Sid Schwab, MD
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Latest articles
Physician voices
Clueless at the time, when I applied to medical school, I imagined myself one day making house calls, good ol' Doc Schwab, paid in chickens and pies, smiles, and blackberry jam. There I'd be, delivering babies on kitchen tables, patching…
Clueless at the time, when I applied to medical school, I imagined myself one day making house calls, good ol’ Doc Schwab, paid in chickens and pies, smiles, and blackberry jam. There I’d be, delivering babies on kitchen tables, patching up Old Lady Jones’s leg on the sofa, shaking out thermometers, and feeling foreheads. One of my roommates in med school was the son of such a doctor, although instead …
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From house calls to the OR: a surgeon’s journey and unexpected lessons
Physician voices
When I joined The Everett Clinic forty-two years ago, we were thirty-some physicians. The main campus consisted of what's now called the Founders' Building and a couple of parking lots. The building was industrial and off-putting, guiding patients to various…
When I joined The Everett Clinic forty-two years ago, we were thirty-some physicians. The main campus consisted of what’s now called the Founders’ Building and a couple of parking lots. The building was industrial and off-putting, guiding patients to various locations by way of colored stripes on the floor. TEC had just opened its first satellite office in Marysville and had negotiated an exclusive contract with a now-defunct health insurance …
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The demise of doctor-owned medicine?
Physician voices
Of the many thousand operations I did in my surgical career, most were life-improving rather than life-saving. To me, life-saving implies immediate or imminent risk of death: gunshot wounds, stabbings, gastrointestinal bleeding or perforations, punctured lungs, and cracking a chest…
Of the many thousand operations I did in my surgical career, most were life-improving rather than life-saving. To me, life-saving implies immediate or imminent risk of death: gunshot wounds, stabbings, gastrointestinal bleeding or perforations, punctured lungs, and cracking a chest in the ER for a stab wound to the heart. Potentially life-saving but less dramatic is removing a malignancy that, untreated or treated later, would likely have killed the person.
Most …
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How a ruptured spleen saved a life
Conditions and diseases
Let me describe what it's like to operate in a potentially disastrous situation. Notwithstanding having one's faculties and wits gathered and finely honed, being as in command of yourself as you can possibly be, it may test and demand everything…
Let me describe what it’s like to operate in a potentially disastrous situation. Notwithstanding having one’s faculties and wits gathered and finely honed, being as in command of yourself as you can possibly be, it may test and demand everything you can bring to bear. I’ve been in war, where I feared daily for my life. It’s not pleasant, but in some way you can get used to it. In …
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Surgical decision-making: Navigating catastrophic scenarios
Physician voices
"Musta been the ham sandwich," he said as he leaned onto the operating table and belched a couple of times. We were halfway through an operation, and Doug, my partner, didn't look all that good. I'd been in practice for…
“Musta been the ham sandwich,” he said as he leaned onto the operating table and belched a couple of times. We were halfway through an operation, and Doug, my partner, didn’t look all that good. I’d been in practice for all of a year, still greenish, and he, ten years my senior, was my guardian angel, my guide through the vagaries of the world of private practice, and the best …
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Navigating the gray area: a doctor’s perspective on treating a colleague
Physician voices
When I think of Big Joe, I see his overalls and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of…
When I think of Big Joe, I see his overalls and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of the earth, tough, stoic. And now, bright orange. My initial recommendation, while probably justified, damn near killed him. Big Joe hadn’t been sick a day in his life. He worked …
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Big Joe: living proof of a surgeon’s fallibility
Physician voices
I didn't know her name until it was over, much too late. What I knew was she was thirteen and that on this winter day, someone in her family had been pulling her behind their car on a sled. No…
I didn’t know her name until it was over, much too late. What I knew was she was thirteen and that on this winter day, someone in her family had been pulling her behind their car on a sled. No doubt laughing and looking in the rear-view mirror, the person driving had whipsawed around a corner, and the young girl — probably screaming (fear? delight?) — held onto the sled …
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I didn’t know her name until it was over
Conditions and diseases
High on my list of favorite operations was surgery on the stomach: The anatomy is neat, the re-plumbing alternatives clever, technical challenges rewarding, and, because it’s well-supplied with blood, complication-free healing is pretty predictable. Also, several procedures were invented by…
High on my list of favorite operations was surgery on the stomach: The anatomy is neat, the re-plumbing alternatives clever, technical challenges rewarding, and, because it’s well-supplied with blood, complication-free healing is pretty predictable. Also, several procedures were invented by and named for history’s pioneer surgeons, and it’s nice to feel the connection, heir to the discoveries and invention of the greats. Let me tell you about one of my …
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A surgeon’s favorite stomach surgery patient
Physician voices
One of the most dramatic changes from my training to the present is the nearly complete disappearance of elective ulcer surgery. (Reminder: as I've said before, "elective" means non-emergent, as opposed to unnecessary.) The revolution began with the advent of…
One of the most dramatic changes from my training to the present is the nearly complete disappearance of elective ulcer surgery. (Reminder: as I’ve said before, “elective” means non-emergent, as opposed to unnecessary.) The revolution began with the advent of drugs that effectively reduce gastric acid production and settled in for real when the relationship between ulcer formation and the bacterium known as H. pylori was worked out. I have to …
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A reflection on stomach surgery
Physician voices
Do you have any idea how beautiful you are? Well, OK; maybe for some it's were. Before you got a little thick in the middle, smoked, or even just breathed city air for enough years, or drank a little, or…
Do you have any idea how beautiful you are? Well, OK; maybe for some it’s were. Before you got a little thick in the middle, smoked, or even just breathed city air for enough years, or drank a little, or did a few drugs, there was a time — and maybe it’s still true — when you were knock-down, take-your-breath-away gorgeous. While operating inside a belly, I’ve often stopped working …
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Do you have any idea how beautiful you are on the inside?
