In February of this year, Carmen Tarleton underwent one of the most successful face transplants yet. Today at The Verge, Katie Drummond has penned a must-read feature on the story behind Tarleton’s facial transformation, complete with photo, video, infographics and diagrams.
Many rural hospitals are receiving notices or are anticipating retirement plans from their general surgeon(s). This has been expected, yet has been overshadowed by the struggle to recruit and keep primary care providers. All areas of the United States will suffer a shortage of general surgeons now and in the future, yet rural areas will bear the brunt of the shortage. There are many reasons for the problem but most focus on supply, demand, overspecialization of the specialty, and lifestyle factors. We must also consider the fact that in rural locales, other surgical specialties are not typically available to help meet demand. As an example, an urban-based physician may primarily practice as an ENT, yet be able to fill in the work schedule with other surgical options that cross over into what is typically general surgery domain in rural areas. So.. what has changed?
Up until now, removing brain tumors has been a fairly imprecise—and thus highly dangerous—art. Cancerous tissue in the brain looks almost exactly like healthy tissue, and being just one millimeter off is enough to permanently affect a patient’s quality of life. Plus, it’s almost impossible to tell if any post-surgery neurological damage is from the tumor or the surgery itself. Jim Olson, a pediatric neuro-oncologist, looked to an unlikely source to solve the problem: scorpion toxins.
Here’s a reason to leave any and all tonsil examinations up to the professionals. From an article last year in the journal BMJ Case Reports comes this anecdote about a woman who managed to keep a pen marinating in her gut for a quarter-century until doctors plucked it out..
As I have currently been completing one of my final surgery rotations — I think it’s time I introduce my audience to the real side of surgery, not what you see in Grey’s Anatomy, or House MD. Let me start by saying, this will be one of your most memorable experiences in your clinical years — it may be the only chance you will ever have to see a liver transplant, an open-heart surgery, a laparoscopic gastric bypass, or even a simple appendectomy.
If you want it to be, it can be an unbelievable experience, but it can also be quite intimidating. In the end, think of it as an opportunity to learn some basic concepts about surgery that will benefit you regardless of which field you chose to go into.
To start, there are four basic parts to any surgery: rounds, the operating room, clinic, and call.
It’s an old joke: a long line of people waits at the Pearly Gates as St. Peter slowly checks them in, taking an eternity. Little guy in a white coat shows up, carrying a leather bag, stethoscope around his neck. St. Peter waves him through. “What the hell was that?” someone asks. “Why does that doctor get cuts?” “Oh, that wasn’t a doctor,” Pete says. “It was God. He just likes to play doctor once in a while.”
But it’s no joke. Whereas I don’t buy the “playing God” aphorism, I’ve had to make life-and-death decisions on occasion, and I don’t like it. I mean “life and death” literally: this person lives. That one dies. Saving a life is nice, and part of the job; failing to save one is horrible, yet inevitable. But deciding in advance — looking at a situation and concluding it best to let things go, or choosing to render help when the outcome might be regrettable — is a responsibility beyond understanding. Maybe it also comes with the territory, but who has the roadmap?
Bowel infarction is a good example. Dead bowel happens for a lot of reasons. Untreated, of course, it’s fatal. In operating, one may find — depending on the cause and the anatomy — a small segment of intestine the removal of which is not only life-saving but free of side effects; or you might find essentially the entire gastrointestinal tract dead and black. Removal in that case is possible, too, leaving the person entirely dependent upon permanent intravenous feedings. Or there might be enough small and large intestine remaining to handle oral intake with or without intractable diarrhea, with or without the need for complicated supplemental nutritional support.
And there you are, in the operating room at three in the morning, looking into a belly. No crystal ball, no outcome-prediction software; no moral counseling or ethics committee with two-cents worth of advice. What resources do you marshall; how do you decide whether to close up and deliver the bad news to the family, or to go ahead? Can you make a decision without interjecting your own moral values? Should you? Surely it’s conceivable that two people might make different decisions; ergo, it’s subjective. Who, then, has the right? Rarely, you may know enough about the patient to have an idea of what he/she would want. But how can you apply that when you’re not sure what kind of life will result from going ahead? Wrongful death? Wrongful life?
The picture above shows an awake left parieto-occipital trephine craniotomy being done.
Here the trephined bone is being replaced, normally we do not fix the bone with anything however in areas like the forehead the bone must be fixed to give a good cosmetic look.
So, now you’re asking — an awake craniotomy?
In neurosurgery, more complicated techniques involve awake surgery where the patient is not given a general anesthetic. When doing such surgeries, the scalp can be made to be totally numb by using local anesthetic, and this is usually well tolerated.
It all started the second week of May. I had this excruciating pain from just above the peri-umbilical region of my abdomen and the epigastrium which ran downwards to the right iliac fossa — it felt like the worse acid of my life! I was in pain. I couldn’t eat. I couldn’t sleep. It just hurt, hurt, and hurt. And being the stubborn medical student that I am, I still went about my days and just pretended to ignore it the best I could!
A few days later, the pain became a sharp burning pain localized directly at McBurney’s point. I knew exactly what was wrong, I had appendicitis. I performed the Psoas sign test, only to confirm what I had known already.
As stubborn as I was, I ended up wandering into the emergency room of a local hospital which surprisingly I had never stepped foot in before. The hospital staff was extremely friendly and took me in and treated me promptly even though I had no medical or health insurance of any kind.
The emergency physician was actually pretty cool, he reminded me of myself a lot! ..but then again, I do want to go into emergency medicine.
After a short series of tests and CT scans I was rushed into emergency surgery to have my appendix removed.
The surgery went well, except for the part where the anesthesiologist couldn’t wake me up immediately — but, not to worry, these kind of things happen from time to time. I ended up leaving the hospital a day later, feeling like a million bucks — minus the huge scars across my abdomen, and the post-surgery pain.
I didn’t think much more of my visit to the emergency room, and my subsequent surgery until all the medical bills started flooding in..
My jaw dropped, I couldn’t believe what the hospital wanted to charge me! The hospital wanted to charge me $2,000 just for using iodine during my surgery, so you can imagine how much all of the bills ended up coming to..
The bills for my surgery, hospital stay, and other medical expenses ended up totaling a staggering $40,000 since I didn’t have any medical/health insurance!
Did you know that medical bills cause 60% of bankruptcies in America. Knowing this, on top of studying for the USMLE, and trying to already find money to pay for medical school.. I just felt like I was doomed!
It all just made me stress out, and in turn freak out that much more! I was going nuts trying to figure out how to pay for such incredible bills on top of paying for medical school, and everything else — which ended up only leading me to get depressed, temporarily.
I searched far and low for a solution. I talked to the hospital. I talked to the billing representatives. I talked to the physicians. I talked to everyone.
And, guess what!!? It paid off!
I just got a letter in the mail — the hospital (Memorial Hospital of Carbondale), along with a few generous physicians, decided to cover my medical bills in full! I, Ziyad Nazem, am forever grateful to these kind souls, and would like to thank them from the bottom of my heart.
So, you see..
This, this is just proof, that the healthcare system really does work — you just have to believe in it.
I got a chance to see how the healthcare system works. I got a chance to feel it, and see what millions of Americans go through first hand — which was great, because now I know how we can change it.
If only, we could provide free medical care to everyone!