Adventures in General Surgery

Favorite quotes from my first three weeks of the surgery clerkship

Attending Physician: "What is this?" Pointing to a structure in the heaps of bowel resting partly in the attending's hand, partly in the patients abdomen, and partly on top of the patient's abdomen.
Me: "Is that the appendix?"
AP: (Spoken in strong southern drawl) "Jeffrey, this is not Jeopardy, this is the OR. There is no need to state your answer in the form of a question. What is this?"
Me: "The appendix!" Affirmatively
AP: "That is right!"

Second episode
AP: "What is this?"
Me: "Transversalis fascia"
AP: "Give him a zero!"
Me: "oh, sorry, that is the aponeurosis of the external oblique muscle."
AP: "Correct. Don't apologize to me. You can call your mother and apologize to her. She might appreciate that."

Third episode
AP: (to the scrub nurse) "Scissors to him." "Cut this"
Me: (cut)
AP: "That was too short"
Me: "OK"
30 seconds later
AP: "Cut this"
Me: (cut)
AP: "Too long"
Me: "OK"
60 seconds later
AP: "Cut this"
Me: cut
AP: "Too short"

There are two lengths that a medical student can cut the sutures in a Rochester OR...too short or too long. At least this takes the pressure off of cutting the sutures at the right length.

Good Things to Come

Tomorrow, I finally get to take my first step, Step 1 USMLE. That stands for United States Medical Licensing Exam, I think. In an effort to kill some time until the exam, I was just perusing the 'ol internet and came upon this little video. And I liked it. Good Things to Come

I know you are already bored with the water issue. Don't be deceived. This is not about water, sort of. The picture above is taken from my copy of the National Peace Corps Association Worldview, Winter 2005. You may be asking why I have a copy of such a magazine given that I never worked with the Peace Corp and considering the fact that it is 2010. Bueno, that I can't explain. Why is a picture from this magazine posted on my blog? That I can answer. Because this is the very same picture as seen in the April 2010 National Geographic referenced in the previous post on water. You can also find a copy of the picture at this link. Oops, you'll need to search the archive to pull up the April issue.

I guess I just thought that my magazine would provide their own pictures for their magazine; or maybe I had the expectation that they would at least use up-to-date pictures. When I read that article in National Geographic, I thought those people in Rajastan were really thirsty, lined up at that well at the precise moment that I was reading the article--this makes sense because I was reading it late at night, when the sun would be high in the sky over India, as portrayed in the photograph. It turns out that that was so five years ago, maybe more. So what is the story like now in Rajastan? That well is probably dried and gone. Or maybe its the people that are, dried and gone. Or maybe everyone filled their jug and called it a day, everything's fine. I'd like to believe the latter.

"Mock, ing, yeah, bird"

I decided a few weeks ago to read, To Kill a Mockingbird, every night of this summer. I didn't have a goal to finish it 'X' number of times. I just decided I should keep this as my nightly escape from studying for the boards be it that I read the novel once or fifty times through.

And look who else decided to join me in this: The Whole Country

I don't know, karma, or what. I don't know what this means; perhaps I'll find myself in Bozeman this summer for a little chat with Mista Brokaw.

The issue of water is not new. The Media has been gabbing about it for years. I remember the first time I personally had to DEAL with it. For six months, I boiled my water in the mountain town of Azogues, Ecuador. After boiling, I'd pour it through a plastic funnel which we had covered with a t-shirt. The t-shirt without fail turned brown, and the water theoretically turned not brown i.e., pure. At points when the water level was running low, the city would shut off water altogether. This happened much more frequently in other cities where we could expect to have running water at certain hours of the day. Of course, there were some days when the pipes were dry during the expected time interval of running water. It was for those kinds of surprises that we kept a handful of gallon jugs filled in the bathroom. Dumping a jug of water over you can some times be a welcome change. Ya know, that added sense of independence: finally liberated from the control of the shower head.

