Left brain week. Right brain weak.

All right, three drafts started and nothing finished. My brain seems to be engaged in the left hemisphere this past week. The right side is apparently lying dormant, out to lunch, gone fishin'.

I got all of my tax prep completed and off to the CPA dude. Who BTW looks exactly like the Family Guy with blonde hair. I watched an episode last night, and today while we looked over what I had brought him, I couldn't look directly at his face without an incredible urge to burst into laughter. For those of you who don't watch The Family Guy, Peter is naked at some point in just about every episode. So, who say's accountants aren't funny?

Here's an off beat quote typical of Peter.
Bonnie: Somebody save him, he can't swim!
Peter: Oh, he's not even kicking. Kick Joe, kick.
Lois: Peter, he's a paraplegic!
Peter: That doesn't mean he can't hear. Kick Joe, kick!

Well, until my creativity decides to return, I'm off to fill out a Uniform Residential Loan Application.

Do the Robot

Well, technology has finally caught up to my town. Not one, but two area hospitals have purchased the DaVinci . In casual conversation with surgeons I haven't found anyone who professes to want to use it. I hear it is great for suprapubic radical prostatectomies and no, I haven't talked to any urologists lately. Then again, how many rad prostates are done in a year? How giant is the learning curve? And how quickly can the team open if there is trouble? Another example of hospital administration spending everyone's money but their own on a behemoth that could well take, hmm how many years......well possibly, never to pay for itself.
Which brings me to the real point, for myself anyway. If, and that is a big if, this little multi-million(?) dollar piece of technology does catch on, where does that leave me in my role as first assistant? I thought laparoscopic surgery was boring (don't tell the bariatric doc I said that). It's going to be no fun at all if my only role is to exchange instruments in the cold dead hand of a robot.

Thought before dinner

I'm not on call tomorrow.
But I haven't worked today!

I didn't work yesterday and
next week, one orthopod is away.

Tonight is my last chance
of the last days three,

To do what I love the best
and get in some surgery.

O.R. Funny of the Day

I work with four orthopaedic surgeons now. Two of them are very intense. One is outwardly even tempered but has been known to go off on an occasional tantrum. The fourth one is super laid back and has a sense of humor that I totally get and he cracks me up. Today, during our last case together, I mentioned that one of the other surgeons called me by his wife's name once during a case. I thought that it showed that he was comfortable with me as an assist.

To which he replied, "That's nothin'. I told the E.R. nurse I was talking to on the phone that I loved her before I hung up."
photo credit
And, he was with his wife when he did it!

I can do that in my sleep......

Another week has flown by. I had an awesome, very busy week. Almost like old times. Scheduled cases all day, trauma all night.

Sunday night, just as I was getting ready to go to bed around 11:30, my phone rang and off I went to the hospital. Assisted the trauma surgeon until 0330 Monday morning. Then another trauma surgeon who happened to be on ER (general surgery) call that night, asked me if I wanted to help him on his two cases to follow. He and I both had cases that morning at 0730. We got done just in time to head off to other hospitals.

I had five ortho cases to assist on Monday. That evening I got home around four thirty. I fixed myself a grilled cheese sandwhich and some tomato soup, one of my favorite gourmet combinations. I settled into the recliner with my food, a warm fuzzy blanket and the cat. Next thing I know, I am trying to aspirate a mouthful of grilled cheese! What the hell! Seems I was so tired that I actually fell asleep mid-chew. As if that wasn't enough, I did it twice. I finally decided I was more tired than hungry and gave up on the food.

photo credit

Stolen! Lucky Underwear

Found this link at ATM. Want to post today but I am feeling lazy. Maybe later. Meanwhile stealing this was easier, and more fun.

Your Lucky Underwear Is Red

You're confident and bold, and your lucky red underwear will only make you more sure of yourself.You have a great zest for life, and you tend to take on impossible goals - and succeed. When it comes to love, it's hard for you to take the time to open up. You're too busy conquering the world.So if you're looking for a little more romance, put on your red underpants. And see where their passion takes you!

