I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes.
I wasn’t …
The time I almost got fired for saving a young woman’s life
On September 4th, 2014, iconic comedian and TV personality Joan Rivers passed away due to complications following what seemed to be a routine visit to her gastroenterologist.
Up until now, a wave of speculation and mystery has surrounded her case with a trove of unanswered questions. What happened on that tragic day? What kind of procedure did she have? Was it a dangerous surgery? Who was in the room?
On October 16th …
After Joan Rivers: How we can make patients safer
We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter — and who can ask for anything …
Having children during medical residency: 6 tips to survive
I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the …
What medicine can learn from the Secret Service failure
The term “Golden Age” seemed to permeate multiple domains in the 1950s, almost to the point of triteness. The field of cardiac surgery, however, deservedly earned the term as pioneer after pioneer introduced innovation after innovation that advanced the specialty. Walter Lillehei in Minnesotta, Wilfred Gordon Bigelow in Toronto, William Chardack in Buffalo, and Ake Senning in Stockholm were just some of the trailblazers of that era.
The four surgeons also shared …
Innovation in cardiac surgery: When doctors worked with engineers
When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?”
When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?”
When you steel yourself …
We owe it to our patients to put on our game faces
Watching my first below-the-knee amputation on my surgery rotation, I felt a curious mix of revulsion and detachment. The woman on the operating table had a gangrenous infection that had spread across her foot. Her long history of smoking and her delay in seeking medical care meant that she had stiff, black toes by the time a surgeon first saw her. The only treatment was amputation.
In the operating room, the …
A ritual to recover the empathy toward bodies we care for
A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours.
Nighttime cholecystectomies were converted 11 percent of the time vs. only 6 percent for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay.
The study, published online in the …
Cholecystectomies at night: Are they safe?
Part 3 of a series. Read part 1 and part 2.
The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. “Ho hum,” says a lawyer who read my first two posts in this series. “Get out the violins.” It’s as if, because I make my living operating on …
Patients are doubly screwed by the malpractice system
Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.”
— Abraham Verghese, MD
The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, …
What a student learned: Medicine’s hidden curriculum
What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, …
Perioperative team training: Can we learn from basketball?
I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance …
When is it right to share our personal struggles with patients?
Anesthesiology used to be a job that was attractive for people who don’t like patients very much. The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done. Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the …
Anesthesiologists have to start to truly care for patients
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An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.
A doctor’s self-worth can be tied up with a lot of issues.
How well can we make a diagnosis?
How elegantly can we perform the surgery?
How happy are our patients? Our staffs? Our families?
How many articles …
Fall in love with medicine again
In September, Doximity, a closed online community of over 300,000 physicians, released its ratings of residency programs in nearly every specialty. Many, including me, took issue with the methodology. Emergency medicine societies met with Doximity’s co-founder over the issue and echoed some of the comments I had made about the lack of objectivity and emphasis on reputation.
I wonder if it is even possible to develop a set of valid …
Can surgery residency programs be ranked?
Admit it, we all do it. All physicians check their quality ratings on the various online sites. If the site allows comment, we read the comments. If we get a bad rating, we try to figure out who was the patient.
Isn’t that the chronic back pain patient who was addicted to painkillers and got mad at me because I wouldn’t renew …
Physician ratings reward doctors in narrow practice
Residency life.
I don’t talk about it much, and that’s on purpose. Here’s why: My life is wonderful. I really love it. Is it perfect? No. Is anyone’s life perfect? Definitely not. I would never wish to portray my life in a negative fashion and certainly not to wish for sympathy. I would talk about it in an informative way, but even …
What I wish I knew: Advice for spouses of doctors and residents
Recently, NPR published the results of a study confirming that removal of both breasts (a double mastectomy) fails to improve the chance of survival compared to breast conserving treatments for breast cancer. The headline of the story was “Double Mastectomies Don’t Yield Expected Results, Study Finds.”
This finding is not actually news to informed physicians. Since the 1980s, there has been widespread recognition that both mastectomies and lumpectomies offer an …
The nuances of breast cancer surgery don’t fit in a headline
The other day, I got into an argument with my parents about choosing wedding décor — and I blame it on my surgical training. My parents had borne the brunt of the work for the previous eleven months. allowing me to focus on my elective surgery rotation, flying to fellowship interviews, publishing my first article, and putting out the types of …
The problem with wedding planning when you’re a surgeon
I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today.
Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a …
A case that illustrates the good, the bad and the ugly of American medicine
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