We use a lot of water in the bathroom, but it was in the kitchen where Ecuador taught me the value of water. People were incredibly resourceful with their kitchen water. I felt like I was always looking at a camp kitchen when I saw how little water the Guayaquilenos used to do their dishes. Those in the campo (country) were even more strict, and rightly so; there was one pump that came out of the ground about two miles from our apartment. Bicycles or motorbikes were always parked there, day or night, with people hunched over to fill their plastic jugs.

The water issue came back to the forefront for me when I was in India. Again, more people lining up at the well to get their daily supply of a few liters or whatever they could carry on their head or shoulder.

The sum of all these experiences left the impression that life is different in different parts of the world. I was grateful for the water I enjoyed, and I recognized that others were not as lucky. The whole, "You better eat that; there are starving kids in Africa who would do anything to have those vegetables," lesson came full circle. There... I finally knew with my own two eyes what I'd heard as a child. So mature, right?

Honestly, now that I think about it, those experiences changed me a little more than to believe that I knew more about the disparities in the world. This past summer in Peru, I developed a habit that I still keep (mostly) of turning the water off to lather and then turning it back on to rinse in the shower. And I don't let the faucet run while I'm doing dishes. Score.

However little or much I've done, it doesn't feel nearly enough after reading the April 2010 National Geographic. If you haven't, give it a look. But I warn you that it is tough. In this month's edition, we learn that 40% of the Tibetan Plateau's glaciers could be gone by 2050. "Full-scale glacier shrinkage is inevitable." Ice cover declined in the Tajikistan and northern India regions at rates of 35 and 20 percent over the past five decades.

What happens when glaciers melt? Grazing lands disappear, rivers and cities flood, freshwater supply diminishes, less light is reflected back to the sun, more absorbed, temperatures rise faster, people are displaced, dams are built to control and capture the run-off, 80 million people have been displaced due to dam projects--I saw this in India where a colleague was fighting to keep the tribal community she and her husband had served for 25 years from being displaced. The dam was approved despite two years of legal debate.

The point is, water is scarce in a lot of the world. And we don't care about the consequences of getting what we need. And it looks like it is only going to get worse. With 83 million extra people joining us on Earth each year, how do we accommodate?

The obvious answer is, I don't know. When the facts are drawn up and the numbers tallied, things can look down right depressing. I remember feeling overwhelmed when I saw in the National Aquarium of Baltimore at the ripe age of nine that the Amazon Rainforest would be gone the year...(I can't remember exactly, just the fact that it would be gone was devastating to me, and it still is). I recently heard a news report of a child who found out about global warming on the internet and came to his dad in tears. The more time we have on this planet, the more concerning these issues are.Honestly, I'm still scared. But what can we do beside buy energy saving appliances (which I just did--Yeah, three cheers for the NY energy star appliance swapout!!)?

Why did God rain down manna for the Israelites each morning, but our brothers and sisters in the slums of Dehli wake up and fight one another, sometimes to the death for a place in line to get a little water? Does he love us any less?

Personally, I see three areas where we can contribute to a positive change in the planet's water supply. 1) Pray and ask God to provide the water that we and all of our peeps need. 2) Do the little things that we can to reduce our carbon footprint, if only to feel good inside, and 3) Support organizations that are actively working on issues related to water supply. Oh, and 4) accept that if the environment is no longer amenable here on our planet, than that's it. We'll adapt until we no longer can adapt. Hopefully, adaptation will involve less war and more technology but I imagine that it will involve both.
Picture Key
* Tsunami refugees lined up for what I believe was water and cooking oil. Cuddalore, India 2005
** Tsunami refugees, women getting water from the remaining well. Nagaputtnam, India 2005
*** Glacier lake created from glacier melt. Cordillera Blanca, Peru 2009.
These lakes catch the melt. The Andes are speckled with these lakes. They are beautiful, but very dangerous. In 1941, the rock support gave way to the built up pressure delivering an avalanche wave of water at devastating force on the city of Huaraz. Four to six thousand people died. Many smaller slides have happened in the last fifty years.

**** Summit of Mt. Ishinca, elevation 5530 m, 18,000 ft This trek took us through the path of the 1941 avalanche.