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Welcome to the latest edition of SurgeXperiences, the fortnightly carnival of blog posts related to surgery.

I am doubly honoured to be your host today. I am the first Indian medblogger to host this international surgical blog carnival and I am the first radiologist to do so.

Many thanks to Jeffrey Leow, the creator of SurgeXperiences and Ramona Bates for allowing me to host this edition.

It is not often that a radiologist is welcomed into the midst of surgeons [and some surgeons make you aware of it ]

The operative word here is “welcomed.” I say so because the relationship between surgeons and radiologists in general is very complex. I compare it to a couple who have been married for decades. But the blogosphere’s most famous surgical blogger Sid Schwab, said it best in a comment that he made on one of my posts a while ago.

“I suppose my relations with radiopods was testy at times. Can live with ‘em, can’t live without ‘em. And vice versa.“

Sadly, Sid doesn’t blog anymore. More is our loss. Perchance if you are new to the medblogosphere and haven’t come across his blog,  you can try some of  his best posts here in this sampler that he has left for just the likes of you.

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I had given a lot of thought to setting this edition to a surgical theme, but I gave up because I’m not creative enough to link the disparate submissions into some grand unified design. I’m at my best when I see things in black and white (and shades of grey), so I present the submissions in a loosely organised fashion…

The Operation Theatre:

bongi, the medical blogosphere’s most intrepid surgeon who works in the notorious province of mpumalanga in south africa sometimes has to orchestrate everything in the operation theatre.

Lana Nelson the Sooner State Surgeon, a new entrant into the world of blogging, writes about single incision laparoscopic surgery aka no scar surgery.

Øystein Horgmo posts about how a Whipple procedure for pancreatic cancer that he was filming was deemed inoperable on the table.

Dr. Plitz aka Ant Ears recounts his experience with a run-of-the-mill appendicectomy where textbooks and skills labs fail.

Is live-tweeting a surgery an example of social networking run amok?, asks Janet Colwell in the ACP Internist. She was not alone. The twitterverse and blogosphere  were all atwitter over the appropriateness, or not, of this.

Here are some of the tweets: (via this site, which my Firefox browser warned me was an attack site - exercise caution in opening the link)

# Dr. Rogers places a laparscopic sponge on the defect created by the tumor and holds pressure for a few minutes#hfhor 8:50 AM Feb 9th from TweetDeck

# Dr. Rogers is using suture to stop any residual bleeding#hfhor 8:44 AM Feb 9th from TweetDeck

# The kidney is now completely perfused and no longer on clamp#hfhor 8:43 AM Feb 9th from TweetDeck

# Stacey Dusik is providing superb surgical scub assistance during this crucial portion of the case#hfhor 8:42 AM Feb 9th from TweetDeck

Personally, I think this is a bit over the top and I agree with Ramona that the Chief Resident, who was appointed (or forced to be) the official-twitterer, could have been utilized better.

Emile Cambry Jr of These Two Cents, a tech blogger, is ambivalent about this. After the initial enthusiasm, he raises an important question “I wish the program covered whether the patient approved of the public tweeting of the operation.”

Both the enthusiasm and caution were shared by the grand doyen of the medblogosphere, Kevin MD.

Proving the point that you don’t need new-fangled Web 2.0 technology like twitter to be innovative in the OT, Buckeye choses to go the literary way. He does his OR Dictations à la Hemingway and Beckett. Excellent stuff. If I could, I would award him a Pulitzer for the most original OR reporting.

Being a Surgeon:

People in high life are hardened to the wants and distresses of mankind as surgeons are to their bodily pains. G.K. Chesterton.

though it happened years before he became a surgeon, experiences such as this seem to have prepared bongi to face what life (and the poorly run state hospitals in his region) threw at him, alone.

Rambodoc, probably the most famous Indian medical blogger, opines on that great intangible, surgical experience; and asks if a HIV positive surgeon should be allowed to perform surgeries - a compelling post. I liked this line the best…

Where does a surgeon’s right to privacy end and the patient’s right to know begin?

Many thanks to Rambodoc for submitting a bunch of surgery-related posts from his eclectic blog and my apologies to him for not including all of them here. I urge everyone to explore his excellent blog. I love the way he plays with words. Here’s a sample from another post about a difficult patient…

Immortality is an invisible stain inherent in human actions and thoughts.

A consultant (at whatever humble level I practise) does not get his hands dirty. Today, I am not shy to say this, I had some of her puke on my hands. I must say that I have done far worse: shaved heads and pubes, pushed wheelchairs, got my dress mucked up with blood and pus, and removed thousands of maggots from the festering sores of drug addicts, beggars and alcoholics.

