Balls and Walnuts
more than you ever wanted to know
Category Archives: The Barbarous Craft
Of bubbas and pain
I wheeled my cart back to my car and watched a three- or four-year-old Mustang pull into a handicapped space. The placard went up, and then two apparently able-bodied people got out and walked without effort to the grocery store. No chair, no walker, no cane. No limp.
When we lived in Texas, it seemed like a month couldn’t go by that some bubba would stop me as I got out of our car and observe, “You ain’t handicapped.” The first one or two times, I would say (in my least friendly voice), “No, but my wife is,” and watch them furrow their brows at Karen. I suspect many of them would have liked to extricate themselves from their embarrassment by saying, “She ain’t that handicapped,” but even though she “only” uses a cane, it’s obvious to anyone with eyes that Karen doesn’t have an easy time of it.
Did we ever lecture these busybody bubbas? We might have. It’s hard not to be at least a little angry over the unfairness of being young and disabled, and if a target for that anger presents its mulish ugly puss, why not take the opportunity to vent? But it does no good. The bubbas don’t learn and we’re no less unhappy than we were before.
I would never dream of bitching someone out for parking in a handicapped space, provided he had a placard, no matter how able-bodied that person looked. I can control my inner bubba. I can do that because I understand something about disability: it doesn’t always show up in a person’s gait. Some of these people are in severe pain, and not all of them limp. Sure, there are a lot of limpdicks out there with placards they don’t deserve; maybe their mom or grandmother died or had an extra, or maybe they had an injury which has long since healed. But I can’t know that. Ultimately, it’s none of my business.
***
Wasn’t it Karen’s brother who looked at our placard and said, “Gee, I wish I had one of those”? Or maybe it was my brother. Or both of them. Anyway, there’s only one reasonable response to a dimwitted comment like that: “No. You don’t.”
I have a fading memory of someone’s spouse getting all wide-eyed, saying, “Gee, honey, he’s right!”
No duh.
***
My philosophy on this? It’s better to let the limpdicks slide than to add to the troubles of the folks who already have a pile of crap on their shoulders. The limpdicks are their own punishment. I used to have the same philosophy when it came to prescribing pain meds: better that a few drug-seekers should get their fix than for me to under-treat someone who really needed his pain meds. That was before the Feds started busting docs for over-prescribing. Yes, I can go to jail for doing my job. Isn’t medicine in the USA wonderful?
***
Nah, I don’t know where I’m going with this. Life’s unfair. Bubbas are assholes. Not exactly a news flash, is it?
Live blogging tonight, probably after 8 PST. See ya.
D.
To your health
Some years ago, a patient brought me this book (Rev. Heumann’s Family Health Book). It reminded me of the fine time I’d had in med school, hanging out in the basement of our library reading marital aid books from the 1920s. From time to time, I’ve considered collecting such books. Rev. Heumann’s book isn’t in good enough condition to be considered a collectible, but it’s still blogworthy.
As you can see, the cover is graced with the good reverend’s visage framed by a rising sun. The image communicates: Yea, God Himself has approved this tome. And if that’s not good enough for you, the first page tells us, “This book has been revised by a registered physician. New York, N. Y. February 1, 1935.”
Mine is a 40th Edition, making me wonder whether Rev. Heumann was even alive in 1935. His company surely was. Within the front cover is a blue tear-out to be used for mail order palliatives such as “Spasma Drops” (for asthma, three dollars a package), snuff powder (fifty cents a package), Insomol Tablets for insomnia (two-fifty a package), and Serasal Tablets (for “purification of the system” — two dollars a package). More ads are scattered throughout the text. Not only did Rev. Heumann sell drugs, he also sold appliances, like the one for bedwetters shown below.
Focus
I love these staged operating room photos. You’ll find one in the brochure of every general surgery residency across the country. Know what’s funny about it? The only time general surgeons turn the lights out is for laparoscopic surgery. Yup, this photo is 2% truth, 98% dramatic effect.
Senseless digression: While I was a grad student, my thesis advisor co-founded a software company whose product analyzed DNA sequences. The company wanted to run ads in Nature and Science and all the rest of the journals, so they commissioned an advertisement company to do a photo shoot in our lab. Why shlep electrophoresis rigs and micropipettes to a studio when the studio can come to us?
My advisor wanted one of our post-docs to “star” in the ad. The ad man looked us over and deemed us all too unscientific. He brought in a model — a dumpy, balding, pasty-faced man who looked like he had been raised in a potato cellar. We all got a good laugh out of that.
Back to surgery . . . and to that photo in particular. I suspect folks like these shots because they capture the intense focus of the operative experience. That bright light? That’s your attention. Everything else drops away into the shadows. It’s what many of us love about operating.
