Reflections in a Head Mirror

What do we mean by patriotism in the context of our times? I venture to suggest that what we mean is a sense of national responsibility ... a patriotism which is not short, frenzied outbursts of emotion, but the tranquil and steady dedication of a lifetime.
-Adlai Stevenson  


Late, as usual, I rushed from the Operating Room to the Cancer Center clinic, mentally going through the checklist of tasks needing attention. I pushed open a hallway door and ducked between the chairs in one of the Center’s waiting rooms, heading toward another door that would bring me to the work area.  

Suddenly, I stopped short.

Instead of the usual groupings of patients reading, talking, or resting, I realized that everyone — patients, family members, nurses, clinic staff, and physicians — was looking upward, focusing on the waiting room televisions. Some of the people nodded or commented quietly to their companions, but they never took their eyes from the screens mounted high on the walls above them.  

For there, on the televisions throughout the hospital and the rest of the world, a new President of the United States was being inaugurated.      

As I stood with my hand on the door, I reflected on how rarely events in the outside world are able to bring things in a hospital to a near-standstill. A couple of previous moments have come close:  

During my fellowship in Houston, I was working on an experiment in a research lab the morning of Jan. 28, 1986, the day the space shuttle Challenger was lost. I can vividly recall the anxiety and profound sadness felt throughout the institution. It was days before the pace of work recovered.  

Years later, I was in the middle of performing a neck dissection the morning of Sept. 11, 2001 when the attacks occurred on the Pentagon and the World Trade Center. As the events unfolded, I finally had to ask the helpful anesthesiologist who kept charging in every few minutes with updates to leave us alone so we could concentrate on our task at hand. When the case was finally completed, I was overwhelmed with the palpable sense of uncertainty that pervaded the building.  

Last week, though, the mood in the hospital was quiet but optimistic. I sensed that we all slowed down for a while — maybe so we would be able to someday recall where we were at that moment in history.     

Each of the clinics in our new Clinical Cancer Center has a solid, uplifting name like “Courage,” “Life,” or “Faith.” It was with no small sense of satisfaction, therefore, that I pushed through the doorway to go see my waiting patients, on this day of Mr. Obama’s inauguration, in the clinic called “Hope.”   

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The following is feedback received for this blog: I had an similarly profound morning during President Obama's inaguration. Or clinic was slow, as Tuesday mornings are. On a chance, I brought in my laptop, knowing that my doctor was not holding clinic. I was also hoping that my supervisor would allow me to set up my mac in his dictation area, allowing us girls a chance to catch some of the events while keeping atop of phones and patients. She took a little pursuading, but I knew whe really wanted the oppertunity also. I recieved a yes. I had a really unusual experience, getting quite caught up in the moment with a few coworkers that I do not usually see eye-to-eye with. They shared a couple "hallaujah's" with me that day, and even a few tears. I was allowed to"break the rules" and the resulting effect was somehow very satisfying. For me on that day, I had already experienced a little change and hope. - Karen

Reflections in a Head Mirror was a finalist for "The Best Literary Medical Weblog" of 2008! I did not win, but was tremendously honored to be included among blogging peers like Notes of an Anesthesioboist, On The Clock, other things amanzi, and Running for My Life: Fighting cancer one step at a time. The top vote-getter in my category was Ronni Gordon at Running for My Life.

The finalists are listed here and the winners in all of the categories are listed here. Congratulations to all of the winners, especially Ronni!
 

"Men fear death as children fear to go in the dark; and as that natural fear in children is increased by tales, so is the other."
-Sir Francis Bacon  

Anatomy Lab is a rite of passage that no physician ever forgets. Human dissection begins during the first days of medical school. Unspoken questions well up. What does a cadaver look like? How will I react? How will I ever remember everything? What if I can’t deal with working on a dead body?

A cadaver feels more like cold, moist, heavy fabric than a person. The color is all wrong and the tissues are firm and unyielding. As the dissection continues, many of the features that we recognize as being "human" are lost, although the contours and the scaffolding remain. Three decades later, I have vivid memories of the intricate anatomy of "our" cadaver.

Each year, I try to spend a few afternoons helping students perform Head and Neck dissections while demonstrating surgical procedures and discussing clinical illnesses. The questions are earnest and the students stump me regularly. As we all ignore the fact that a dead person lies on a table between us, we discuss everything from cancer to cosmetic surgery.

Over the years, I had learned to disconnect the cadaver from the person. That attitude changed abruptly when one of my cancer patients announced that he had donated his body to Science. He hoped fervently that he would "end up in a cadaver lab teaching medical students." I congratulated him, and hoped, fervently, that he would not. I marveled at his gift and thought of him often after he died just a few weeks later.