An American medical student who has travelled to Sydney, Australia for her neurosurgery elective writes about the excitement of Surgeries…

It is amazing to watch him and it is even better to be able to assist him…. At 10pm he finally asked me if I wanted to scrub in - what a question! He could have asked me at midnight and I still would have said yes! During the day I got a little upset, because I am not blond and not skinny… and those girls seems to get more attention and chances quicker…. But at some point it was my turn, and I loved it!

I loved the “blond & not skinny” jibe. The surgeon must’ve fit the stereotype to a t, like bongi or Rambodoc

it’s not always blood, sweat, swearing and toil for surgeons. escape from the travails at work is just a short ride away for bongi who choses to spend his down time at the exotic kruger national park.

Anaesthetists:

“Of all medical specialists, an anesthesiologist is probably the least likely to fall apart or ‘bail out’ in a crisis situation.”

The above quote is from a letter that the American Society of Anesthesiologists sent to the producer of Grey’s anatomy that T, the Anesthesioboist mentions in her post about the depiction of Anesthesia in the Movies.

Eish Diskakhi, a long-suffering South African anaesthetist turns to verse…

You may enjoy the anonymity and use it as a scapegoat for sloth and ducking responsibility….

You may enjoy ignoring the phone because you know it brings more work…

You may enjoy removing the phone off the hook because your sleep is then uninterrupted…

How corny, but what if that phone call is your life hanging in the balance?

…to vent his ire, lamenting the fact that people die everyday because of phones, lack of responsibility & lazyness.

Dr.Ottematic is not really an anaesthetist, just a 4th year medical student rotating through anaesthesiology, but her post about Communication & Conflict in the OR is superb!

Clinic & Wards:

DrB encounters a boy with a Boxer’s fracture in her New York clinic, where the father seems to have been expecting a diagnosis of chip off the ol’ block syndrome.

David Khorram, an ophthalmic surgeon in Saipan and author of Marianas Eye shows us a Dermoid from Hell.

Being questioned before visiting surgeons during ward rounds, is this medical student’s worst nightmare. Having seen a bunch of nasty surgical professor types as a medical student myself, I sympathize with Afiza.

Bruce Campbell aka Headmirror explains how he quells his patients’ apprehensions during The Pre-op Visit.

Radiology:

Sumer Sethi presents some MRI images of intrabiliary rupture of Hydatid cyst, the most common complication of Hydatid cyst of Liver.

Sumer is the only other radiologist blogger in India and the creator or Radiology Grand Rounds. I urge you to take a look at the excellent series of musculoskeletal MRI cases that he has posted recently in his blog.

Patients:

Ronald Thomas, a Britisher who had an Aortic Dissection is alive today thanks to surgeons’ expertise.

He made it to Glenfield Hospital where he was treated by Dr Leon Hadjinikolaou and his team – who are the best the world at saving people with the condition, called an aortic dissection. Almost everyone who is operated on by the team – 93 per cent – survives. This rate is higher than anywhere else in the world. [Amazing stats!!]

Chris Oliver, a Scottish trauma surgeon who underwent a bariatric surgical procedure (adjustable laparoscopic gastric band), celebrates his “second bandiversary” and wonders if a further band-tightening is warranted.

James Booth of The Scut Report, a medical student, got zap, zapped & LASIKed.

Robin of survive the journey, writes an excellent research-cum-personal post on bariatric surgery not being the answer for obesity and “hidden” Cushing’s syndrome.

Terri, a young mother is on her way to being healed after an outpatient surgical procedure to remove a bone cyst in her foot that was impeding the healing of a stress fracture.

My friend and neighbour George, a maxillo-facial surgeon in Salem, writes about one of his patients. A tragic tale with a heartening message. I encourage everyone to read his other posts. I’d say he’s the Indian equivalent of bongi. He’s that good - both in surgery and writing! Maybe better in the writing part, because he knows how and when to use capital letters

Luther, a young man with Crohn’s Disease writes short but expressive post about the difficult choice that surgery is, in an aptly titled post: Of Which We Shall Not Speak.

Neo-conduit, who as her name implies (at least to medical people) had a cystectomy and urinary diversion procedure writes about embarassing moments in the hospital.

News, Information & Recent Advances:

Examining Cosmetic Surgery: 4 Considerations Before You Go Under the Knife via Nancy Miller & Surgical Technician Schools.

In a related post, plastic surgeon Ramona is astounded that anyone would allow a non-physician to perform cosmetic enhancement “injections” in their home.

Sheepish from The Paper Mask diverts his ponderings on the recent bushfires in Victoria, Australia with some clinical content - Tips for dealing with major burns.

