Thank you for chancing upon my blog somehow. Whether you are some SEO person assigned to increase your client’s visibility in this increasingly cluttered WWW, or a bored somebody perusing medical blogs, or a fellow medical student, or better yet, a doctor who is actually spending time reading the ramblings of “that blogging medical student”, i welcome you humbly to my blog.

so what’s been happening in my life so far? well, i just finished my Family Medicine rotation. 9 weeks just zoomed past like that. in your mind, perhaps family medicine is all about coughs, cold, routine blood pressure check ups. for some part that is true. there is a lot of preventative health stuff going on – BP control, diabetic screening, colon/cervical/breast/prostate cancer screening, vaccinations, diet, lifestyle. if you enjoy explaining such stuff to your patients, then great, do Fam Med. otherwise, u might, just like me, find it a ‘tad boring. GP-land is not as exciting as they make it out to be, at least at Monash. see, we get this Professor of General Practice, who incidentally wrote THE bible for general practice. his name is john murtagh, and mention this name, most if not all australian trained doctors will know him. he is synonymous with excellent general practice teaching and care throughout his career. “General Practice” is in its 4th edition, and prof murtagh has written numerous other books to aid GPs all over the world. how is GP different from internal medicine then? shouldn’t we stick to Harrison’s Principles of Internal Medicine? oh yea, to me, i still value american medicine higher, and harrison’s is the gold standard of internal medicine for me. CMDT 2010 is also something i use frequently. however, GP texts tend to focus on primary presentations, e.g. murtagh’s book has a section with many many chapters on first presentations, e.g. cough, back pain, chest pain, headaches, etc. the symptom is the topic of the chapter, not a particular disease. patients don’t present with a left bundle branch block, they present with syncope and lethargy.

anyway, its all part of training to be a doctor. most avid readers know i want to be a surgeon. however, i dont want to be a cut em and dice em brainless surgeon, if that even exists. probably exists in the preconceived notions of unlearned individuals who probably never had the honor of working or learning under surgeons. or in comedies like scrubs. nonetheless, i want to have a broad base of medical knowledge to back up my future practice, which is why im studying so hard now. more than ever. partly because of exams, but also for the future. 4th yr is the yr of our big MBBS exams at Monash. 5th yr we’re pretty much on our own, trying to get good letters of recommendation from various consultants so we land an intern job in a hospital of our choice.

so yea, im preparing for it US-style. im working my way through lange step 2 CK Q&A, and Kaplan Step 2 CK Qbook. they shd put me in good stead with int med, surgery, psych, obgyn and pediatric clinical knowledge. lets hope monash exams ask stuff similar to step 2ck standard! otherwise its still good prep for step 2ck which ill take next yr

kudos, thats enough for an update in the midst of exam prep!! take care now, thanks for dropping by, and i promise more frequent posts after exams.

oh and if u want to host SurgeXperiences, let me know! gimme a yell. the only online surgical grand rounds needs you!

a 75yo icteric woman noted to have multiple lesions in her liver that on CT imaging are suspicious for metastatic CA. which of the following is the most likely source of the PRIMARY cancer?

(a) stomach (b) lung (c) colon (d) cervix (e) pancreas (f) gallbladder (g) eye

ANSWER:

traditionally i think i would answer (c) – colon. it is the most relevant answer to surgeons because of the possibility of resecting the mets and 5yr survival rates are about 50% even with met colon ca.

however, against my better judgement, a friend who responded to this facebook post, answered EYE. at first i thought it was ridiculous, but further pursuit revealed an emedicine article that suggests otherwise: http://emedicine.medscape.com/article/369936-overview

a 1982 study quoted

Analyzing the data from 9700 consecutive autopsies in patients with 10,736 primary cancers, Pickren et al found that liver metastases were present in 41%.[1,2] They found that the primary sites most commonly metastasizing to the liver are the eye (77.8%), pancreas (75.1%), breast (60.6%), gallbladder and extrahepatic bile ducts (60.5%), colon or rectum (56.8%), and stomach (48.9%).

 

1. Pickren JW, Tsukada Y, Lane WW. Liver metastases. In: Weiss L, Gilbert HA. Liver Metastasis. Boston, Mass: GK Hall Medical Publishers; 1982:2-18.
2. Pickren JW, Tsukada Y, Lane WW. Liver metastasis. In: Weiss L, Gilbert HA, eds. Analysis of Autopsy Data. Boston, Mass: GK Hall and Company;. 1982: 2-18.

Welcome to this fortnight’s SurgeXperiences. This is edition 308.

Without further ado, let’s check out the best in surgical blogging!

Regulars

Buckeye Surgeon take a (painful) trip down memory lane as he came across some survey published in the Archives of Surgery talking about public vs health professionals’ viewpoints on end-of-life interventions. [READ HERE]

Dr Chris Oliver, a UK orthopod, who chronicles his amazing journey from obesity to trialthons, shares 2 articles on his blog about lap-band and battling the obesity epidemic. [READ HERE] [AND HERE]

Marianas Eye, an ophthalmologist working in Saipan, shares his column contribution to the Saipan Tribune about healthcare reform. [READ HERE]

Dr Bruce Campbell shares another piece of his great literary writing in “The Save”. [READ HERE]

Just so we don’t forget, even though he’s been off the radar a bit, Surgeonsblog still has many fantastic posts worth reading. [READ HERE]

The Independent Urologist has some tips on how to quickly capture a patient encounter in the EMR within 5 minutes. [READ HERE]

IntraopOrate replies to an email from a “surgery addict” and sheds some light on how to get to be in the OR more often! [READ HERE]

Aggravated DocSurg rants about how doctors (really) think. [READ HERE]

Blogging about research

This is gaining popularity at the moment all over the medical blogosphere. I guess medical bloggers are realising it is much easier to provide an opinion via a blog than to write a letter to the editor or comment about it formally in the journals.

Are mastectomies overly used for breast cancer treatment? The latest JAMA issue, which focuses on surgical care, has a study that reports otherwise.. [READ HERE]

Plastic Surgery 101, penned by Dr Rob Oliver a board certified plastic surgeon, shares his thoughts on this as well [READ HERE]

In the same JAMA issue, comparison is made between prostate cancer surgeries done the old fashioned way, or the new sexy way with minimally invasive techniques – often with the assistance of Da Vinci robotic system. WSJ Blogs give you the low-down. [READ HERE]

Military-related

The work which supports the healthcare of the military or those hurt in war zones are indeed commendable.