When classes began the following August, I approached the lab with dread. How would his presence change my ability to teach in this most unnatural of environments? I made the rounds through all of the dissection stations, stopping at each but always looking to see who was on the next table. It was eerie and a bit unnerving. 

My patient was not one of the cadavers and I suspect his prior surgery made him unsuitable for a place on one of the tables. Nevertheless, I have approached the Anatomy Lab with a different attitude ever since.

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The following is feedback received for this blog: I'm a first-year medical student and we're well into our cadaver. I'll admit that during dissection I don't really connect to the cadaver as a person, although ironically we do get closer to them, physically, than any spouse of 50 years ever could. We are the only ones ever to run a finger down their spinal cord or azygous system of veins. Inevitably though, hours after the dissection when the books are closed for the day, I feel grateful for the people who have donated their bodies for our education. It's a privilege to see the content of an anatomy text as the real content of a chest cavity, and their gift is not taken for granted. -Bill Ragalie Hi Dr Campbell - I am sorry about the loss of your patient. Being a doctor has to be a calling because I sure couldn't work on cadavers, but thank God for all the people that do. It is admirable that people donate their bodies. Even that bothers me and I feel guilty for saying it. It sounds like your patient and you had a good relationship and no doubt were mutually blessed with the encounters. Speaking as a patient...it means a lot to have a caring and compassionate doctor. I have written about my doctors, how important they have been. I could not imagine going through all the urological issues I have if it weren't for the wonderful care of my urodoc, partners and their staff. I know it is shop talk and you get desensitized around things that would give most people pause. It is interesting how life events can change our perceptions, continually teaching us a new lessons. Your post was beautifully written - SeaSpray seaspray-itsawonderfullife.blogspot.com

I think that I shall never see
A list of posts so fun to read. 
The writing’s sharp and never dull
Because the topic’s surgical!
The stories come from many lands
And emanate from surgeons’ hands.
So whether doctors cut or write
The anecdotes should bring delight.
So, with a basic theme of “trees,”
We’ll tour the world now, if you please.    



In Africa, the baobab
Grow stout and old, but never drab.
Doc Bongi’s stories make us pause,
We read and often drop our jaws.    

Bongi’s submissions this week provide an insight into how triage is done when too many people show up with stab wounds (hint: it has to do with whether the the puddle of blood on the floor is expanding), and why Africa is both exasperating and captivating. He also shows us a happy lioness (and why she is happy). Finally, he tells a story about breaking tragic news to a family after a drunk runs down two young boys.  



Australian trees we might discuss
Include the famed eucalyptus
Med student Jeffrey gives us links
That show he reads, and writes, and thinks.  

Monash Medical Student, Jeffrey Leow, provides great surgery-related reading this week! He links to blogs about an orthopedic surgeon in Kenya who needs to do a risky spine procedure which he has never before attempted, a comment on the impending shortage of surgeons, a gallery of REALLY dreadful celebrity cosmetic surgery outcomes, a nice discussion on the difference between plastic surgery and cosmetic surgery, and a quick summary of how to irritate a surgeon, written by an ophthalmologist’s family member.    

Monash Medical Student also provides some links to recent surgery-related articles of interest. For example, he provides links to stories about an operating room fire in Taiwan, a donated cochlear implant procedure at UCSF for a young Iraqi boy who was deafened by a US missile strike, a spooky (if true) story about a plastic surgeon who apparently claimed to power his SUV with reprocessed human fat which taken from patients during liposuction, and a day in the near future when doctors will be able to reach any place in the GI tract either through the mouth or else, you know, the other end.  



In Arkansas, the trees renew
Magnolia, dogwood, redwood, too.
It’s also where Ramona tucks
And quilts, and writes, all done deluxe.  

Suture for a Living provides some great surgery-related posts! I never knew this definition for “bottoming out” before. She also tells of a polar-exploring Russian physician who did his own appendectomy! (Here is a link to other “self-surgeries” by physicians and non-physicians.) I loved the listing of the top surgically related posts that she provided in 2008.  

Other posts which she submitted this week are remarkable. Here is a tribute to several U.S. military physicians who have been killed in Iraq. She provides a moving essay written by a physician in South Asia who struggles whether to operate on a patient with very advanced cancer and little support. She also provides a link to an essay by a junior surgical resident who diagnoses appendicitis and gets to do the surgical procedure … you can feel the young doctor’s excitement!  



The patients’ blogs are strong as oaks.
Their stories brim with angst and jokes.
This week, they’re kind to all their docs
When surgery works, it really rocks!  

Here are submissions from patient-bloggers. Karon Flinchum talks about her experiences with bariatric surgery. (Here’s a link to a patient-blogger who underwent bariatric surgery at our hospital, as well.) A satisfied Lasik surgery patient also leads discussion on his blog.    



