To Cut or Not to Cut?

aaaaahhhhh!!! life has been such a crazy busy emotional mess lately. some parts great, some parts scary.

several times recently i've had to help family and friends make decisions about whether or not to get surgery. just yesterday my dad underwent back surgery for a herniated disk that was causing him agonizing pain, not allowing him to sleep, and totally interfering with every aspect of his life. several months ago my grandfather debated the risks of taking out a tumor in his bowels at his tender young age of 86. the BHE and i have also been discussing the risk/reward of cosmetic surgery after major weight loss.

all these make for hard decisions. surgery can be dangerous. it can also save lives. every day at work i see proof of both. so where does that leave me in advising my loved ones on whether they should let someone cut them open? besides needing heavy sedation for several days leading up to any work i might need myself, i am still very much for it. despite the risks of infections, blood clots, wound ruptures, etc, etc....the list of complications is staggering and we see them all....despite all this, the huge majority of the time we don't see it. everything goes smoothly and patients are wildly improved because they were willing to take the risk.

taking tumors out saves a life. sometimes that's all it takes. taking off the bad joo joo that's pressing on a nerve on the spinal cord and instantly allowing you to be free from the pain that has controlled your life. taking out a diseased and dying organ that's dragging the rest of you down with it. releasing pressure on the brain to give you back normalcy. giving you the body that you've earned after years of hard work losing weight. or reconstructing breasts for you after battling cancer and winning except for the lady parts you're missing...those are such amazing things we can do for people.

and sometimes surgery is not the answer. most of the time every conservative measure is taken to manage the problem without having to cut. clearly. but when all other treatments have failed, or for those things that have to quickly be controlled/removed/assessed/attached/drained right NOW, surgery is the answer.

no one wants to have their abdominal muscles cut through. no one wants a scar. no one wants the pain and fear and risks. but most of the time from all the cases that i've experienced professionally, and now personally, when all is said and done, go ahead and cut.

Learned Some, Ate More

in new orleans last week for a PA conference. and for food. lots and lots of food.

the conference was great- really good lectures from knowledgeable speakers on a variety of subjects. there's always reviews on hypertension and diabetes management, which is helpful. and this conference, though general medicine, was also very gyn-centric, which was great.

the BHE and i lived in a small town in the south for a while and i worked in a hospital there while we did. we quickly learned that the stereotypes of southerners as idiot rednecks is totally crazy. most of the people we knew were brilliant, creative, well-spoken and sophisticated. in the hospital where i worked, the standard of care was up to par with any other hospital i've seen and the staff was very well educated and trained. the only differences in care i could perceive is that people down south are just more polite/friendlier (they really are) and there's a lot more God infused into conversation- even patient/physician dialogue.

so all that being said, it was no surprise to me that the MD's who spoke at the conference (all louisiana physicians) were top notch speakers and i got a lot out of their talks. i do love the local colloquialisms, though. one urologist kept making me smile when he referred to urinary incontinence as "losing water."

and new orleans is one of my all time favorite cities on the planet. we went to a (very muddy) jazz fest on saturday and saw "simon and garfunkel" and "better than ezra" and a couple local bands. totally fun.

and we ate po boys (shrimp, crawfish) and boiled crawfish, fried green tomatoes, beignets, and chargrilled oysters, to name a few. num.

i have been SO BAD in not posting lately. stay tuned for a conversation on mexican folk medicine. i did an internship way back when with migrant farm workers (most of them mexican) and learned a lot about traditional treatments. so crazy cool...and i think you might find it interesting, too. so stay tuned.

Tired of McSurgery ready for a McBreak

well, it's been a loooooong week. i've been working the afternoon shift (3-11:30) and i've been scrubbed pretty much the entire shift every day until today. long cases. tiring cases.

lots of discussion of health care reform. these heated debates around the OR table are welcome relief from the mind-numbing tedium of some of the cases. and then other cases have been harrowing emergencies where we all hold our breath the whole time.

when i get home i stay up late and never entirely catch up on sleep. i also never see the BHE on weeks like these, which is suck. and my brain hurts.

so instead of writing something informative or sophisticated as is my norm (ahem), i will simply share w/ you an article i found on McDonald's menu items from around the world. i was recently having this discussion w/ someone and i contended that some McD's serve beer and they said that was impossible, and we went around and around on the subject and we ended up digressing into Pulp Fiction quotes.

some of these are just fascinating- i would really like to try a McLaks but probably not a McSpaghetti.