Military pediatric surgeon Dr Coppola has recently published his 2nd book about this time in Iraq. His book is now available for pre-order. Reviews from many notable authors have been fantastic! [READ HERE]
Dr. Donn Chatham, who heads the American Academy of Facial, Plastic, and Reconstructive Surgery, has announced a new program to help soldiers who sustain serious facial wounds. The program, called Faces of Honor, aims to provide more expert care in surgically repairing soldiers and veterans who may not have access to cutting edge treatments in their veterans administration hospitals. [READ HERE]

Professional misconduct

It is sad that increasingly surgeons are dominating the medico-legal scene.

2 plastic surgeons in Singapore are fined S$2000 and S$5000 by the Singapore Medical Council for professional misconduct: one failed to provide supervision for a laser lipolysis procedure performed by a nurse, one performed cell therapy involving the injection of animal foetal cells into patients for anti—ageing and rejuvenation purposes. [READ HERE]

A Pennsylvania plastic surgeon is being investigated for possible bribery. [READ HERE]

Special events

Over at the Clinical Congress of the American College of Surgeons, a trauma surgeon paints a bleak picture of the U.S. trauma system — 38% of the U.S. population may not be covered by a statewide trauma system. [READ HERE]

Many bloggers were off this weekend to the BlogWorld Expo at Las Vegas, including Bongi all the way from South Africa. Ramona who blogs at Suture for a Living, shares a little poem about her trip and provide links to all other similar posts about the great time they had. [READ HERE]

NEXT

Sorry no announcement about next host yet. But meanwhile, you can still submit your best surgical posts VIA THIS FORM.

The archives of SurgeXperiences are stored here (Season 2) and here (Season 1).

Subscribe via RSS or email to SurgeXperiences over at this link.

See you in 2 weeks!

I haven’t been posting much… So what’s been happening?

Well, i’m currently doing my 9-week Family Medicine posting. We get attached out to the General Practice once a week. On Mondays, Wednesdays and Fridays, we go to a central teaching location at the Department of GP where we get didactic lectures and clinical skills tutorials, where they hire simulated patients for us to practise our history taking/management. The focus is now less on history taking, and more on using the 10-step management plan devised by Professor John Murtagh, a guru of family medicine and author of a textbook called General Practice.

Anyway, i’ve also been doing some of the assignments that come along with this GP rotation, which i shall not bore you with.

What else? I completed editing of the SIHS newsletter for Summer 2009. You can download it from Adam’s website here (pdf file). The feedback has been positive.

Another thing i was busy about was finding out about General Surgical Residencies in the USA and about electives during my final year, in SDN forums and such.. I changed my mind from doing the Mobile Surgical one in Ecuador with Cinterandes, to doing as many rotations in USA as possible to get more letters of recommendation from US faculty to boost chances of residency application success. So i hope that comes to light. Also spent quite a bit of time deciding which USMLE Step 1 materials to get and finally got down to it. The SDN people really got great results, at least those that post on the forum! Most have >230/99. I do hope i will be one of those posting such great scores in the future. Probably gonna take it in 5th year between Apr – June 2010.

Other than that, my girlfriend is coming to Melbourne for a visit, so that should be awesome. It’s been a long time since we first started dating; i ought to close the deal sometime soon! Probably at the end of internship or something.

Also been helping out a friend to train for the Melbourne Marathon. we are taking part in the half event. what is cool is that next year, my brother, the legendary ultra marathoner in Singapore ( i say this because he has been getting quite a bit of media for his crazy running enthusiasm) will be taking part in the Mind Alpine Challenge with me. its a 100km event that scales 5-6 peaks in the alpine region in Victoria. will be gawdfully tough and i have some events lined up to help me prepare for them!

• 24 Jan: Mansfield to Buller – 50km (http://www.aura.asn.au/MansfieldToBuller.html)
• 6 Feb: Cradle Mountain – 82km (http://www.cradlemtnrun.asn.au/index.php?option=com_frontpage&Itemid=1) only 60 allowed, first come first served.
• 20-22 Mar: Mind Alpine Challenge - 100km (with my bro d’ man!) (http://www.rfv.org.au/Alpine%20Challenge%202010/home)

… this is a continued series of my reflection of my 9-week psychiatry rotation. read the 1st part, 2nd part, 3rd part. I have previously written about my Paediatrics rotation, and most recently my Obstetrics and Gynaecology rotation.

Aged Psychiatry

How apt for my 9-week Psychiatry term to come to an end with patients in their twilight years. I spent 2 weeks at an aged care centre consisting of a rehab, geriatric and aged psychiatry facility. There were 3 components of our stint here – aged psych ward, behavioural support team (BST) , and intensive care team (ICT). The aged psych ward consisted of mostly demented and depressed patients. There were the odd schizophrenic ones. A patient i saw from CL psych the previous week was here as well. I went out on a visit with the BST once, and that was to an elderly man who kept turning on the taps in the nursing home where he was residing. ICT tends to the patients who had just been discharged from the aged psych ward. I also went out on a visit with them once.

After getting a feel of how to interview demented and depressed patients, i sought to do other more “exciting” activities. They do some ECT sessions here, so i attended one. “Shock therapy”, as it was commonly called, isn’t as bad as it sounds, or popularly portrayed in mainstream media. Apparently it has had quite a bit of bad press. With pictures like these, who could blame them.

ECT has advanced quite a lot and now, patients only received 3 seconds of electrical voltage placed strategically on their foreheads (some unilaterally, some bilaterally). After which, they sustain a 20-second or so brief period of seizure activity. Usually ECT comes in packages of 6. They have no idea how it works, but it does. Majorly depressed patients with melancholia have reported feeling much better after. Schizophrenic symptoms can go into remission. It works wonders.

Some other thoughts

Finally, we recently had a tutorial on chronic mental illness. During the tutorial, several issues came up. We were given a brief overview of the Community Care Units that the Psychiatrist was heading. A multi-faceted approach including neuropsych, occupational therapy, family intervention, psycho-education, social support for carers, dual diagnosis management, social skills development, vocational rehab, is emphasised. Then we started talking about institutions and asylums. Australia was de-institutionalised some decades ago. Unfortunately, some patients fall between the cracks and not suited for CCU care or residential services. The psychiatrist herself was reflecting as she told us, was she chemically restraining patients (E.g. those with chronic schizophrenia) just so their psychotic symptoms are controlled well enough to fit into society just because we cannot provide adequate services for them?

