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!

The meeting was in San Francisco, a place I've been to a couple of times now for surgical meetings. The first meeting I went to I spent so much time enjoying the city that I felt guilty for not being a dawn-to-dusk surgical lecture freak. I biked from Fisherman's Wharf across Golden Gate bridge and down to Sausalito, looked at some art galleries, and then biked back madly in time to make a formal banquet. I ate at some spectacular restaurants, once courtesy of some nameless pharma rep whose product and company I don't remember. And oh, yeah, I also heard some talks about surgical advances.

Well, last week's meeting is the three-ring Barnum & Bailey's of surgery. The daily conference newspaper announced that 9,986 surgeons were in attendance. I arrived early the first morning to get my name tag slid into a plastic holder and browse the poster exhibits. There were research projects displayed from all over, the mundane to the arcane. One poster had a picture of over 100 metal objects swallowed by a schizophrenic patient; the objects formed a clump in his stomach due to three magnets he had swallowed! Other posters presented more mainstream research. After looking through the 300-page program summary, I slipped into a forum discussion by four famous surgeons on how to manage ICU patients with open abdomens. Original research was presented in other sessions, like my favorite: "Chewing gum accelerates patient discharge after colon resection."

Next I wandered down the hall, met up with some friends, and went to the "Technical Exhibit Hall", the massive room housing over 5,000 "exhibitors" (read: vendors hawking their wares); this is one for every two surgeons in attendance! This place was about the size of 10 high-school gymnasiums. And don't think that these were simple table-and-trifold-poster exhibits. Ethicon/J&J's area was the size of a basketball court. Probably fifty black-suited, tanned, pearly-white-smiling reps stood behind counters, waiting to answer your every question about the "ACE Harmonic system", or the new "8.8mm LigaMax clip applier for 5mm ports". Massive Ethicon display signs hung from the ceiling, 2-inch plush carpet underfoot, and the schwag abounded.

Schwag, the freebie junk, was passed out by virtually EVERY vendor (of course, with the company or product name emblazoned on it). Atul Gawande puts it nicely in his book, Complications:

You might think six-figure surgeons would be oblivious to this kind of petty bribery. But you would be wrong.

The more enticing marketing ploy was the "toys" - the surgical equipment out for your trial use. You could cut through a ribeye steak with the newest ultrasonic scalpel, cook the inside of a piece of turkey with a radiofrequency probe, stitch some rubbery skin-like substance with a new mechanized no-stick needle device, or put on a headset to view in 3-D the insides of your "patient," really a plastic box with objects to manipulate using long laparoscopic instruments. You could play all day. The more bizarre attractions included a computer terminal from which you direct a rolling "medi-robot" remotely. With lots of gadgetry, this robot displays your face as it rolls to the bedside of a patient and speaks with them via a two-way videophone. The robot can zoom in to look at the details of the iris, monitor vital signs, and even use an electronic stethoscope to allow you to listen to the heart and lungs. Baffled, I asked the vendor, "Why would anyone want to use this?" He launched into a long explanation, which boiled down to "You can see your patients without actually going to the hospital!" Shaking my head, I left. I didn't go into medicine to sit in my office while I patronize patients with a robot so I don't actually have to touch them.

One afternoon, Carrie and I escaped town to see Muir Woods, an old-growth redwood forest north of SF across the Golden Gate bridge. We finished our tour in Sausalito, browsing through Rodney Lough, Jr.'s gallery there. His photography is stirring, and we've admired his work for a while. Monday night was spent at the J. Bradley Aust Surgical Society cocktail reception and dinner at Ristorante Milano in the Nob Hill neighborhood. Tuesday morning Carrie and I walked to the nearest Starbuck's (less than a block walk anywhere in San Francisco, I'm convinced) to get our morning joe. I then went to learn more about complications during laparoscopic cholecystectomy while Carrie scrapbooked in our hotel room. That night we went shopping for some gifts for Eden, Lily, and my mom and dad, who were keeping them. Eden, who is fascinated with Cinderella, got a Cinderella doll (which looks remarkably like Barbie...) and on opening it after our return, began hyperventilating, giggling, and making her pleasure generally known.

Dinner that night was with Jose and Kristina at Cha Cha Cha, a Cuban restaurant in the somewhat bizarre Haight-Ashbury district. The fried plantains were delectable; I had a steak seasoned with a citrus chile sauce. Washed down with sangria and an Anchor Steam, we were well satisfied. It was on to Ghirardelli square for dessert with some other friends who joined us. The next day we flew back home, as I had to take trauma call that night.