

Testimony

The words used can change the perspectives of others, as Bongi explains in old school.

Just because you think something is true, doesn’t mean it is, as Dr Rob explains in Doctors and Barbers.

Health Beat also is continuing to talk about the character of surgeons, with a a fascinating eyewitness story of operating room dynamics.

In a very interesting article, Fighting Fatigue explains what to be aware of when operating on patients with Chronic fatigue or Fibromyalgia.

Hearsay

Bongi shares the results of inexperience, and the perils of inadequate handover.

Half MD also provides “hearsay” about how to succeed during your surgical rotation.

Digital Evidence

Scanman shares images showing what happens when X gets out of its normal location.

Sterile Eye shares evidence that skin cancer is not fun, and sun bathing should probably be avoided, too.

And what would you do when faced with losing your sense of hearing, due to a planned surgical outcome?

Scientific Evidence

Orac feels passionately about the value of scientific evidence and explains his views in Maybe we should use therapeutic touch instead of growth factors to culture cells.

Surgery Lounge also champions the necessity of evidence in surgery.

There are other unusual uses for scientific research.  Ramona at Suture for a Living tried to use scientific research to become an astronaut.

DNA evidence

Turns out genetics is relevant to surgery. Clinical Cases Blog explains in A Surgeon and Genetics: “What I cannot see does not exist. So forget about genetics!”

Ballistics

Some of the outcomes of kidney transplant can be suprising, according to donorcycle.

Trace evidence

Karen Little at Just up the Dose thinks that it is important to cut independently, and not simply trace the line suggested by others.

Character evidence

Dr Val explores how surgical behaviour can testify to character, in Good Surgeon, Bad Surgeon.

Nurse Ratched thinks Dr Welby can teach us about character.

What can we do about this? Well QuietusLeo hopes the Burned Girl can teach us to cure rudeness.

Hormonal (!) Evidence

Ramona at Suture for Living looks at Women in Surgery, and the role that mentors or character witnesses might play.

The Wall Street Journal chimes in on this topic, also emphasizing the importance of role models.

And as for motivation?

IntraopOrate shares what motivates her in surgery.

Bongi also has some ideas.

The next episode of SurgeXperiences will be hosted by Sterile Eye. Find out more about SurgeXperiences blog carnival. You have two weeks to submit your surgical articles here.

Ties and relatives

// August 29th, 2008 // 3 Comments » // Uncategorized

Dr Rob reminded me this week that patient encounters go beyond medicine. I once knew a sweet lady with locally recurrent breast cancer. My supervising surgeon was a teddy-bear of a man - like your favourite grandfather. At the end of dealing with her medical issues, I would fetch Mr Teddy-Bear, and he would always meet with her.

Surgeon enters room.

Sweet lady: Hello! A yellow tie! I could see you halfway up the corridor.

Mr Teddy Bear (grinning): A present from my son: a Father’s day gift. Helpful if there is a power outage - I won’t need a torch! What about you - are you still causing trouble?

SL: I’m fine. I make up problems so I can come and visit Cris. How are the girls? (referring to MrTB’s 13 year old twin daughter)

MrTB: Good. I played golf with them last weekend. Getting better.

SL: You or them? Wow. I don’t see how you find the time.

MrTB: I’m not sure, either. Keeps me tired, though. Any complaints for me?

SL: No, I just love your staff. They look after me. It’s a pleasure to have to come.

MrTB (shaking hands): Good. I’ll see you next week.

The conversations were always the same - ties, self-depreciating jokes and family talk. The barest, briefest mention of medicine. Mr TB demonstrated some of the advantages of being a consultant. Surgery can create long-term partnerships with patients. And when everyone understands what is going on, the relationship is all that matters.

5 Cool Things

// August 27th, 2008 // 1 Comment » // Uncategorized

1. This web of science is cool.
2. This post on the cost of owning things is cool.
3. Lego photos are cool.
4. This take on how nasty people behave is cool.
5. Robocop exoskeletons are cool.

   

Zebra sightings

// August 26th, 2008 // 5 Comments » // Uncategorized

As a third year resident, in my “unaccredited registrar” year (before I was accepted into surgical training), I worked as a Cardiothoracic registrar. It was a lucky break, as I never asked to do it, and I was meant to do six months of nights and holiday covers instead. But it was a bit intimidating to be first on call for Cardiothoracics, a speciality I had previously never worked. Our roster was a week on call, once every four weeks. It was pretty gutting.

One night I got a call from the ED staff saying they had a sick young male with some sort of chest infection. It was a weird call, but as a really junior registrar, with no experience, I was not going to turn anything down without passing it by my consultant.

This 20-something guy had been sick with an URTI for a few days. He started to get headaches and feel unwell, and he finally went to his doctor and was diagnosed with Quinsy or peritonsillar abscess. It’s not unheard of, but it is an unusual thing to call a cardiothoracic Reg for. So he has his throat lanced and he has appropriate antibiotics, but he looks sicker than that. Luckily, the ED docs decide to CT his neck, and find gas bubbles. So the radiologist extends the scan and finds gas bubbles in his mediastinum (the bit of the chest between the lungs that encloses the heart, and major arteries, oesophagus, nerves and all good things.).

In theatre that evening, the young man had a thoracotomy to drain pockets of stinky pus from all around his heart. Black-brown strings of pus, lying over pulsing things - B-grade-movie-worthy. That was insufficient, so he also got a median sternotomy. He had four wide gauge chest tubes that continued to clog up in ICU for the next week, leading us to institute continual pleural lavage for a few nights. And he went back to theatre so many times, we lost count. Eventually, he got his wounds closed. He even left hospital, about 20kg lighter.

He was a really nice guy, and really happy to do whatever it took. Not surprising, really. I would have been, too. Because he was just young when it happened, I can’t help thinking that his life is now defined by that completely random earth-shattering event. As his death would have been, I suppose.