On that note, it brings me to wonder about allocating funding for a healthcare system. Who should decide these allocations? Just to state a common example: should we continue to pump money into neonatal intensive care units to sustain the lives of these little ones? Some of them are born very prematurely (e.g. under 24 weeks) and not many can survive. Round-the-clock NICU care is expensive and there is no guarantee of their survival. Even then, their young lives will be troubled with numerous complications, e.g. bronchopulmonary dysplasia. Should the money then be spent on the elderly in geriatric wards, aged care facilities and nursing homes? After all, these people have worked hard their whole life, contributed to the society and economy and now it should be society’s turn to look after them… Are we then forced to make a decision as to which life is valued more? Should we?

Concluding thoughts

I first started Psychiatry with a negative preconceived notion. I exit having enjoyed some of it, especially so after writing this long reflective piece on what i thought about this entire 9-week sojourn. I doubt i’ll pursue a career in Psychiatry, but at least i had a taste of it to confidently i wouldn’t want to do it for the rest of my life. I’m encouraged by the fact i attained a Distinction for my 5000-word Psychiatry Case Report, but i received some help from tutors. All in all, I’m certain I’m to face some psychiatric conditions further down in my career, and I hope these 9 weeks can adequately equip me to deal safely with them. Besides, it also helps me to understand the mystery of the human mind much better. I remember keenly a tutorial on Personality Disorders. The tutor commented, “Who are we to judge and segregate how one acts into various sets of conditions known as Personality Disorders?” Of course, he did go on to explore how some of these conditions like OCDs can significantly impair one’s daily functioning and that is when these people seek the help of psychiatrists or psychologists. I’m glad that now i can vaguely make out different personality traits in people i come across and friends as well through conversations. And surely, you would have derived my obsessive-compulsive trait (apparently quite common in medical students) in trying to finish this entire reflective piece in one sitting. I hope you enjoyed reading about my experiences, and i look forward to hearing your comments.

… this is a continued series of my reflection of my 9-week psychiatry rotation. read the 1st part, and the 2nd part. I have previously written about my Paediatrics rotation, and most recently my Obstetrics and Gynaecology rotation.

Child and Adolescent Psychiatry

Persons under the age of 16 afflicted with mental illnesses can be a sensitive and heart-wrenching situation. I was attached to Child and Adolescent Mental Health Service (CAMHS) community clinic. I sat in consultations with a Paediatrician who has a special interest in Autistic-Spectrum Disorders. She was clearly very enthusiastic about this, and displayed it by providing with numerous education articles she wrote. She asked me to spend some time to read them all, and provide a summary to her. Remembering some of these online quacks i’ve come across while blogging, especially the passionate blog articles by Orac regarding anti-vaccination, i asked her take on all these. This was replied by her printing off a lengthy book review of Paul Offit’s “Autism’s False Propets: Bad science, risky medicine and the search of a cure”. I appreciate her keen efforts to quench my thirst for knowledge.

Of course, Child and Adolescent Mental Health isn’t all about Autism. I sat in some consultations with some of the Psychiatry Registrars and we saw patients with conduct disorders, learning difficulties, and notably one with significant substance use. The polysubstance abuse was causing him to have disturbing visual hallucinations of himself getting killed in various graphic ways. A few others i remembered were teenage girls with eating disorders. What is sad about some of these cases is a consistent pattern surrounding an unstable family environment – mum divorced and recently remarried, dad and mum are separated and had previous histories of heroin abuse, etc. I feel a surge of melancholy as i wonder about their future. They will be the next person committing suicide from the Westgate Bridge, or the next up-and-rising drug dealer in town, or more scary yet, the next patient i see in the Emergency Department as an intern, treating them from paracetemol overdose or multiple lacerations on their forearms.

Consultation Liaison Psychiatry

This week prove to provide a more acute perspective to Psychiatry. Medical patients in the main hospital who develop or have a psychiatric condition may require some form of psychiatric care. This is when the CL team is called. At where i rotated, owing to the vast numbers of inappropriate referrals, the CL team necessitated a referral form faxed to their office, with a full MSE completed. No other requests would be entertained. The acutely delirious granny in the geriatric ward who was suffering from a UTI, or the aged grandpa, admitted for treatment of his pneumonia, who was found attempting suicide for the 2nd time on the ward. A most memorable patient was a 68-year-old lady who presented with weight loss, malaise and lethargy. CT scans revealed multiple mets and the primary tumour was not found yet. Prognosis is poor and she was receiving chemotherapy. Understandably, she displayed signs of major depression. When the CL reg was notified, he told me that sometimes there is more to  Psychiatry than to just start the patient on some medications, like in this case, a tricyclic antidepressant. “Sometimes they just want to talk. Let them whine to you. They just want someone to listen to them.” And so we did, for nearly 2 hours we listened intently to this woman’s story, and found out her depression did not just start after the discovery of her cancer, but years before after she broke off with her ex-neighbour. This affair was undiscovered, but culminated in her selling her property via him (he was a property agent) and him dying suddenly of prostate cancer. She was filled with remorse and regret. I certainly hoped the time we spent helped her a little, even just a little.

This CL week gave me an insight into some of the common problems i might face as a medical or surgical intern on the wards. What makes a good referral, when should i refer, what expectations do i have for the CL psych team.

(to be continued…)

My 9-week psychiatry rotation is about to come to an end, and i thought i’ll continue my reflections on this year’s rotations. I have previously written about my Paediatrics rotation, and most recently my Obstetrics and Gynaecology rotation.

I must admit i first approached Psychiatry as a specialty in a reserved and guarded fashion. We were first exposed to snippets of it in 1st and 2nd year, where we were taught components of a Mental State Examination, including cognitive assessment via the Mini-Mental State Exam. A memorable moment was our Clinical Skills exam (OSCE), where we had a simulated patient suffering from acute psychosis. We were just several months into our medical training, and as infants, were expected to conduct and sustain an interview with a hugely uncooperative patient, and thereafter report back on our MSE findings. I swore I hate psychiatry from then on.

My preconceived negative sentiments toward Psychiatry as a specialty did not improve when in the first week, we had observed interview sessions in front of our group of 10 or so students. The clinician selected a patient unknown to us and himself and with proper consent, brought this patient into the room full of students. My colleague and I set off to interview her. She was extremely guarded, and constantly stared me down. There was certainly a lot of transference and counter-transference going on and i had to be careful not to project her hostile feelings back onto her. She was, for the most part, unwilling to engage and did not give us a good sense of why she presented. Halfway during the interview, she stood up and surrendered. “Stop trying to get into my head! I don’t want to do this anymore!!” She promptly exited the room, and we were all quite taken aback. Thankfully, this was not met with any major clinical sequalae and she settled without chemical restraint after a while.

