Who Let the Dogs Out?

Wow! What a difference a month makes. Things have accelerated this month like crazy. By tomorrow at days end I will have assisted on 40 cases in the month of October. All this before the winter ski/snowboard/MVA/domestic violence/drunk driving season. You will almost never hear me say this but, "I want a day off!" It's those 0730 starts every day that kill me. I'm a night owl dammit!

Trick? Treat?

It has been a very busy two weeks for me. I have had no time to get claims out or answer emails or lurk much on my fav blogs. I did catch the October Calendar Docs over at Addicted to Medblogs. As I had hoped, Oct. featured the bad boys of M.D.O.D. The badder they are, the better I like 'em! Safety in the annonymity of cyberspace. Etotheipi has given me a new perspective on Pathologists. Actually, my perspective didn't change.....it has just been confirmed. (See my comment in Calendar Docs part one).

M.D.O.D. is by far, the most entertaining compilation of blogging docs. If only there were a way to produce their essence in Hollywood with some high powered sit-com producer like Bright/Kauffman/Crane (Friends), or Castle Rock Entertainment (Seinfeld). I think they would be a hit. They could replace Scrubs , which is sadly in it's last season.

Trauma Hopes and Dreams

Word's finally getting out that I am serious about assisting for the trauma service.

I volunteer to be on call to assist the trauma surgeons anywhere from 5 to 7 nights a week. There are five surgeons who know they can call me whenever they are on. Most traumas that come to the OR, with perhaps the exception of some ortho trauma, are indigent. Victims of the notorious "SumDood" never seem to have health insurance or for that matter, a job. I can't bill Medicare or Medicaid or the (state? county?) indigent health fund. Put it all together and you'll see that my reward is not monetary. I do it because I love it. I do it because every surgery reveals a new technique, another anatomy lesson, a chance to fix or remove what's broken, torn or punctured. I like to participate in restoring a bloody misshapen mess back to neatness and order. My scheduled cases pay the bills, trauma cases are all about the adventure.

About a week ago, just after midnight, I was called in to assist on a stabbing "victim." I had not intended to be available that night, but I could not refuse. Lucky for me, or maybe more appropriately, as fate would have it, the trauma surgeon who was working that night is Chief of Trauma Services. I had expressed my interest in working in some (or any!) capacity with trauma services to him about a year ago. Perhaps a hospital paid position of some sort. My vision includes staying in-house, being the liaison between the ER and OR, relaying accurate information between departments and expediting surgery starts by helping the OR crew get set up and ready, assisting on the operation, whether it be as a first or second assistant, and doing whatever I can to help post-op. I'm sure he had all but forgotten about my year old inquiry. Since that time, there have been indications (from my Favorite Trauma Surgeon, who said he will recommend me) that some sort of position may indeed be forthcoming, and it may well be a position that I qualify for.

"Do you come in a lot?" Asked the Chief, as he explored the first gaping wound to see if the knife had penetrated the peritoneum.

"It depends on the surgeon on call." I replied.

I was able to rattle off the names of three of the five trauma docs who call me on a regular basis before the conversation was interrupted. I wanted to steer the conversation back to the original topic but, I have learned the hard way that sometimes less is more when I want to illustrate a point.

The peritoneum spared, we irrigated and closed one complex abdominal wound, and one not so complex. He thanked me for coming in and we said goodnight.

The next day my scheduled cases were scattered around at three different locations but I ended the day at the trauma center. I was on call with my Favorite Trauma Surgeon (F.T.S.). Around 1830, just as I was about to wrap it up and wander home, the trauma pager went off so I headed up to the trauma bay.

I don't know if this season has begun in other parts of the country, but here the depression is already overflowing. Almost a parallel to the holiday shopping season which seems to begin before Halloween these days, the Winter/holiday blues now start in the Fall. Our trauma is an attempted suicide by shotgun that managed to miss everything vital on that side of the face, but due to the damage intubation is not a viable option and airway is an immediate issue. We need to set up for an emergency tracheostomy. Off I go to the OR where we have bumped an ortho case. The room is already opened because we will use the ortho set up for drapes and sponges. The scrub has added a trach tray. I call the anaesthesia assistant and I drag the difficult intubation cart and the trach cart into the OR. I explain the truth of the situation to the Anaesthesiologist, dispelling the rumors which have made their way to the OR quicker than I could. The circulating RN has everything in place. I go out to the control desk to meet the ER crew and my F.T.S. as they roll in with the patient.

We are underway with the procedure when in walks none other than Chief of Trauma Services. He is here not to scrub in but rather to document the wound. First I think nothing of it but then I realize that he is seeing me with one of the trauma docs that I mentioned to him just the night before. His attention is on the extent of injuries and not on me, but I know that he knows I am there. He knows that I am serious, and he knows that my F.T.S. really does rely on me. And I feel as if I'm one step closer to that rumored trauma services position. All trauma all the time, with compensation! Talk about a dream job.

surgeXperiences 106

Due to time constraints (and perhaps a lack of imagination!) the format of this edition is more practical than clever. Since October is Breast Cancer Awareness Month, I begin with a few posts on the subject, from informative to personal.