This Really Does Play Out

i have a PA student right now and so i'm busy giving her lots of good career advice. like h'eh.


http://scienceblogs.com/insolence/2006/05/how_to_choose_a_career_in_medi.php

Flavored Ice and Family Updates

these are two things we need more of in surgery.

one of my wonderful grandfathers had major surgery this weekend and is doing quite well (praise God!). but again being on the other side of the mask made me realize that we have some room for improvement in the care we give our surgical patients and their families.

being starved sucks and we need to be more aware that checking a diet order on a form has a great impact on someone's mood and well being. and "ice chips" do moisten otherwise parched lips, tongue, and throat but are otherwise just annoying and awful. if only we could make them onion ring or cheesecake flavored- that might be more satisfying.

and when a family is waiting anxiously during a surgery on their loved one, frequent updates (calls from the OR to the waiting room) are SO helpful in curbing the terror that creeps up in your chest.

more soon. i've been slacking in my posts lately. it's been crazy what with my gpa being in the hospital and i'm on the floor this week (BOOH!) and i have a PA student (COOL!), and we're having weekend guests and yada, yada, yada.

more soon. for reals.

(but PS, real quick- SO GLAD I WENT INTO MEDICINE! feeling very fortunate that i was able to both assist with my care when i was the patient last august and also that i have been able to be a resource to my family during my grandpa's ordeal. this whole (surgical) PA thing has paid off. and good timing too, huh?)

Roosters Aren't Allowed in Hospitals, Apparently

been taking lots of call lately. this means that outside of our regular shift (mine is 7a-3:30p mon-fri, we as a dept have to cover all the nights and weekends for all the scheduled and emergency cases. we split up the call, and you can usually take as much/little as you want. mama wants a new pair of shoes (living room furniture, vacations), so i'm taking more lately than usual.

i was on call all last weekend (friday night through monday morning) and worked into the wee hours of sunday night/monday morning, so i started the week kinda tired. and then was on call again last night. i got called in at 11:30, stayed until 1:15, drove the 20 mins to get home (cuz they won't call me back again for sure!)...got into bed about 1:35 and was just falling back to sleep...when i got paged again at 1:45. got back in my car, shivering in the now sub-30 degree weather and was back at the hospital scrubbed from 2:30-4:00....when finished, i dragged myself upstairs to the call room to get a little bit of sleep before my normal 7am day shift started.

the call room is in this very centrally located (so loud!) area and it's always too cold or too hot and there's rarely fresh sheets/towels and the bed is this flimsy little twin bed and...it's always the greatest sleep of my life. by the time i get to it, i'm so desperate for sleep and entirely drained, i'm looking more like a wandering mental patient than a useful PA.

so i slept hard from 4:30 and on through my alarm up until 7:40 when i was paged to come to the OR for my first case of the day. WHAT?! so i frantically tried to unscramble my brain and make sense of where i was and what part of the day it was and where i needed to be. fortunately, we had a little staff cushioning today so i was able to shower and eat and relax for a while before getting into my cases...but i ended up scrubbing 2 long cases and doing admissions and other stuff all day. i stayed pretty clear headed, if not a bit discombobulated.

on a side note, the emergency cases were genuinely urgent and we may have saved lives, or at least, vital organs. it's exciting and stimulating to be in on things like that. even if it is in the middle of the bloody night. (so to speak).

so now i'm home. i indulged in way too much of all my favorite foods (i deserve it! leave me alone!) and my plan is just to watch movies and lie around all night.

greatest feeling ever.

I Plan to Start Smoking, Eating Bacon Cheeseburgers and NOT Dealing with Those Funky Looking Moles

everyone is talking about the health care reform. are we all panicking at the hospital? not so much. but is everyone a little disgruntled about it? well, sure.

here's a pretty good run down of the bullet items on the bill.

cheers.