Community Psychiatry

My 2nd and 3rd weeks took place in a community clinic where patients were case managed. The case manager is often a social worker or a registered psychiatric nurse. They have clinical reviews by registrars or consultants periodically. I found these incredibly boring, to be honest. They were mostly well managed and their psychotic symptoms (most had some type of schizophrenia) were under control. There were also dedicated sessions of “Clozapine reviews”, where treatment resistant schizophrenic patients are reviewed medically after being commenced on the atypical anti-psychotic. They require weekly FBEs because of the rare but serious complication of agranulocytosis. Weight gain can sometimes a problem as well.

My fortnight there was also highlighted by some outreach trips to a certain undisclosed rural location, about an hour’s drive away. I was fortunate to have a registrar who liked to teach and also delighted in imparting his perspectives into psychiatry. He particularly emphasised things like being able to work in a team with other health professionals. The psych nurses seem to like him a lot. I hope  i can be one such doctor in the future, with great rapport with the nurses.

A memorable patient was one who was suffering from major depression with melancholia. Everything about her looked depressed – she wore dark clothing, looked dishevelled and unkempt, walked and talked slowly, loses concentration from time to time, lost weight, reports insomnia and her affect was blunted and restricted in range and reactivity. That is not one i will forget for a while.

My fortnight ended off with a bam when we saw a very angry patient who received some electroconvulsive therapy (ECT) some months ago. She suffered from retrograde amnesia, a common self-resolving complication and was very cross about it. She claimed the doctors treating her did not explain to her properly these matters and treated her without her consent. To complicate things, she had a history of paranoid schizophrenia characterised by delusions of religious grandeur. ECT is not usually indicated for schizophrenia.

What I felt to be a confronting issue was Christian patients suffering from mental illness. At what point do you acknowledge that there is a mental illness stemming from chemical imbalanced in your neurological pathways, and at what point do you say that you need to rely more on God to overcome depression, for example. I still do not have the definitive answers, but i am keen to put forth an explanation that certain people are indeed more prone to mental illnesses genetically or chemically and the beauty of it is that God has granted wisdom to researchers and doctors to invent and use psychiatric drugs to successfully help these people cope better.

(to be continued….)

“A boy of about five walked towards me, his hand held open, asking for food. I felt nausea as he appraoched. “He is cursed,” Hurzi cautioned. “There are more like him coming from the villages.” At first I thought the boy had been shot in the face. He had a gaping hole eight inches in diameter just below his right cheekbone. The jawbone was exposed, and the flesh around the opening was rotting black. Through the hole I could see his tongue moving as he tried to talk to me. He was suffering from cancrum oris, a very rare effect of prolonged starvastion, where immunity is all but nil and the normal bacteria of the mouth proliferate and begin feeding on proximate flesh. I had only seen old pictures of it in tropical medicine textbooks. This was real, and for a moment I had to turn away. Disease follows hunger and will likely kill before the body expires from starvation.”

- James Orbinski, when he was serving as a medical coordinator in Baidoa, Somalia, with “Doctors without Borders”

Picture of a boy suffering from “cancrum oris”. Deliberately shrunk. Click to enlarge.

An Imperfect Offering is a good book. I definitely recommend it to any health professional or anyone interested in Humanitarian Work or International Health.

Dr Vijay, a practising radiologist from India, has just hosted SurgeXperiences for the 2nd time at his blog “scan man’s notes”. SurgeXperiences 226, is the 50th edition and the final one of SurgeXperiences season 2.

Official SurgeXperiences logo, courtesy of Vitum Medicinus.

SurgeXperiences was set up to be the definitive Surgical Grand Rounds in the medical blogosphere. A surgically focused blog carnival featuring all the best posts related in anyway to the diverse field of Surgery.

SurgeXperiences was first started 1 July 2007. It is hosted by various hosts ranging from surgeons to anaesthesists to radiologists to students! It is on every fortnight and each season lasts approximately a year.

• Season 1 [Jul 2007 - Jun 2008] had 24 editions. An archive can be found here.
• Season 2 [Jul 2008 - Jun 2009] had 26 editions. An archive can be found here.

A big and special thank you to all previous hosts. Your time and efforts do not go unnoticed and i hope the traffic this carnival brings you is sufficient of a motivation to host another time!

Here’s to all 50 and 50 more!

Welcome to the 25th edition of SurgeXperiences – the one and only Surgical “Grand Rounds”, where the best surgical-related posts are gathered into one succinct post every 2 weeks. Thank you for dropping by, and because i’m in  exam mode, i shall present this edition in a Q&A fashion; enjoy!

Regular contributors

Q: What is “cell phone elbow”?

A: It is the layman term for “cubital tunnel syndrome”. For a detailed writeup, hop on over to Suture for a Living to have an expert tell you all ’bout it.

Q: We all know experience makes a difference, especially in surgery. But has this ever been validated by a study?

A: Yes! Aggravated DocSurg tells us so, in “I see Jimi in the mirror!“

Q: Who has had an eccentric superior and not know how to react to his comments/jokes?

A: Bongi! He tells us a story about his professor of thoracic surgery.

Q: What is Buckeye Surgeon suggesting over Quality Assurance Committees for physician-initiated healthcare reform?

A: Cost effectiveness! Why? Read here.

Q: What is “Dr Bard Parker’s” take on the working hours limits on surgical trainees nowadays?

A: “kids these days” sums it up. Link on to hear what he’s got to say over at his blog “A chance to cut is a chance to cure”!

Q: How can one cope better with having ‘difficult conversations’ with patients?

A: Find out here as Dr. T (Notes of an Anesthesboist) shares her experience on the recent ‘difficult conversations’ she has had.

Q: Is it possible to be ruthlessly kind, especially in the teaching of medicine?

A: Perhaps, as Bongi (Other Things Amanzi) relates an incident about treating a patient with a 3rd degree circumferential burn.

Newbies

Q: I notice there are not many Australia surgeon bloggers.. Are there any new ones who decided to write about their cool surgical lives?

A: Yes! The diary of a surgeon is revealed! Over at Crikey Bulletin, which features Prof Guy Maddern from Adelaide.

Q: What is it like after vision correction surgery? Is there someone who can tell us about his/her experience?

A: “I was surprised to discover I was immediately able to open my eyes and see normally.” Read all about it from web architect Matt Raible’s blog.

Q: What is the caption for the following advertisement? Who is the advertiser?

A: The caption is “Plastic Surgery Loans“. It is an ad by Fortis Bank.

