Month: March 2018
Difficult Conversations
I’m a trauma and critical care surgeon. I deliver bad news. It’s not one of the perks of the job, but it’s one of the very important parts of my job. I have seen it all. The full spectrum of emotions: shock, sadness, terror, fear, rage. You name it, I’ve seen it. I say this because I thought I understood it….the emotions, the feelings my patients’ family members have when I deliver bad news. I’ve been less than gracious in my mind when I see families “falling out” at the shock and horror of losing a loved one. Everything changed September 2, 2011. I will never forget the phone call from my brother-in-law. As I raced to the hospital across town from mine, I cried. Something was seriously wrong with my sister. My car literally ran out of gas before I could park in the emergency lot (yes, I’m one...
“Dear Pat” responds to a “Feeling lost, Surgical Mom”
Dear Pat, I just returned to my clinical rotations after completing my research years in the lab and having my first child. Before I left for the lab I was planning on a career in Cardiothoracic, Transplant or Vascular surgery. Now as a new mother, a lot of the attendings I work with have suggested I consider “lifestyle” specialties with more controlled hours. Am I being nearsighted in my specialty choices? I love being with my family, but I feel I have come too far to make career choices based primarily on “lifestyle”. However, I do not want to pick a specialty based on “ego” either. Part of me wants to prove everyone wrong -- but will my children and family pay the price? Feeling lost, Surg Mom Dear Surg Mom, There is no right time to have a child(ren). Regardless of when you choose to start a family, childbearing...
The Myth of the Young, Healthy Physician-in-Training
Surgical residents are in an often unrecognized position—encouraging and reminding patients to see their primary doctor for regular preventative health tests and cancer screening. Rotations on various surgical services provide an opportunity to discuss injury prevention and substance abuse issues (trauma), smoking cessation (vascular), obesity (bariatrics), and various cancer screenings, especially breast and colorectal cancers. Indeed, every rotation brings a new challenge of mastering the proper cessation and screening guidelines for a particular surgical patient population. Despite having an important role in preventative health for surgical patients, surgical residents are among the most at-risk young health professionals for neglecting preventative health care needs, at times delaying or even ignoring their own age-appropriate vaccinations and family history-directed cancer screenings. In a systematic analysis of resident well-being, residents were found to have lower self-rated mental health scores and well-being that the similarly aged population norm (Raj 2016). Residents were also found to...
Sati’s Surgery: An Exploration of a Surgeon’s Vulnerability Through Kuchipudi Dance
In Greek mythology, Chiron, the master of the healing arts, suffered an incurable wound from Hercules’s arrow. Carl Jung referenced the centaur’s fate when he developed his famous “wounded healer” archetype, using Chiron as his inspiration for understanding how one’s own pain drives our desire to heal others. It was during my surgery rotation that I began to understand the impact of this shared vulnerability on both patient and physician. A small, thin incision was drawn across the patient’s neck. I watched from behind the patient’s head, retractor carefully held in place as the thyroid slowly came into view. Four hands worked seamlessly, dissecting away the tissue holding the organ in place. Suddenly, the blood started to pool. There was some whispering from the surgeons: Why is she bleeding so heavily? The two surgeons peered in closer. The culprit was a bleeding vessel which gave everyone a sense of relief...
A Surgeon’s Scope of Practice
For the 18th year, March has been dedicated to Colorectal Cancer Awareness. Since the mid-2000’s, we have seen a rapid decline in the incidence of colorectal cancer, mainly due to the early detection and removal of polyps during colonoscopy, and an increase in screening. However, the disease will still affect 1 in 22 males, and 1 in 24 females during their lifetime. At a time when colorectal screening is of utmost importance, there remains competition for which providers perform the endoscopy: the surgeon or gastroenterologist? As a General Surgeon, endoscopy is an integral part of my practice. Endoscopy is a field that was developed by surgeons. I believe we possess an advantage over other endoscopists since we routinely visualize the colon anatomy during surgery. During abdominal surgery, we are allowed the opportunity to see variations in anatomy, like colon length, redundancy of the sigmoid or transverse colon, the angles of...
Too Young to Have Colon Cancer?
We all have that anecdotal story that changes our practice. We read the literature and pretend we are data driven until we have a patient with a complication, or see the crazy zebra diagnosis that makes us paranoid or concerned, and changes our practice. For me, as a colorectal surgeon, it was a gastroenterology colleague who was anemic. A bit tired and run down, she eventually went to have a colonoscopy after several months. The cancer in her colon had already spread to her ovaries. But she isn’t the only story… How many times have I heard the story from a patient with rectal bleeding diagnosed with hemorrhoids without even a rectal exam? How many times did the change in bowel movements get ascribed to irritable bowel disease rather than getting a colonoscopy? How many times did I need to see a patient under the age of 50 who waited...
9th International Women in Surgery Symposium – Realizing the Quadruple Threat
I had the privilege of attending the 9th Annual Women in Surgery Symposium on February 16-18, led by Dr. Sharona Ross and Dr. Patricia Turner. The Women in Surgery Career Symposium started 9 years ago in Dr. Ross’s living room as a way to provide professional and academic development for women surgeons and to inspire those pursuing a career in surgery. The theme of this year’s conference was the Quadruple Threat: Clinical Excellence, Confidence, Character and Charisma. Clinical Excellence was present in every aspect of the conference, from the session on Friday evening where upcoming changes in healthcare, billing and coding were discussed, to the Sunday morning session moderated by Dr. Sandra Wong on quality outcomes. The session focused on patient satisfaction, the importance of online reviews, and the value of ERAS and NSQIP to improve patient outcomes. Dr. Paula Ferrada led a session for students and residents on how...
In the Moment
I had reached a point when I knew that something had to give. I could no longer listen to the constant “would haves/could haves/should haves” and “when I become a______, when I reach______, when I no longer ______, when I finish______” that screamed in my mind drowning out the potential to fully participate in life at hand. The opportunities to fully engage and experience the here and now were increasingly lost. “Live the actual moment. Only this actual moment is life.” – Thích Nhất Hạnh Serendipitously, I was invited to spend three days immersed in a mind-body facilitator course with a group of multidisciplinary professionals from several colleges at the University of Cincinnati. The training, lodging at a beautiful rural hotel in Amish country Ohio, and gourmet meals were free (supported by grant funding). The catch? Commit to facilitating at least one 9 week Mind-Body Skills course annually for professional...