What Color Is Your Lucky Underwear?

When it comes to love it's hard for me to take time for anything, I'm always working in an O.R. somewhere in town. Maybe I should start wearing my lucky red's under my scrubs. Except with my luck, my passion will take me to another O.R....wrong type of passion! Can I have both?

Actual photo of me in my reds.......baw haw haw!

Welll now........inn't that spatial.........hmmmm?

I was wishing for some general surgery. Well, the other week, I got what I wished for except, it came in the form of laparoscopic surgery. I also got my wish to work all day. Started at 0730, ended at 2100. Lap chole, revision gastric bypass, revision gastric bypass, ORIF distal ulna (different surgeon obviously), then back to join the bariatric surgeon, revision gastric bypass, and exploratory laporoscopy with repair of internal hernia.
There is something about laparoscopic gastric bypasses (or revisions of) and bandings that I can't seem to grasp. Pun fully intended. Perhaps it is the fact that I am on the patient's left side. When I am on the patients right side during a lap chole, I have very little trouble knowing where my graspers are and directing them without direct visualization. Put me on the other side though, and I am a spatial retard. Perhaps it is the fact that I am reaching across the patients upper abdomen. I am starting to figure out that if I look at (the outside of) the patients belly and aim towards the Nathanson liver retractor, I will be in the general area or at least be able to see the tip of my grasper come into camera range. The bariatric surgeon is kind to me and says that it is hard because I am working opposite of the camera. I have absolutely no idea what he means by that, but I'll take it.

Speaking of the camera, it is in my other hand, the left one, as I fumble around with the grasper in my right hand. My job as camera person is to provide the surgeon with a clear visual field without wobble or extraneous movement while keeping the area he is working in, in the middle of the screen, being careful not to come in too close nor too far away with the camera. If that sounds easy, it isn't. At least not at first. I still occasionally drift off and start looking at things I find interesting which isn't anything the surgeon wants to see. If you sense the surgeons movement you will sometimes gain a clue that you are in improper position with the camera. If he is squinting and leaning forward, you are too far away. If he is doing a sort of ducking stance and looking up at the screen as if he is trying to look under something, you are too low. Craning his neck to the left or right means you are too far right or left.

Since the patient is in steep reverse trendelenburg, or head up, my camera arm is sometimes locked in mid air with nothing to rest on. Being a bariatric patient they are often wide enough that I am sometimes accomplishing quite a reach between my camera arm and my grasper arm. It is a test of endurance for any one's left deltoid. I also often find my left foot going to sleep at the heel. Since you are operating in the upper abdomen, the video screens are at the head of the bed and your body is turned at about a 45 degree angle to the patient. Imagine someone laying on a table in front of you. Now stand at their left hip facing straight across the person's pelvis. Now turn your entire body so that you are looking over the persons opposite shoulder, or right shoulder in this case, and that is the approximate position one stands in in the assist spot. For some reason I tend to shift all of my weight onto my left heel and soon find it numb and tingly.

Another (assistant) side effect of laparoscopic surgery seems to be syncopal episodes. I have seen some bloody, gory stuff and never missed a beat, but put me in hours of intense laparoscopic surgery, and at some point I'm going to start to feel an episode coming on. By intense I mean prolonged periods of holding still. Holding the camera still, that bite of stomach you have in your grasper still, and holding yourself very, very still. All the while staring at a video screen in a darkened room. It all spells syncope for me. Fortunately I have never given in to the dark side. I have to look away from the screen, which can be tricky because everything but your eyes must remain put, or as I've said, still. I will take a quick survey of the clock, the anaesthesiologist, the circulator, the ceiling, the far wall, anything to get my brain disengaged, and then go back to the surgical field. The best advice I ever got was from a neurosurgeon who told me, as I was retracting a nerve root while he drilled, to remember to breathe. I am so intent on holding everything still, in neuro as well laparoscopic surgery, that I forget to breathe. Sometimes, just breathing will do the trick. I think this is why engaging someone in conversation also works, as I often hear anaesthesia say, "If your talking, your breathing."