Q: Speaking about plastic surgery, what is the title of the book Dr Maria Siemionow recently published?

A: Face to Face.

Q: What is this book about?

A: Dr Siemionow recounts her experience of leading a team who successfully performed the world’s first full face transplant at Cleveland Clinic. [link contains an exercept of the book as well]

Special tribute to a great surgeon

Q: What TV show did the late Prof Chris O’Brien (renowned head and neck surgical oncologist) star in?

A: Prof O’Brien was featured in an Australian reality medical TV series called Royal Prince Alfred, which showcases interesting cases and the doctors who work at this top Sydney hospital.

Q: What did Prof O’Brien die of?

A: Glioblastoma multiform, diagnosed in 2006. (source)

Q: What is the title of the book he wrote?

A: “Never say die.” Linked here is a 60-minutes interview with him after he was diagnosed.

Q: Who treated Prof O’Brien?

A: Dr Charlie Teo, a top (and some say controversial) neurosurgeon.  When contacted, he said this of his former colleague, “People face death in many different ways but he faced it with such dignity and tenacity … he taught me some great lessons on life….. He knew that he was fighting a formidable enemy and yet he still remained very positive until the bitter end.”

Surgical care

Q: Do doctors really read through the patient notes?

A: Apparently not, as Buckeye Surgeon discovers in a case where he recommended hospice care for a patient, but no one listened!

Q: Is it right for a surgeon to leave post-op care to the hospitalist?

A: No! Certainly not the not-so-Happy Hospitalist, who hears from another hospitalist that an orthopedic surgeon has been doing so and only seeing the patient on the discharge day. To quote, it’s “one of the worst examples of patient abandonment I can imagine.”

Q: How many pounds did Wrexham Maelor Hospital pay for surgical blunders made there over the last 3 years?

A: HALF A MILLION! Read more here.

A pinch of humour

Q: Is there a comic about medieval surgery that could make me laugh?

A: Maybe. Check one out at scanman’s posterous.

Q: What not to do or say when asking for an autograph from a sports star?

A: I’ll leave you to find out from yet another tale from Bongi, entitled “skande“

Some announcements

Q: What is so special about the next SurgeXperience edition?

A: It is the 50th edition!

Q: Who is the lucky blogger who gets to host SurgeXperiences on this very special occasion?

A: Dr Vijay, who blogs at scan man’s notes.. Be sure to submit your posts via this form. SurgeXperiences 226 will be hosted in 2 weeks’ time on 28 June 2009.

Q: Can i subscribe to SurgeXperiences using RSS or email?

A: Certainly! Do so over at this link.

Q: Where can i check out previous editions of this awesome surgical blog carnival?

A: The archives of SurgeXperiences are stored here(Season 2) and here (Season 1). Feel free to check them out!

~ ~ ~

Let’s  round up with a joke (that carries a little tinge of politics), courtesy of In From The Night:

“Three Californian surgeons were playing golf together and discussing surgeries they had performed.

One of them said, “I’m the best surgeon in California . In my favorite case, a concert pianist lost seven fingers in an accident, I reattached them, and 8 months later he performed a private concert for the Queen of England.”

The second surgeon said, “That’s nothing. A young man lost an arm and both legs in an accident, I reattached them and two years later he won a gold medal in track and field events at the Olympics.”

The third surgeon said, “You guys are amateurs. Several years ago a woman was high on cocaine and marijuana and she rode a horse head-on into a train traveling 80 miles an hour.All I had left to work with was the woman’s hair and the horse’s ass.

I was able to put them together and now she’s Speaker of the House!”

Fascinating pictures from NY Times’ coverage on Tanzania and its high maternal mortality rate. Ether, if i’m not wrong, is a very old-fashioned way of anesthesia. 

One of my clinical tutors at the hospital i rotated for Obstetrics & Gynaecology is semi-retired now; he comes in weekly for an antenatal clinic and gives us weekly tutorials on mainly obstetrics. I can see that is his passion.  Often, he goes to sub-sahara Africa for medical missions. He liaises with the government officials and recently i heard him speak at one of the Friday morning CME meetings, where he talked about maternal mortality at Sudan. He reflected about his experiences and how the introduction of misoprostol easily dropped the rates of maternal mortality (hugely contributed by uncontrolled post-partum haemorrhage). According to UNICEF, in Sudan, there is  a maternal mortality ratio of 1,107 deaths per 100,000 live birth. In Australia, the rate is 8-10 per 100,000. What a stark contrast eh? Between 1991-96, 1 woman died in Australia of PPH. Most of the 1107 women who die per year in Sudan die of PPH. 

My 9-week Obstetrics & Gynaecology rotation ended today. I clearly remember attending one labour ward night shift (9pm to 7am). I was quite happy because one of the ladies consented to having me around, watching and learning. It was indeed a privilege to attend their birthing process. The lady was in stage 1 labour, so nothing much was happening. The midwife was checking some of the drugs and preparing them. She taught me as she did – syntocinon, ergometrine, misoprostol … we use this if there is PPH. sync is to help the uterine contract.. in the event of a PPH, we might use ergo, miso PR, etc. 

If only the women in Sudan had access to these drugs …

My time in O&G land was an eye-opening experience. I attended many theatre sessions; that was where i could do Vaginal Examinations under Anaesthesia! Women really didn’t care what happened when they’re knocked out. Most threw in that comment when i asked them as they waited in the pre-surgical area. It’s weird though, most had no palpable pathologies. I did feel a couple of retroverted uteruses though. No adnexal masses. I stopped doing them when i hit the minimum of 5. We have a logbook to sign off. One of which was to watch 1 hysteroscopy. I ended up watching like 3o or sth. I can almost do one if they asked me to. Just have to know how to fiddle and connect the hysteroscope and attach the Hartman’s bag. 

I loathed Obstetrics. That’s because as a student, you follow the midwife. No offense to midwives, but i don’t find their job very interesting. I admire their patience and preserverance in sticking around with a women for her labour. Gawd its long and boring. I would much rather be a resident, who usually only comes in a couple of times to pop their head in and check how the woman is progressing. And they come in for the final crowning bit. Push! Damnit woman push!*

* ok, not they don’t say that.

Gynaecology is so much more interesting. In fact i like it. I scrubbed in for 2 total abdominal hysterectomies, one for a uterine myosarcoma and another for a massive 10cm fibroid. 

Another cool pic i had from my iPhone was that of a dermoid cyst. Now to understand this, you have to know that dermoid cysts can have ectodermal derivatives in them – epithelial tissue, hair, skin, even teeth! Too bad this one had no teeth!

