Carrie and I went last week to the annual meeting of the American College of Surgeons...thus the title of this post. We flew into Oakland Int'l Airport on Sunday, Sep 16th and took the shuttle to the BART (Bay Area Rapid Transit) station. Well, any other day the BART would have been a perfectly good way to negotiate the Bay area, but on this day we arrived at the BART station to find a stadium-full of Oakland Raiders fans, disgruntled at their loss, pressing onto the trains. Surrounded by black and silver, sweaty Raiders fans, we squeezed onto the train with our luggage, wearing a skirt and heels (Carrie) and a blazer (me), since we left from church to fly that day. Oakland is a pretty industrial city, and we were just about the only people of the pale persuasion on the train that day, let alone dressed up in church clothes! ...read more »

Read a good article on how Plato can inform your understanding of Christian thought.

I think one of the most exhilarating moments of my medical life occured last night on trauma call. Without going into too much detail (to protect patient confidentiality), here it is:

Around 2 a.m., the call went out on the paging system: "Code III trauma, by ground, stab to chest, combative, vital signs unknown, airway patent." We all shuffled to the trauma bay and gowned up. As the patient rolled in the door, we could tell he was in shock: he was grunting, weakly moving his arms and legs, not responding to questions, with a single stab wound to the left of his sternum. I put an ultrasound probe on his chest and saw the fluid around his heart, a critical condition known as pericardial tamponade. Shortly after intubating him and putting in a large-bore central venous line, he lost his pulse. We rolled straight to the operating room, prepped, gowned, and after a midline chest incision, sawed through his sternum. Opening the sac around his heart, dark blood and clot poured out, and the heart started beating. A single hole in the right ventricle spurted blood into the air, and I put my finger in it to control the bleeding while the attending worked to improve our exposure. A couple of sutures later, all was dry. About that time, the thoracic fellow walked in the OR (we had him paged at home). Without a lot left for him to do, he helped me close the chest, which is harder than it sounds! The best part is, I went back and saw the patient in the ICU later, and he was awake and writing notes on a pad (he was still intubated and couldn't talk, unlike in the movies). ...read more »

Went last night with Jason and Colin, some guys from church, to our indoor soccer league game. We're one of the worst teams in the lowest league, if that tells you anything about how not good we are. Anyway, the league games take place in the barrio in some warehouse on North Alamo Street, and yesterday Jason's wife heard on the news right before we left some headline to the effect that "SOCCER GAME ENDS IN MURDER!!!" and it showed some nondescript building. So, we of course went anyway, and there were no vehicles there of a law enforcement or emergency nature. Quick and dirty - we tied, lost the tiebreaker shootout, I scored one goal, and I feel like such an OLD MAN. ...read more »

Fascinating year-opening convocation speech by Dartmouth's student body president. He tells his fellow students,

You really are special. But it isn't enough to be special...In fact, there's quite a long list of very special, very corrupt people who have graduated from Dartmouth.

He concludes with a short reference to Christ's solution to our problem: we are special, but not necessarily good. The heart of darkness down inside each of us can be changed. "The problem is me," he says. "The solution is God's love."

Saturday I had the day off. Carrie made a brunch of pancakes, bacon, herbed scrambled eggs, juice, and gourmet coffee. Oh, yeah! Then we finished the day with more coffee, at our friendly neighborhood Starbucks.

In this day, residents in the US get (an average of) one day off every week. I count this a blessing, since such guidelines did not exist when I started surgical residency. We are also limited to working only 80 hours per week, with no shift lasting longer than 30 hours. "To what," you may ask, "do these residents owe their slack working conditions?" Well, there is a vast computer network, a borg, which has assumed self-awareness, called the ACGME. The ACGME is actually part of the axis of evil. And I assure you, ACGME is NOT interested in how happy I am. ACGME could care less. It's merely about appearing to do something for patient safety, before the government makes the rules for you. No one, from the boss to the Congress, wants to look like they're doing NOTHING when something goes wrong. No, no. It has to appear as if there is some activity, there have to be hearings, deliberations, official-sounding proclamations. ...read more »

Bought a cello this last week. I decided to revive a college interest and buy my very ownCello. We'll see how rusty I am after 7 years of not having touched one! The photo is a stock one from the company I bought from (on eBay). China is now making some pretty nice entry-level string instruments with much better quality than even just a few years ago. (Read more)

So now Carrie has to put up with lots of squeaks...if we had a dog, he would howl every night as I "twinkle, twinkle"!

My friend Jose, another fourth year resident, and his fiancee Kristina were married this weekend. The ceremony was just off the riverwalk in downtown San Antonio.

...that's what our house became recently, thus frying our modem, DVD player, alarm system, and upstairs HVAC unit. How easily it can all go away! Anyway, that's why no posts from the last week.

Yesterday Carrie and I got a chance to go out for a date. We chose to go to Silo, a mid-town spot which I highly recommend. Special thanks goes out to our friends Brian and Carri, who kept Eden and Lily.

I HAVE desired to go
Where springs not fail,
To fields where flies no sharp and sided hail
And a few lilies blow.

And I have asked to be
Where no storms come,
Where the green swell is in the havens dumb,
And out of the swing of the sea.

--Gerard Manley Hopkins (1844-1889)

It seems I'm the trauma magnet. On my first two nights on call as the trauma chief, we've gotten two patients with iliac artery/vein gunshot wounds, two ER thoracotomies, an ER pericardial window, and a splenectomy (it's hard to explain how rare THOSE are these days in trauma, though my dad had one in the 70's for a lacerated spleen). That's in addition to all the other uninjured or varyingly sick and injured patients that we admitted overnight. You see, trauma surgical residents LIVE for operative trauma. So much of trauma care nowadays is multispecialty nonoperative care, that "trauma surgery" has become an oxymoron.

I can't believe I get paid to help sick people by operating on them - there's nothing like it in the world. I don't get bored with that. I guess that's why God has me in this vocation, which He providentially knew would be endlessly interesting. ...read more »

I went today to help with the relief over at the old Levi Strauss building on the Southside. I guess there are about 1,000 Hurricane Katrina refugees there in an enormous room. The spirits seemed to be shell-shocked but grateful. I didn't find any disgruntled or angry people (except perhaps fellow medical personnel frustrated with the lack of an organizational system). The feeding, housing, and clothing seems to have gotten along well - HEB-donated food was plentiful in the chow hall, they had a kids play room with coloring books & toys, and everyone seemed to have a cot. The showers (in tents outside the building for the men) kept busy, though you wouldn't know it from the always-present but not overpowering body odor smell in the main hall.

Medical triage and treatment was where I helped. There were about 5 or 6 of us doctors by the end, and maybe 3 times that many nurses. Refugees were already there since last night, so there wasn't a mass triage; it was simply up to the patients to seek care. I saw probably 30 people in 5 hours; we cleaned some wounds, drained some infections, reassured others. We were well-staffed, I think. Some of the kind and dedicated volunteers I met were striking. ...read more »

So on this 2nd day of September 2005, I finally enter the information age with a weblog. I'll see how it works, if I can update it more often than the (average) 1 time every 2 years that I have been updating my homepage.