By the end of the night, I was ready to go home. If you had given me five open abdominal surgeries to assist I don't think I would have been as wiped out. Another surgeon had come along and booked a lap chole to follow us when we had finished our line. He was waiting in the lounge for his case to start. I knew that at this time of night he probably had no assist. I felt guilty if I at least didn't offer, but instead I sat in the lounge with him as I decompressed from the day. He didn't ask, and the O.R. crew volunteered an extra staffer to scrub in with him. I hightailed it for home.

"Physician heal thyself"

Reading Bongi's post this evening I am reminded of a story that the Colorectal surgeon I used to work with relayed to a few of us in the OR. He prefaced the story by saying "I can't believe I'm about to tell you this, and I know I'll live to regret it."
That really got our attention and there was no backing out for him at that point.
Seems when he was a resident he had his own hemmorhoidal situation. Embarrassed to have someone else treat it, he decided he could do it himself. It involved a mirror and a syringe of lidocaine. In the bathroom, pants down and bent way over holding the mirror with one hand, he attempted to inject the the little bugger with the other hand. However, he missed. Seems he managed to inject his left testicle somehow instead.
He did live to regret telling us the story but only until we tired of referring to him with the obvious nickname "numb nuts."
And now, in his honor, here is a little song.

T.G.I. Monday

I only had one case Friday. A ditzel at that, calcaneal fx. Not that it wasn't challenging, just not very fulfilling for myself and, it is all about me. Didn't have any call Friday night or Saturday night. Didn't work at all this weekend. Well, not yet anyway. I am on call tonight for the trauma surgeon, the ER call surgeon and the ortho trauma surgeon. Despite the numbers, chances that I'll work get slimmer as the hour grows later. The weather also plays a factor. The colder it is, on a Sunday night especially, the less chance Sum Dood will be out in the streets creating juicy traumas.
Tomorrow however is shaping up nicely. Two total joints in the morning, one hip and one knee. I am excited because I believe we are using the Zimmer NexGen on the knee. Probably posterior stabilized but I'm not sure. It is the system I know the best though some will say it is not the best system. Then I rush across town for a sigmoid resection with one of my favorite surgeons. I have so many favorite surgeons. I am very fortunate. I am psyched to go to work every day. This week, I have even been chosen as assist over another surgeon on two occasions by two different docs. How totally awesome is that?

Don't shoot me, but....

After all of the pain, after all of the whining, all of the sleepless nights, torturous days and fearful thoughts, I feel so much better that I have decided to cancel my Thursday appt. with the Physical Medicine and Rehab Doctor. Bad Patient. I don't make this choice lightly, and I am not saying I will not seek treatment eventually, but I can do so on my own terms now that I am comfortable enough to work and sleep with minimal discomfort and seem to be improving daily. I even talked to three different surgeons and the concensus is , if they were me, and they felt better, they would cancel too.
I will probably follow a different course of treatment though. I think I'll go to the chiropracter. Just kidding! I will probably go and establish myself as a (bad) patient with my new Primary Care Physician (won't she be thrilled!), and go from there.

On another note. Worked two nights of call in a row. I haven't seen any call action in a long time and I've missed it. Even had a good talk with one of the ortho trauma docs. I have been telling him for the last year that he can feel free to call me when he needs help. I finally quit offering because he has never called. Last night I just happened to be at the hospital when he booked his two tibial nailings. I was actually hanging out for the general trauma surgeon. I made him ask me to help. I didn't offer. We had our chat, which he instigated, and he say's, for about the umpteenth time, that he will start calliing me. Maybe he really will now, because this time, he thinks it was his idea. You know how men are. Right now it's off to the shower before I'm called in again. After two nights of orthopaedics I'm ready for some general surgery.

Happy New Year!