Thanks to all contributors. Here's to continuing success.

Much like the wire itself, Mammorable patient, posted by Sid Schwab on his blog in Sept of '06 has migrated to Medscape

Dr. Bates has two very informative posts on breast reconstructon. Part I, and Part II.

Orac of Respectful Insolence shares some of his views about breast cancer awareness month and an article from Time magazine which "...points out that dealing with breast cancer in the rest of the world is a much different affair than it is in the U.S. and Europe"

A personal reflection from MedblogAddict. A touching tribute in memory of her friend who lost the fight against breast cancer. Related in three parts, A Kernel of Corn Beginning, Middle, and End.

Bits and Pieces

DR. J C posts on Brain Blogger and shares why he blogs anonymously .

Doris explains the two types of Plastic Surgery, and the latest from L.A.

Fit Buff has something for everyone. Here is a sampling in Morning Mix.

Plasticized has lot's of short tidbits that are fun to read. This one shows us how to chill after a face lift.

Foreign Affairs

Chris, an American Military Surgeon deployed to Iraq, shares with us his humble abode which he longs to get back to after 18 hours of fixing broken people.

From Dr Bruce Cambell comes a story of a non-traditional patient who shares a wonderful tradition.

Technically Speaking

Someonetc at Orthopaedic-residency shares a technique for sucessful percutaneous pin placement in Think Before you Shoot

Buckeye Surgeon makes a tough decision in a Tough Case

Emergency!

RugbyGirl MD presents a interesting case from the ER with a twist, so to speak.

911Doc shows us why vital signs are vital in Bread and Butter

Doctors in Practice

Here is a great post from T., the Anesthesioboist, about matters of the heart

#1 Dinosaur shares the progression of 18 Years of solo Family Practice

Here's a fun blog from Tommy ,a surgeon in training, featuring a cholangiogram and a special guest....

The Human Factor

A sad yet heartwarming article on Steven E. Kopits , miracle maker. Contributed by Hungarian Med Student ScienceRoll

Meet David as he shares his story of "Brian". A patient's perspective of maximizing control over his complex needs during hospitalizations, making his unavoidable experiences a little more tolerable.

That's Funny!

Karen, from Just Up the Dose, shares perhaps her most embarrassing moment in Tunnel Vision.

From my friend Bongi, here is an offering that is sure to create a visual for all to enjoy in Fashion Statements

Too Late to Classify

And, again from Orac, another visual which still leaves something to the imagination.

Thanks to Jeffrey at Monash for asking me to host. Be sure to participate in surgeXperiences 107 to be hosted by a Canadian medical student at Vitum Medicinus.

It's all fun and games until the election.....

This clip is making it's way around the blogosphere. I found it on Dr Luks orthopaedic blog. It's so funny, I was crying with laughter.

I found this link in my email in box.

Here are my top results.

1. Rudy Giuliani 40 points (What! I despise Republicans!!)

2. Dennis Kucinich 37 points (Who? )

3. Joe Biden 35 points (Are you serious?!)

4. Barack Obama 35 points ( Is he still running?)

5. Hillary Clinton 35 points (Isn't she married to someone famous?)

BTW, doesn't John Edwards look like he's hiding something devious behind that phony smile?

Karma

I've been neglecting my blog for a week or so. It has been a busy week. I have an idea brewing and hope to have it up this coming week. However on the days I'm not scheduled in the O.R., I am on either ortho trauma call, or general trauma call. WooHoo!

I leave you with a joke for now.....

A motorcycle patrolman was rushed to the hospital with an inflamed appendix.

The doctors operated and advised him that all was well. However, the patrolman kept feeling something pulling at the hairs in his crotch. Worried that it might be a second surgery the doctors hadn't told him about, he finally got enough energy to pull his hospital gown up enough so he could look at what was making him so uncomfortable.

Taped firmly across his pubic hair were three wide strips of adhesive tape, the kind that doesn't come off easily. Written in large black letters was the sentence:

"Get well soon....from the nurse in the Jeep you pulled over last week."

Be nice to nurses and they'll be nice to you!

Casting Call! SurgeXperiences 106

Sorry, call for submissions is a day late.....I'm late for everything except work.

I am happy to host the next edition of surgeXperiences 106 on Sunday October 14th. Submissions are already rolling in. Keep them coming! You may submit here, or send them directly to me at makeminetrauma (at) gmail (dot) com. Deadline for entries is Friday, October 12.

Thank you in advance to all participants!

I know, the cartoon is not surgical but it is funny!

Enjoy the Show!

Take a peek at Suture for a Living and enjoy the carnival at SurgExperiences 105. A fun presentation by Dr. RL Bates.

Mistaken Identity?