So anyway, that’s that. We also had a week where u follow a private consultant and experience the  life of a specialist. He practises mainly obstetrics. He tells me an average OBGYN does about 120 deliveries a year, he does about 3 times of that. A quick search of his name yielded recommendations on Bubhub, and other mummy forums. its nice that he can see sisters of sisters, friends of friends who all like him so much, and even a GP who refers her patients to him for specialist care! he provides her complimentary antenatal and obstetric care! he made me reconsider obstetrics, but warned me of potential lifestyle issues. and oh, the malpractice coverage is huge! but i think if i ever stepped down that path, i might focus more on gynaecology, particularly gynae surgery, e.g. oncology, or endometriosis interest, etc.

that’s O&G in a nutshell. my exams are next friday 12 june and the OSCEs are on 16 june! 

it seems that top individuals in their field are more inclined to be engaged in some sort of controversy, like it or not. Recent events in the Paediatric Surgical community here in Melbourne has prompted this post.

Is Paddy Dewan, a renowned paedatric urologist, a saint or sinner? The Age, Melbourne’s newspaper, reports back in 2003. 

“There were charges of intimidation, protracted and ugly contract negotiations, complaints by Dewan about serious errors and patient deaths, and untold instability and upset on all sides.

Finally, the hospital’s chief executive, Kathy Alexander, recommended Dewan be sacked for disrupting the surgical department and effectively compromising patient care. The hospital board, after examining acidic statements by at least 14 surgeons, endorsed the highly unusual move.”

What exactly did this high profile surgeon do to incur the wrath and prompt “acidic” comments from 14 other surgeons? The reporter enlightens us:

“Dewan reported a total of 26 incidents to the Department of Human Services, the Australian Medical Association, the Medical Practitioners Board and even the Coroner. The incidents involve most of the 12 surgeons in the hospital’s department of general surgery. Surgeons see this as a personal attack.

However, Dewan says he went outside the hospital because he was not satisfied with the response of its patient safety committee, where he referred two incidents. “I was not being heard,” he insists.”

After generating sufficient drama at RCH, more ensues this day at Sunshine Hospital! Now the Professor of Paediatric Surgery over there, he has accused staff at Sunshine Hospital of manipulating surgery waiting lists to encourage patients to pay for private services.

“In a scathing submission to a parliamentary inquiry into hospital performance, Professor Dewan has also alleged the hospital’s suspension of his services in recent years meant children with appendicitis and twisted, dying testes did not get timely treatment.”

The drama never ends! Now patients, or rather, their appreciative parents, are rallying to support their beloved surgeon (source: The Wee Kids).

Professor Paddy  also volunteers with overseas missions for underserved paediatric populations with an organisation he set up – Kind Cuts for Kids. This included a trip to Gaza. Apparently Sunshine Hospital – his current employer – isn’t too pleased by his frequent trips overseas for these missions. 

I cannot help but wonder, are highly achieving, perfectionist individuals who care nothing but ensuring optimal care for their patients, bound to rub the wrong shoulders and cause undue friction amongst colleagues? Is Dewan a victim of the system, which to him doesn’t seem to value transparency as much as he does? Or is he a self-made timebomb of overflowing self-righteousness who is an inappropriate whistle-blower? 

I suspect only individuals who have worked directly with him or are involved in this entire saga can make an accurate assessment. But what do you think? Also, have you come across such individuals at your work place?

that’s my bro, doing his 5th desert at Namibia. as part of the Racing The Planet series. its currently the main photo on the 4Deserts : Namibia 2009 main page! 

“SCUT… Forgive me for this; I HATE this word. Ward work is patient care. It’s the work of Angels and Saints. It is a privilege to do. It’s fun. It is necessary to the care of patients. If you call this patient care scut, you (and your proteges) won’t do it. If you call an admission a ‘hit’, you won’t take care of them. Your language defines your feelings. Your feelings determine what you have energy for. I get energy from getting a patient a cup of coffee, drawing their blood well, and closing their skin in a nice manner……… as much energy as I gett from transplanting their hearts and lungs, and bypassing their vessels. I can’t do what I don’t have energy for.”

Curt Tribble, M.D.
Professor and Chief
Division of Thoracic and Cardiovascular Surgery
Vice Chairman, Department of Surgery
University of Florida College of Medicine
Gainesville, Florida

(from cover of Advanced Surgical Recall”

Following a retrospective cohort study on over 19,000 patients who have had bariatric surgery in the USA in 2005, Dr. Edward H. Livingston concluded the following:

“It has been shown that the minimal annual procedure volume required to be designated as a center of excellence [125 cases per year] does not necessarily result in better outcomes, and that the minimum volume requirement is not evidence-based. Most importantly, this volume criterion significantly restricts access for bariatric surgery care,” 

“Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volume. Extra expenses associated with center of excellence designation may not be warranted,”

This led me to wonder the question as stated in this blog post’s title: Being a student at a Centre of Excellence – does it make a difference? Does rotating through a COE ensure one learns from the ‘very best’ in the field, assuming more of them are gathered there? How does it affect a student’s choice on which hospital he/she will choose to work at upon graduation from medical school? 

Dr Livingston’s article can be found in the April issue of Archives of Surgery. .

• Contrary to what Hollywood scriptwriters may think, to do most operations properly, probably requires no more than average manual dexterity. In the author’s opinion, anyone who can write neatly probably has enough manual dexterity to do most surgical operations. The qualities that distinguish a superior surgeon from an average one are far more subtle, reside in the cerebral cortex rather than the cerebellum, and mainly involve complex decision-making and judgement

Addenum [15/4/09]

• The ANZ Journal of Surgery published a special edition in March 2009 (Vol. 79, Iss. 3) on surgical education.
• An article seems to portray differing opinions from Mr Whalan.

Gallagher, Leonard and Traynor wrote about the “Role and feasibility of psychomotor and dexterity testing in selection for surgical training”.

Finally they reveal what is done at the Royal College of Surgeons in Ireland. “… all short-listed candidates for Higher Surgical Training now undergo formal testing of both technical skills and fundamental abilities (psychomotor skills, visuospatial ability and depth perception). Reports on each candidate’s performance are supplied to the interview committee. Furthermore, a prospective database is being kept for correlation with future surgical performance. We believe that selection into surgical training should take account of attributes that we know are important for safe and efficient surgical practice.”