And then there are those of us who stress out over each and every case. Of course, the two states — anxiety and keen focus — can and do coexist. You try to table the anxiety and let the case itself dominate your mind.
One of the reasons you hear stories about a surgeon throwing instruments, screaming abuse, or otherwise acting like a four-year-old deprived of his Power Rangers fix is that something has upset his concentration. The surgeon has to stop and rally his attention once again. It takes effort. It isn’t fun. Operating is fun. Waiting for your scrub, circulator, or anesthetist to fix a problem is not fun. It’s annoying. And if it happens often enough, it affects patient care.
Sometimes I wonder if I don’t scream enough or throw enough instruments. Today, I had a wobbly microscope. When you’re looking at things under magnification, even a slight harmonic motion looks like an earthquake, and this was far from a “slight” harmonic motion. I asked my circulator to fix it, she said she couldn’t do anything until after the case, so I shut up. Afterwards, when I complained about how irritating it was, she said, “You didn’t say anything else about it, so I assumed you were fine with it!”
Grrr. Maybe I should do like my son does. If he doesn’t get a question answered, he repeats it until it does get answered. It’s an effective technique.
For the most part, though, the focus was good today. It was a relief, too; it gave me several hours in which I didn’t need to wonder if I was being a total creep for making my friend in Santa Rosa wait ANOTHER month for my decision, didn’t obsess over the merits of this job opportunity over that one, wasn’t asking myself for the fiftieth time if I’ve done my family and myself a disservice sticking with this community for nearly ten years*.
I had better things to think about.
D.
*One of my friends in the hospital said, “People are wondering how you lasted this long.”
Layers
Today was bloody hot here in south coastal Oregon: 86F, a high for the state. Of the three positions I’m evaluating, Wunderground sez:
Santa Rosa, CA: 89F
Olympia, WA: 63F
Seattle, WA: 63F
If we decide in favor of Washington, weather will be a huge consideration.
Next week, I’ll be going to my interviews in Olympia and Seattle. I was freaking out earlier today about clothing. What should I wear? My nurse anesthetist, whom I used as a reference, told me they asked him all the usual questions (does his head explode on a regular basis; have you ever seen him kill a man with his bare hands — you know, stuff) and they also asked, “Does he dress appropriately to work?”
“I don’t know,” Bill said. “I only ever see him scrubs.”
Which is, if you think about it, the right answer from your nurse anesthetist. But it got me thinking: do they care about clothing that much? My God, what should I wear?!
I left a message with the recruiter. He called me back a little while ago and told me to err on the side of conservatism. If I were an orthopedic surgeon, I could show up in shorts and a Hawaiian shirt and they would still want me; ENTs are in demand, but not so rare that I could get away with that sort of nonsense. Suit and tie, he recommended.
So I scrambled to find my suit. I recalled the coat being in good shape, the pants not-so-good, and I was right. These pants are so thirty pounds ago. When I put them on, I look like a balloon animal that’s been squeezed in the middle.
“You HAVE ANOTHER SUIT,” Karen said. I insisted I didn’t. She insisted I did.
She was right, of course.
By now, I had stripped down to my briefs. I pulled on the pants (which are tight, but not nearly as constricting as the other suit pants), put on the coat, and buttoned the top button, creating a plunging V which showed off my salt-and-pepper chest fur.
“Take a picture of me,” I said to Karen. “This looks good enough to blog.”
“I don’t get you. You’re freaking out over what to wear, but you’ll put an absolutely humiliating picture of yourself up on the blog.”
“I’m a man of many layers.” Which is true, but I suppose the CEOs of the hospitals who might hire me should find that out in small doses. “Anyway, what I really need is a white suit.”
“A white suit. Uh-huh.”
“And a pastel tee-shirt.”
“I see.”
“No. You don’t.”
They would have to hire me.
D.
Radiofrequency uvulopalatoplasty for snoring
Yeah, you read that title right. Sometimes I feel motivated to make a public service announcement. Not often, but sometimes, and tonight’s the night. And since the chances are pretty good you (or your spouse) snores, I figure I won’t lose too many of you with a relatively serious post.
This first bit is for my malpractice insurance carrier:
I am NOT offering medical advice; I am merely providing information. Read the disclaimer. It has flashy things and animated buttons to keep you entertained.
Another note: my victim patient, Jeannie, has given me permission to use her images in these blog posts. Wasn’t that nice?
Look, she’s even smiling about it.
Follow me below the fold for a discussion of snoring, obstructive sleep apnea, and the use of radiofrequency uvulopalatoplasty to successfully treat snoring.