Mar 02

What does one write when one’s life lacks significant events. True, as you can see in the Kritik section, I’ve been cross-country skiing, I’ve been appreciating the arts, I’ve been busy. Most of life’s best moments are not earth shattering.  I’ve gotten back into the grand scheme of things, which is probably not good for my health, in that I’ve been quite busy at work, especially doing almost entirely Surgical Oncology and some large challenging tumors, but that makes me tick. It’s everything else, including the agony of sorting out politics with the hospital and other doctors, all of whom, myself included, possess too large of egos for their own good.

 

It is true that I’ve been doing a moderately large volume of breast cancer surgery. A week ago, I resected a right sided poorly differentiated retroperitoneal liposarcoma, including right colon, kidney, ovary, and some liver, taking me about 2 hours, without any help save for the surgical tech on the case. I simply could not get a partner, nurse assistant, or anybody else to help. Fortunately the patient is doing well. She weighed about 105 lbs before surgery, and weighed 84 lbs. afterwards. It was about a 20 lb. tumor. Today, I had the help of one of my partners, doing a left retroperitoneal liposarcoma. I was able to save the kidney, but took left colon, distal pancreas, spleen, and greater curve of stomach, besides the tumor itself, about 10-15 lbs worth of blubber. This took about 1-1/2 hours, with only about 300 ml blood loss.

You can see the spleen on the top, colon below, but the pancreas behind all that yellow fat that’s tumor. The photo of afterwards shows a void…

I’m trying to show the cut edge of the pancreas, which I stapled across, and then sewed over with 3-0 silk Lembert sutures.

 

These tumors typically would have had to go up to Seattle in years past, and usually be managed much more poorly than I would do on one of my worst days. Using one of my partners, I’ve been able to do a number of laparoscopically assisted transhiatal esophagectomies, all in under three hours, with the patients all doing well. Strangely, as you get older and better at surgery and make better judgments, you also burn out easier, and get exhausted earlier in the day. Then, you have to face the hospital, that treats you a little less than dog excrement, which is great for helping you maintain humility, but terrible for you acquiring any sense of self-worth or pride in your accomplishments. It leaves me progressively closer to just wanting to through in the towel…but…I love surgery and doctoring. There must be an alternative in this profession.

 

I’ve spent time tackling large volume books, which will not turn over book reviews quickly, the current being Tremper and Longman’s “Introduction to the Old Testament”. I am slugging my way through Thomas Friedman’s “The Lexus and the Olive Tree”, and should have a review of that out by the end of the month.  Other books that I’m working through are not reportable, including

 

Both are wonderful repetition for developing German fluency, though I would learn German better by just spending a few months over there, like daughter Diane is currently doing.

 

Toward the end of the month, I hopefully will have done my first Century (100 mile bike ride), assuming that weather permits. You’ll get a report on that.

 

Meanwhile, I just learned that one of my very very best friends was recently stabbed with a knife in the operating room used on a patient dripping with Hepatitis C. How terrible can a person feel about his best friend? Suddenly, he is at an enormous risk of acquiring Hep C from the patient. Why can’t lawyers or politicians or administrators experience terrible, life-threatening events like this on a daily basis? Maybe they wouldn’t be so hard on docs. Each event like this makes me seriously reflect on the craziness of our profession…  We have had authority removed from us doctors, which was given over to hospital administrators and clipboard nurses. Decisions must now be made by the team. We cannot reprimand a hospital employee for messing up. It is our fault, always. Patient rights have assumed such a high priority, that it restricts any ability of a physician to protect himself. Just try to check if somebody is HIV positive without first asking their permission. If they refuse to grant you permission, you are not released from any obligations or responsibilities in their care. Like my dear friend, a re-think of our entire role in medicine is occurring. I have no idea where I will end up.

 

And to my very best friend, have a nice time in Paris with your wife and kids. I’ll pray that you not actually get Hep C, and that your time in Paris will inspire you to new and higher ventures.

 

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