“Although technical proficiency is definitely an important prerequisite for a successful outcome, other qualities such as intellectual abilities, personality and communication skills, and a commitment to practice are important elements in the profile of a competent surgeon.”

Paediatrics has just finished. I should talk about it

I discovered i am not a natural with babies/toddlers, in terms of rapport establishing, etc. I guess i lack the experience with limited interaction with my cousins/nephews/nieces. I tried, but I am not a natural. If I am to be blessed with a wife and children in the future, then these 9 weeks of experience with kids might come in handy… but as they grow older, its easier; you can ask them about school. who’s your favourite teacher? who’s your best friend at school? what’s your favourite subject? what do you wanna be when you grow up? etc etc

Paediatric surgery was fun. We had cool stuff happening; gastroschisis, sacro-cocccygeal teratoma, duodenal atresia, colonic atresia and then several boys came in with blunt trauma to pancreas after bicycle accidents. one even had a distal pancreatectomy. Highlight was scrubbing in late night for perf appendix, which i used for my case report.  classic RIF region of maximal tenderness, widespread peritonitis. great thing was, when the paed surg reg, W,  was arranging for an ICU bed, while the pt was having his fluid resus, we students went to grab some Mackers (and offered to get him something too). it was a legendary night that will stay in my memory. (oh, W requested fries and guess what – strawberry milk shake! we teased him a lil about it later, made him all the more self conscious. lol) opreatively, had the suction ready when the peritoneum was next to be cut. frank pus +++.  manual breaking of adhesions in abdo cavity. we had a lili trouble finding the appendix but got it in the end. 

another lap case i watched was a neonate case. lap removal of adrenal ?mass. most likely extra-pulmonary sequestration. 

Oh, and an extremely rare thing i came across at Paed Haem/Onc clinic. 7 month old infant scheduled for orchidopexy for right undescended testes. when testes was brought down, some other tissue was attached to the testicle. it was resected. discharged with no complications. over the next few months, mum noticed lump was getting bigger and when she went back to get it checked out at the same hospital, they dismissed it as scar tissue. she sought a 2nd opinion. the surgeon took it out. pathology came back –> wilm’s tumour, with all the characteristic classical histological features. he had intensive chemo for 5 months. he has to be monitored for mets and any primary occurence in the kidney. thankfully renal US and CXR to date (he is now 3) are clear. saw him at outpatients. 

Interesting / confronting issues: 

Bushfires in Melbourne: When asthma kids come from bushfire-affected areas, i must admit i do not quite know what to say. The doctors are Melbourne-based. They can say the right phrases to display sympathy. They ask the right questions that display practical concern: are you making plans to evacuate? They factored in their empathy whilst explaining the asthma management plans. As we got further away from Black Saturday, residents made comments like “It’s gonna be a smoky day this weekend. More kids will come in. (with a tinge of urgh)”

Childhood obesity: We had a week of lectures as a “Paeds in Sem 1″ Cohort. During this week, we were also supposed to prepare a 10-min presentation on Contemporary Issues in Paediatrics. There were 10, but more interesting to me were things like educating children with disabilities, youth suicide in Australia, immunisation, water fluoridation. My  group was given a science-y topic : childhood obesity. I guess I’m thankful because a topic like “health indicators in indigenous children” or “socioeconomic status and health of Aussie children” will be more difficult, especially in terms of finding information. When i was in 3rd year, my conclusion from dealing with the moderately to super obese was to lap band them, because it is the only thing that works. Educate them it is not a one-stop fix. Involve a dietician. Make them promise (and follow them up) re diet and exercise. Be their partner in health. Banding is the only thing that actually works, as the evidence and literature quite unaminously proves. screw orlistat. Lapbanding helps kick start and continue their lifestyle changes. But how does this change in kids?

We were chatting to a General Paed Surgeon after his list one arvo. He was really nice. He told us one time he attended a Paed Surgical conference and someone presented something on banding. That person was “absolutely lynch-ed”. The anaesthetist chipped in. He had a patient die on him once. There are difficult to intubate, and hard to manage peri-operatively. But he still reckoned it is the only thing that works, at least for adults. 

Obesity is an epidemic in Western societies and considering how a big percentage of the entire world lives in starvation, you cannot help but wonder why. 

New people: i’ve always been a rather introverted person, compensating with a outward show of extroverted-ness. inherently, i am shy. when i tell friends that, some chuckle because i don’t portray that side often. Meeting new people has been interesting. There are still people within my graduating class whom i do not know at all, or very well. Years 4 & 5 will change that as we move around hospitals. Occasionally, an anti-social nonchalant thought creeps in “i’m not gonna stay in Melbourne for good anyway, why bother?” i usually mentally smack myself after.

E for electives. tweeted a bit about it. plans still uncertain. hope to go to S america. plan to learn spanish. if i master it, then i can speak the 3 most common languages in the world. (english, mandarin). right, as if it was so easy.  though i must admit, when i acted as a mandarin translator at one of the Paeds clinic, i was a lil rusty and struggled a little with medical terminology and sentence structure. parents could tell i don’t speak it everyday, but were nonetheless grateful, as they would have waited ages for the official hospital mandarin translator to come. 

now my 9-week O&G term starts. i will blog and sum up about it when its over again. probably will include things like my 1st pap, vaginal exam, normal vaginal delivery, colposcopy ,etc etc. till then, thanks for listening and dropping by my humble blog.

A mechanic was removing a cylinder head from the motor of a Harley motorcycle when he spotted a well-known heart surgeon in his shop. The surgeon was there, waiting for the service manager to come and take a look at his bike.

The mechanic shouted across the garage, “Hey, Doc, can I ask you a question?” The surgeon a bit surprised, walked over to the mechanic working on the motorcycle.

The mechanic straightened up, wiped his hands on a rag and asked, “So Doc, look at this engine. I open its heart, take valves out, fix ‘em, put ‘em back in, and when I finish, it works just like new. So how come I get such a small salary and you get the really big bucks, when you and I are doing basically the same work?”

The surgeon paused, smiled and leaned over, and whispered to the mechanic… “Try doing it with the engine running.”

(source: somewhere on the net )

Welcome to SurgeXperiences – the one and only surgical blog carnival in the medical blogosphere. Today I will be your host for the 20th edition of the 2nd season.

SurgeXperiences logo created by vitum of vitum medicinus.

To a medical student like me, the field of surgery is very intriguing, to say the least. The daily working life of a surgeon, or even that of a surgical trainee, can be jam-packed full of action, blood, guts and gore. Dull moments in surgery are hard to come by. Surgeons are able to test their hypotheses and see rapid, graphic results from their work. Students are often awed by this process. What also draws me to surgery is the immense satisfaction of being able to completely excise a cancer (hence providing a definitive cure), or relieve the pain of an intra-abdominal catastrophe, e.g. perforated appendix. 