From Reader’s Digest (via Richman’s Ramblings) we have this inspiring story of American plastic surgeon Geoff Williams who corrects facial deformities in children in twelve countries including Mexico, Tanzania, Pakistan, India, the Philippines, and Taiwan. He has performed almost 1,000 operations, most of them since he started his International Children’s Surgical Foundation and he has no plans to stop.

Plastic surgery has been in the news a lot this fortnight thanks to the Oscar awarded to Smile Pinki. It brought tears to the eyes of Freakonomics author Steven Levitt, who saw the documentary much before it got the Oscar.

Killing Tumors, Without the Pain of Chemotherapy - via Nancy Miller & Radiography Schools.

Dr.P aka TBTAM recounts the tragedy of Jade Goody. Moral of the story: Don’t ignore your abnormal Pap smear report.

Jeffrey Parks, better known as Buckeye Surgeon in the medical blogging community offers us “another scintillating peek into the surgical literature” - a very practical review of three articles from the February 2009 issue of JACS.

David Gorski, the Managing Editor of Science-Based Medicine reviews a study that challenges a long-standing surgical dogma.

This study strongly suggests that neither bowel rest, NG decompression, nor the witholding of food is necessary after upper GI surgery as well, with the possible exception of esophageal surgery. Another surgical dogma appears to be on the verge of biting the dust in the face of evidence from well-designed clinical trials. Moreover, if this trial is correct, if anything, it suggests that immediate feeding is actually better than the old way.

The Wellcome Library are making their catalogue of historical medical and surgical videos available on Youtube - via Øystein Horgmo.

This news story of a retired hand surgeon in Virginia being charged by police for shooting a hawk that threatened an orphaned squirrel he and his wife had raised is replete with irony at many levels.

Yet another wrong site surgery story.

Australia’s Dr. Death faces manslaughter charges. Personally, I find the headline of the news article objectionable, discriminatory and misleading. Would it have been different if it was a British-trained surgeon who killed patients in America? What the guy did was wrong. Period. Doesn’t matter where he’s from or where he was trained. This kind of stupid sensationalism has to end.

The Thinking Surgeon:

No. It’s not an oxymoron. (Thanks again, Sid).

forced to work among colleagues like this and worse, it isn’t really a wonder that bongi is philosophical.

if i’m not there worse would happen, i tell myself. but somehow i struggle to believe my own spin

your fans (who are legion) believe you bongi, and don’t think of it as “spin.” and yes, worse would happen if you were not there.

Aggravated DocSurg starts off with some whacky Hard Sell as he talks about the difference between referring to people as “consumers” or “patients” when they interact with the health care system, but he ends with emphatic hard-hitting words. Words worth etching on stone and shipping over to all countries, including my own, which insist on redefining patients as consumers.

Although I am a small businessman, and have the tax headaches to prove it, my business is different than, say, selling shoes. It is my privilege and duty to care for people who come to see me —- as patients. There is a respect involved with that term which is absent from the term consumer, and which is important in maintaining the dignity of the individual as he or she interacts with physicians, hospitals, and other places where medical care is delivered. When we lose that perspective —- when physicians are seen only as “providers,” or interchangeable widgets, and when patients are seen only as “consumers” —- we will have totally lost any semblance of dignity as a profession, and by extension as a people.

Humour:

Dr. Val’s take on Social Media In The OR.

Samurai Radiologist - Things You Wish You Hadn’t Said in Noon Conference.

Surgeons love vestigial organs.

Placebo Surgery via VPmedical.

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The next edition

SurgeXperiences 219

will be hosted by Øystein Horgmo at The Sterile Eye on March 15, 2009.

Deadline for submissions is on Friday, March 13. Suggested theme is anatomy.

Please send in your submissions early via this form.

You can subscribe to SurgeXperiences via RSS feed or email.

An aggregated feed of credible, rotating health and medicine blog carnivals is also available.

Acknowledgments:

I appreciate all the help that I received from my friends Jeff & Ramona.

I’ve included quite a few posts here without getting prior permission from the authors. I know it’s not wrong to do that in a blog carnival, but in case any of you feel that your post ought to be removed from this listing, let me know and I’ll remove it.

I apologize if I have missed any posts which were submitted or suggested.

Image Credits:

• vanakkam from here, modified by me. vanakkam - pronounced wanna-come - is the traditional Tamil greeting which is appropriate for all occasions. And before you ask, yes, I do look like that guy in the picture. Those of you who have seen my facebook profile photo would know and agree
• Photo from The Hindu news article Pinki’s tale fetches Oscar for Mylan. Standing from left: Dr. Subodh K. Singh (the plastic surgeon who operated on Pinki), Pinki’s father Rajendra Sonkar, Pinki and Megan Mylan, director & producer.
• SurgeXperiences logo created by vitum of vitum medicinus.
• thiruvAmUr sivan kOvil kOpuram - from my personal collection.

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