Saturday, May 30, 2009

SurgeXperiences No. 224

My First Time

Welcome, to surgeXperiences no. 224! SurgeXperiences is a fortnightly blog carnival that rounds up recent surgery-related blog posts and news items, with a couple of general medical stories thrown in for good measure.

As this is the first blog carnival I've ever hosted, the theme for this week is 'My First Time'. Thanks to everyone who sent submissions, and to those of you whose posts I've used without asking permission - thanks as well. Let's get cracking!

Virgin territory

Is there anything more exciting (or terrifying) than using a knife to reach into a part of a human being that you've never reached into before?

Bongi, from Other Things Amanzi, tells us about his first trip into submandibular gland territory, and how the experience still leaves him feeling nervous years later. He also tells a story about teaching a fresh orthopod to do an unassisted trache in ICU. This post is also a good example of why surgeons and anesthetists will never be the best of friends, in spite of all the time they're forced to spend together.

Dr Alice from Cut On The Dotted Line had a good post this week, about assisting and being taught by a very thorough but very patient vascular surgeon. For me, new and difficult surgery always reminds me of my violin-playing days, and the exhaustion I would feel after trying to get to grips with a new and difficult composition. Dr Alice must have been toast by the end of this day - but she handles it with her usual optimism.

In varsity, the only practical thing the neurosurgeons ever taught was how to drill burr-holes: a life-saving procedure used to relieve pressure on the brain caused by a bleed after trauma. Personally, I hope never to have to use the workshop's power-drill on a patient, but kudos to this Australian surgeon who recognised serious pathology and had the balls to do something drastic about it.

In this video Dr Barry Rich shows how he performs a no-needle/no-scalpel vasectomy. I wish I could offer something like this to my patients, who all seem to be terrified of any form of surgery. 911Doc from M.D.O.D. shows us what it looks like when a small-caliber bullet goes through a brain (don't worry - no blood 'n' guts, just an X-Ray). This post is also an impressive survival story.

Maiden Voyages

There were a couple of interesting articles this week on surgical simulators. The first comes from the Beeb, and tells of how a team of London surgeons first did a dummy-run of a carotid stenting using the Angio Mentor, which recreates a 3D model of a patient's anatomy using CT scan data. The question to ask is: are surgeons who practise on simulators better than surgeons who practise on humans? This post from Al Fin suggests they are. He also suggests that even apes can be trained as surgeons - an idea I've heard before. I remember one of my consultants at varsity saying 'You can train a monkey to be a surgeon, but that doesn't mean you can teach it manners.' I can't remember why he said that, but he was probably being disparaging about one of his registrars. He was an extremely unpleasant character.

Another new and fancy invention that I've never seen in this part of the world is the CardioARM: a robotic arm that can get into those hard-to-reach places in a very non-invasive fashion. I always wonder if a machine like this is going to leave me jobless one day.

Breaking The Ice

We all need people who have the courage to talk about things that are less than pleasant. This harrowing essay featured on The Kitchen Table was written by a trauma surgeon in Iraq - this is one of the most impressive submissions this week. The surgeon, John P. Pryor, was killed on his second tour of Iraq, and I suspect the world has suffered a loss.

Drunk people in a casualties are virtually always a pain in the ass. Most of the time I just wish they would go away and stop ruining my evening: I seldom think about what their behaviour will mean to them afterwards. The Annester, from No Cure For Stupidity takes a look at a severely intoxicated fifteen year old: it's the kind of thing you can only pray your own children never do to themselves.

People always ask me what I think of the latest influenza-or-whatever scare, and I always say the same thing: thousands of people die from various parasites and a particularly nasty retrovirus in Africa every day, and only a few isolated activist groups seem to be freaking out about that. The NHS Blog Doctor takes a look at this issue over here. In another post from 911Doc on M.D.O.D., we see what happens when resources get rationed. This is a story that seems so typically South African, I can barely believe it comes from one of the Lands of Plenty.

Rlbates from Suture for a Living puts what mus be a very painful topic for her into perspective with a reiew of an article on the risk of stroke during coronary artery bypass graft.

Ben Goldacre is one of my newest heroes - in this column in The Guardian he debunks yet another bit of media pseudo-science hogwash.

The End of the Beginning

There's so much negative said about medicine in The Blogosphere, it's a relief when people have good things to say about the profession. Ane from Meeting the Monkey and The Annester from No Cure For Stupidity talk us through the bad and the good, and tell us why they ultimately love their jobs - read Ane's account here and The Annester's here.

We all relate to patients differently. Pauline Chen thinks medicine brings out the mother in her, while Make Mine Trauma Struggles with the consequences of getting involved.

And then, two posts I've included for sheer funny-value: Mel Content from The Boerewors Emergency Medicine Chronicles tells us about his first day back at work, and Doctor Grumpy shares a terrifying rep encounter. Enjoy!

And that's SurgeXperiences no. 224 - I hope you enjoy the twenty-one posts above as much as I did!

Picture Credits

Virgin Territory
setting out on virgin territory in Greenland
Originally uploaded by rosieandelvis

Maiden Voyages
RMS Titanic
Originally uploaded by skipgoforth

Breaking the Ice
Arctic Circle, breaking ice and a polar bear
Originally uploaded by Steve from London

The End of the Beginning
Finish Line

Originally uploaded by andrew_mo