General Surgery

Merriwether (a patient) recently had some lipomas excised and shares his experience and some post-op photos.   

After a colostomy and ileocystostomy, a patient’s daugher (Tiger by the tale) blogs about the aftermath and impending ICU stay. Wish him a speedy recovery.

Neurosurgery

An obese man is being surgically implanted with electrodes inside his brain and exposed to electrical currents trying to make him weight. This is a first of its kind and I leave it up to the reader to comment at the article re: human experimentation. (image credit)

 

Talking about experimenting on humans, this Italian neurosurgeon was certainly pushing the boundaries when he decided to continue surgery on his patient despite suffering from an anginal spasm himself. “I couldn’t leave [the patient] at such a delicate moment… I’m not a hero, I only did my duty.” Read all about it here.

 

A Russian teenager dies after a rare brain stem operation. The father is now suing the Oklahoma City surgeon in a civil lawsuit for medical negligence.

Obstetrics

Some might argue obstetricians are not surgeons. In South Africa, interns perform Caesarean Sections commonly, but before they do, they have to earn a right to do so, just like any surgical procedure. Dr Karen Little (Just Up the Dose) writes about obtaining this license to cut at where she practices medicine – the Crater vs Civilization. (image credit)

Orthopaedic Surgery

An orthopaedic surgeon from the Philippines, Bone MD (The Orthopedic Logbook)addresses a post to young / junior doctors regarding career choices, and how it is OK to be lost. (image credit)

 

A cerebral palsy patient pays an orthopaedic surgeon a visit at his clinic, recounting an awkward moment.

Ophthalmology

Valerian, a recent customer of eye surgery, shares about his PRK experience. 

 

A Repository for Bottled Monsters shares a journal article about eye injuries and prosthetic restoration in the American Civil War years. Cool pictures and great historical information. (image credit)

Peri-operative medicine

Dr Bates (Suture for a Living) reviews an article on the requirement of perioperative stress doses of corticosteroids.

Plastic surgery

Plastic surgeon Dr Ramona Bates (Suture for a Living) educates us on medical lasers and the law after reading an article from a “throwaway” journal “MedEsthetics”. (image credit)

Sometimes, veterinary surgeons can take pointers from their counterparts who operate on real human beings, just like a certain Dr Michael Pavletic. This vet, faced with a tumour on a cat’s face, turned to an older human reconstructive surgery textbook that suggested a simple skin flap might do the trick. He took what was a routine technique in human surgery and tailored the procedure for a cat. It worked. Today, he is a pioneer in veterinary reconstructive plastic surgery. Read about him here. 

Moving back our focus to human surgery, chronic refractory pilonidal disease can result in an undesirable cosmetic effect after multiple incisions and drainages. Dr Lisa Marcucci (Inside Surgery) describes a commonly-used technique “Z-plasty” to overcome this problem. 

Although cosmetic surgery is only a part of plastic surgery, it is very prominent in the community and considerable attention is dedicated to who had it, should you have it, and the like. I thought i might throw in something since everyone knows about this former King of Pop. Apparently he is having some cosmetic procedures to “doll up” before his return to stage.

Well it seems that some ‘doctors’ have also jumped onto the bandwagon and pretend to be plastic surgeons when they are not. Adventures in Plastic Surgery reports. 

Trauma surgery

Dr Parker (A Chance to Cut is a Chance to Cure) is back with a shout with a continuation of his “Tales from the Trauma Service” series at XVIII.

Transplant surgery

Dr Jeffrey Parks (Buckeye Surgeon) talks about transplant chains, or NEAD (non-simultaneous, extended altruistic) donor chains. He highlights an important issue of moral obligation of those involved to donate their organs to “keep the chain going”.

Diagnostic services

Radiological imaging are sometimes indispensable to a surgeon before he/she takes a patient to surgery. Good ol’ Dr Vijay (Catscanman) has contributed a post full of 3D reformatted images from a post-CABG Coronary CT Angiogram. Check it out; very cool. (image from link above)

Below, articles are not grouped according to surgical sub-specialties anymore. 

The surgical career..

Dr Crippen (NHS Blog Doctor) thinks out loud … “What is a surgeon?“, when a patient of his shows him who did his inguinal hernia repair.

Regarding inter-profession relations, Dr Parker (A Chance to Cut is a Chance to Cure) updates us on some of the drama that has been going on, and what he reckons, in R-E-S-P-E-C-T —  parts ONE and TWO. 

Surgical training … the tough years ahead. at least for me. Surgical resident Dr Alice (Cut on the dotted line) reflects on why “tough love” is best love for educating interns and medical students.

It is no wonder then, why some surgeons are soooo tired. But is tough surgical training to blame in this following case? A plastic surgeon at Beth Israel Deaconess was so fatigued from previous day’s activities that he dozed off during surgery. Now it is big hoo-ha in the news, at least in Boston. 

Advances in surgery

The Medical Quack reports that the world’s first robotic distal pancreatectomy was performed at Fox Chase Cancer Centre via the VikY system. 

Over at Abu Dubai, a surgeon performs the first telesurgery at UAE in front of various colleagues.

Surgical media

Oystein (The Sterile Eye) is a medical videographer from Norway. He has the following articles/media links to contribute. 

• Of background music in surgical videos. What do YOU think?
• The National Museum of Health and Medicine are digitizing their vast archive of meical photos. Check it out.
•  He also recorded a video of a laparoscopic  liver resection, with a brief summary. 
• Lastly, a video of ERCP. 

Gabrielle Eden has a short write up on the background of the famous picture of a foetus grabbing onto a neonatal surgeon’s hand. It is entitled “The Hand of Hope“. 

Will you be in Italy from Oct 27 to Nov 8? If so, you could join in the Vesalius Trust Art and Anatomy Tour – a tour of wax anatomical models at several anatomical museums. Even if you can’t go, the spine-chilling pictures at Morbid Anatomy might suffice. Here’s a preview:

That rounds up this edition of SurgeXperiences. What i lack in terms of humour or expertise in commentary, i hope i have made it up with the images i included.

Next edition will be hosted on 19 Apr at Suture for a Living. 

You can submit your blog posts via the carnival submission form, and check out all the previous editions. You can also subscribe to SurgeXperiences via RSS feed or email.

If you would like to host a future edition, don’t hesitate to contact me.