Physician voices
Part 2 of a series. Read part 1. I realized I was entering into a process the rules of which were entirely separate from normal human interaction when it hit me that news of the lawsuit was in the newspaper…
Part 2 of a series. Read part 1.
I realized I was entering into a process the rules of which were entirely separate from normal human interaction when it hit me that news of the lawsuit was in the newspaper before anyone had had the decency to contact me. What kind of people act like that? Civilized behavior, respectfulness — in short, all the ways in which you’d think nice …
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Why must medical malpractice cases be devoid of decency?
Physician voices
In all my years of practice, my dad called me at the office only twice. The second was to inform me of a horrible family tragedy. The first -- well, I guess in a small way you could say it…
Part 1 of a series.
In all my years of practice, my dad called me at the office only twice. The second was to inform me of a horrible family tragedy. The first — well, I guess in a small way you could say it was the same.
“I hear you joined the club,” he said.
“What?”
I had no idea what he was talking about. I’d …
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Taking lawsuits personally: A surgeon’s first malpractice case
Physician voices
Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists. (By way of diversion, I'll add there were only two of them at the time, and they were both…
Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists.
(By way of diversion, I’ll add there were only two of them at the time, and they were both my favorites. Practical and canny, surgical-patient-wise, they were a pleasure to work with. Over the years we developed great mutual respect and affection; to the extent that caring for critically ill and deeply …
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A relationship between a surgeon and an intensivist
Physician voices
Palliative surgery is tough stuff. Nobody wins much, and it often challenges one's ability to think clearly, let alone to tell the truth. Sometimes, I think, it borders on the deceptive; it makes me wonder who's the object of comfort.…
Palliative surgery is tough stuff. Nobody wins much, and it often challenges one’s ability to think clearly, let alone to tell the truth. Sometimes, I think, it borders on the deceptive; it makes me wonder who’s the object of comfort. And yet, when there’s nothing else to do, it’s often just the right thing. I hate it.
To be clear: We’re talking about surgery to relieve some sort of specific problem, …
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Palliative surgery: A surgeon reflects
Physician voices
The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you're still happy. What's so wrong with that? If I wanted…
The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you’re still happy. What’s so wrong with that? If I wanted to be miserable, I’d have gone into primary care.
When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with …
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Managing unhappy patients after surgery
Physician voices
Speaking only for myself (but guessing I'm not alone), I can say when a patient develops post-op problems, there's a strong tendency to deny it: not to deny there's something wrong; not to dismiss the patient's concerns or symptoms. Just…
Speaking only for myself (but guessing I’m not alone), I can say when a patient develops post-op problems, there’s a strong tendency to deny it: not to deny there’s something wrong; not to dismiss the patient’s concerns or symptoms. Just to grasp first at the less dire set of possible explanations. Maybe it’s just the flu, constipation, drug reaction. That sort of thing. It’s not about blowing it off — …
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For better or worse, doctors are human
Physician voices
One of the hardest things about being a surgeon is the inevitability of complications. It's true for any doctor; but with surgery, it's as if they are lit in neon and given a soundtrack. At least to me. Aiming for…
One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big …
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What goes through a surgeon’s mind after a complication
Physician voices
In my core, I always loved doing surgery, and being surgeon to my patients. As I hope I've made clear in my blog, I was always amazed that I was allowed to do it, and awed at the mysterious beauty…
In my core, I always loved doing surgery, and being surgeon to my patients. As I hope I’ve made clear in my blog, I was always amazed that I was allowed to do it, and awed at the mysterious beauty of it all. As much of a responsibility as it is, it’s also an inexplicably wondrous honor and privilege. Those words aren’t lightly written. But in a diabolical …
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The act of doing surgery will always be honorable
Physician voices
In trying to understand my own burnout, "control" (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I'm unearthing bones not already thoroughly analyzed. But I can give instructive personal examples. For a while…
In trying to understand my own burnout, “control” (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I’m unearthing bones not already thoroughly analyzed. But I can give instructive personal examples.
For a while I was on the board of directors of my clinic, which was then and is even more so now one of the most successful doctor-owned and -managed in the US. During …
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Physician burnout: The additive effect of bureaucracy on the psyche
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