For months now I have been referring to Suture for a Living's author as ribates! It finally dawned on me one day that this isn't her title. What follows is my apology!

I am a bit dyslexic. I remember the correct numbers, but in the wrong sequence, I always have to pause and do an air sketching before I write the letters d or b, or I will invariably place the half circle on the wrong side of the stalk. I even type dyslexic, you is usually yuo, and is adn, etc.
And..... I read things incorrectly over and over again until one day, something makes me concentrate a little harder, and I see the written word in an entirely different context, sporting a whole new meaning. Such is the case with your name.
Since the beginning, I have read your name as ribates, I have often wondered what does ribates mean? Hmmm....must be Latin. I pronounce it ree-bah-tees in my dehydrated brain. Even googled it hoping for enlightenment but got a hodgepodge of results.
It's a wonder the spelling/grammar police never corrected me! Or, no one even noticed, except me, finally, some three months later.

(In the voice of the Pathological Liar) http://videos.matchdoctor.com/4132/Jon_Lovitz_-_The_Pathological_Liar.html
Sorry for the past er...uhm....typos. Yeah, that's it......typos, that's what they are. Typos, that's the ticket.

R L Bates, oh now I get it! So much easier to pronounce and it makes sense!

Tagged!?

Yikes! I've been tagged by Karen of Up the Dose. I'm pretty sure I can come up with 8 random(?) facts about myself, but I'm not so sure I can come up with 8 fellow bloggers to tag who haven't already been tagged. If I tag you and you've already been there, done that, I apologize in advance but maybe you could humor me!

The rules:

1. Post these rules before you give your facts.

2. List 8 random facts about yourself.

3. At the end of your post, choose (tag) 8 people and list their names, linking to them.

4. Leave a comment on their blog, letting them know they've been tagged.

The facts:

1. I once was a weapons qualified, gun toting, armoured truck driving, on-call, ATM money restocking guard for a small, private company.

2. The longer I work in health care, the more obsessive my OCD becomes. I am now questioning how sanitary it is to reuse those plastic produce bags (I'm a big recycler) after they have had "dirty" produce in them. In a restaurant, my silverware either remains on the napkin, or rests on the edge of the plate. If one touches the table, I won't use it.

3. I eat salad with a spoon. BTW, I could fill up a whole page with food rituals.

4. A friend, and at the time, boss, helped me build a home-made camper shell out of plywood for the back of my very old F-250. I still own that truck. (Bless you and yours Tom H.) I then lived in it one very cold winter in the parking lot of the truck stop where I used to work. I've also lived in a late 70's model Toyota Corolla with a dog, during a very cold winter at a truck stop in Midland, Texas. I have since discovered the pleasures of indoor heat and plumbing.

5. I used to love to fly. Within several years after airline deregulation, I developed a fear of flying. I do not consider this a phobia as phobias are based on unfounded or unreasonable fears.

6. The most inspiring message I have seen/heard since......? This video, thanks to Kevin, M.D. , featuring a lecture from Professor Randy Pausch. I take away a renewed determination to become a Physician Assistant.

"The brick walls are there for a reason. The brick walls are not there to keep us out." " The brick walls are there to stop the people who don't really want it badly enough."

7. I live with a dog, a cat, and two horses. My cat snores and my dog doesn't. I'm not sure about the horses. The cat says I also snore. The cat is a liar.

8. I think Halloween is a very scary holiday. I find it unnerving when I see adults driving around in the daylight in full costume presumably for some holiday celebration at work. If we see someone blatantly hiding their identity any other day of the year, say in a ski mask or the mask of a dead president, everyone would be highly suspicious but on Halloween all bets are off! And yes, before you ask, clowns also freak me out a little.

Well, that was the easy part. NOT. Now for eight people to tag.

First, I think I will tag WhiteCoat. I have recently discovered his, or her blog (I am never too sure anymore thanks to #1 Dinosaur !). This is well written and humorous and on my list of daily blog rounds.

Next, ER Tech Dude. Also newly discovered to me.

Number three, Jeffrey at Monash. Thanks for promoting med blogs through Surgexperiences.

Half way there. Rob and his distracible mind now that he seems to have landed permanently in his new URL.

Number five. Ten out of Ten Don't know him well and he may not play, but what the heck.

Ribates. She seems like such a gentle soul. I would love to know more about her.

Two to go....I would love to tag Scalpel but he already bared all as Dr. September, #1 Dinosaur, also interviewed as Dr. August, the interviewee, Addicted to Medblogs, recently meme'd.

I stumbled across this blog and instantly enjoyed it. I hope she has time to respond, we'll be patient. Welcome Surgeon Girl.

And now, number eight. I have procrastinated long enough. He can be cynical and sarcastic, caustic at times, clever and cunning, he tells it like it is, holds nothing back, and he both fascinates and terrifies me. Like a moth drawn to the flame, a bug to the bug zapper, Britney to rehab, I dare to tag 911 Doc.