I live Up North where it is cold,
Each Fall, the trees are red and gold.
But now, the days are short, you know,  
The leaves are gone, replaced by snow.  


Even though these posts were not submitted, I enjoyed them very much and wanted to pass them along. Aggravated DocSurg hits the nail on the head in a recent post about getting “bumped” in the OR. Edwin Leap waxes both poetic and surgical in an essay on the joys of opening an abscess (among other things). Dr. T. also waxes poetic, this time about the beauty of the vocal cords (I would have to agree with her, by the way.) Dr. Val has a reflection on medical mistakes. I also include my own post on how Surgery is a form of Dance. Finally, I loved two non-surgical posts this week: DB's essay about why physician-teachers need to be thoughtful when they work with medical students, and Tony Miksanek's reflection on the Seven Reasons Why Doctors Write. All of the essays will give me much on which to reflect. 


One last stanza:  

So, now, the list of links is wrapped.
My poetry’s completely tapped.
And friends, I beg, PLEASE NEVER PRINT!
“But, why?” you ask. Well, here’s a hint:
I hope you’ll always read on-screen
Because that habit is quite Green,
'Cause blogs are made by fools like me
But only you can save a tree.              


That's it! My apologies to Joyce Kilmer. Thanks to Dr. Rob for encouraging and inspiring medical bloggers to write in verse. Thanks for visiting!


SurgeXperiences is a blog carnival about surgical blogs, wherein surgical experiences are shared. It is open to all (surgeon, nurse, anesthesia, patient, radiologist, pathologist, etc) who have a surgical blog or article to submit. The next edition of SurgeXperiences (215) will be hosted by Jeffrey Leow at "Monash Medical Student" on Jan. 18, two weeks from now. Be sure to submit your post via this form.

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The following is feedback received for this blog: What a delight! Thank you so much for this post. I will carry the memory of each of these stories (and that fabulous prose narrative) with me as I see my daughter through her surgery over the next couple of days. It will make my stay in hospital (my LEAST favourite place) more palatable as I remember these accounts :) GBU Wonderful poem / edition! - rlbates http://rlbatesmd.blogspot.com/

The natural flights of the human mind are not from pleasure to pleasure but from hope to hope.
-Samuel Johnson  


The Christmas letter we fear each year finally arrived.  

The family that sends this letter includes a friend from school — one of those friends that we were close to decades ago but haven’t seen in years and only connect with at the holidays. She sends a card each year describing the family progress in a newsy letter. At the bottom, she always includes a couple of neatly penned sentences telling us “How nice it would be to get together again” and “Please stop by if you are ever in our part of the country.” The picture shows the family, the dog, and all of the kids, now nearly grown up. Usually, there is a mountain in the background and the whole family is arm-in-arm, smiling. They are a handsome, active, and accomplished bunch.  

Despite this, as soon as the letter arrives, we scan down the page with trepidation. You see, the woman in the family, our friend, was diagnosed several years ago with breast cancer. We know none of the details, but, each year, amidst the reports of children’s accomplishments and family trips, there is always some brief glimpse of the specter that walks with them. Here or there, we spot things like: “Despite the treatments, I was able to keep up with all of my volunteer activities,” or “A few cells were discovered on a new biopsy a few months ago,” or “The small tumors apparently are enlarging.” Despite this, each letter contains a list of upcoming events and goals. Those few words overwhelm the page.  

When the envelope arrives, our thoughts fill with a mixture of relief that she lives and anxiety that she continues to struggle. Her smiling face looks up at us from the family photo.

It has been years — a generation, really — since we spoke or spent any time together, yet we are touched and renewed each year by her message of hope and resilience. We look forward, anxiously, to next year.

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The following is feedback received for this blog: Dr. Campbell, I found your blog through WhiteCoat & Seaspray & I must say you write exceptionally well. I sincerely look forward to reading your posts. - Mottsapplesauce http://dmefile13.wordpress.com This post reminds me of 2 situations: I have a similar letter which hits my doormat every year from a buddy in Wisconsin. In the past 18 years, Christmas was the only time we corresponded. Fortunately, a few months ago, I discovered him on facebook. We now correspond more frequently! The second occurrence was a card I received some years ago, where the name of the husband was not shown. Since the card had no return address and I knew the "friend" had moved on, address unknown, I had no way of finding out what had happened. It was very disconcerting. This year's card had an email address on it. I'm back in touch ... hurrah. - Jabulani I'm glad your friend is alright this year. She sounds like an amazing lady. :) Beautiful post. - SeaSpray seaspray-itsawonderfullife.blogspot.com