ARE YOU CRAZY?

I was 11 when my mom died. It was a tragic thing but I was too much in denial to understand it. 4 years later, I was a sophomore in high school. I joined R.O.T.C just to give it a try.  We got to go on cool field trips and on Tuesday we had to come to school in an Air Force uniform.

As you know, I ended up enlisting in the Navy because my brother had done it and my father had done it and in the 60s/70s it was natural to serve your country. I left the Navy as a Hospital Corpsman/Operating Room Technician.  Training for the O.R. was something I wasn’t so sure about.  One of my rotating chores was to “water the dead ones” Yes, I had to poor formaldehyde over dead bodies to keep them fresh.  It’s one of the few times I thought about my mom’s death.  In fact I didn’t even think about having to face blood and guts when I signed up for O.R. school. I was supposed to be a Pharmacy tech until Washington closed the OJT program I was in.  They offered my any school I wanted.  I wanted to stay in the Bay Area so I chose to be an Operating Room Technician.

This is ironic as on one of my field trips while in R.O.T.C. I was forced to wear an orange flight suit over my jeans and Tee-shirt and watch a first aid movie. The room was hot and muggy and I was sort of tired but I was watching this movie when a scene showing a fake injury with a bowel hanging out made me “pass out”.  Yes a guy that would get blood and puss in his face passed out watching a fake first aid flick.  Yes; I fainted.  I came to, with my head between my knees out in the cool shade outside.  What the hell ever possessed me to go into the operating room for a living?

After getting shown the door for my outstanding Laparoscopic skills, I went to work for an agency. Unfortunately, when you work for a Temp Agency, you get all the crap nobody else wants.

I, like many others, were sent to a well-known HMO on the west coast. So with my pride in one hand and my surgical skills in the other, I became popular with many HMO surgeons.  One day I was scheduled to do a simple “Bowel Resection”.  I had gotten to know the senior resident. We’ll call him Jeff.  Jeff was excited one particular morning because he was doing a lower GI tumor resection without a Staff man in the room.  He was riding without his training wheels.  All I can say (and I don’t mean this to sound arrogant) but thank God I was again the 3^rd man in the room.

All was going as planned. It was a female patient and her legs were in stirrups.  I was between her legs.  After an easy dissection into the peritoneum it was time to get the intra anal resection device into place.  Yeah, it means what it sounds like.  It’s a unique device that’s used to go up the rectum and make a clean incision from inside the intestine.

As Jeff’s assistant switched places with me, Jeff said: “Hey Ace, wanna check out this tumor”? I really didn’t but I was polite because I knew how much it meant to Jeff so I said heck yeah. He said: “Hold out your hand”.  I did as he slid this cantaloupe sized mass into my hand.  It slid into my hand in such a fashion that I immediately told (We’ll call him Frank) Frank: “Frank! Hold on a second”.  Jeff asked: “What’s wrong Ace?” I ran my hand down what they assumed was scar tissue, but having spent years in GYN surgery, I slid my hand down the scar tissue and felt a Uterus.  I looked at Jeff across the table and said: “Jeff! Your bowel tumor has a Uterus at the other end of it”.

Frighteningly, this HMO had diagnosed her Ovarian Cyst as a bowel tumor. I guided Jeff’s hand down the fallopian tube and said: “Do you feel that? I think you’ll find a match on the other side.” I never thought that morning that I would be walking two General Surgery Residents through an ovarian cystectomy.  It’s not hard but also not that easy if you don’t know how to open up the capsule.  There were no GYN surgeons available plus we had already thrown the first pitch.  She was wide open on the table. All I can say is: “Thank God they didn’t needlessly remove a piece of her intestine.  If I was put on this earth for 2 reasons, it was to find that rag and stop Jeff from cutting out an innocent woman’s intestine.

What was my reward? (No good deed goes unpunished) I never got to see the inside of that Hospital again.  I guess for fear of leaking this story which happened back in the late 90s.  Who knows, perhaps someone from Time magazine will read my Musings and offer me a job.

Hopefully that lady is alive and well, walking through the park, listening to the birds singing and the wind blowing.

THE RAG

HERO TO UNEMPLOYED

I was working the evening shift. I came in at 3:00.  I took over as the 3^rd person on a major Laparoscopy case which included the resection of a tumor.  For those who don’t know, a Laparoscopy is when they blow up your belly like a Mylar balloon then make 1” incisions and insert tubes that are either 5mm or 10mm.  Then they stick a scope which is attached to a camera and insert small but long instruments like scissors, water irrigators that also suck blood and fluid out of the belly.  Last but not least, the probe.  It’s a smooth swizzle stick that allows you to move organs around without causing friction or damage to other organs.

This was a major case being done with instruments that would fit through a sweetheart straw. There was an extra 10mm straw big enough to put a 4” by 4” sponge in.  Being the 3^rd person at the table, it was my responsibility to make sure we didn’t leave a sponge in this lady’s belly.

*Note: I was well trained and highly respected at Stanford University Med Center under the greatest Laparoscopists in the world.

After 10 hours of removing tumor, we were ready to close. I said: “Excuse me but you left one sponge in the patient”.  Not exactly the kind of news you want to hear after a “Job well done”.  The 1^st Surgeon looked but after 10 hours his eyes were tired.  He said to the 2^nd guy, I need some coffee. Call X-ray and keep looking for the sponge until they get here.  His eyes were tired as well, but when the 1^st surgeon left, that put me in the #2 spot.  I was holding the camera while the GYN chief kept looking.  He was tired and said: “Let’s just wait until X-Ray gets here”.  I said, do you want me to keep looking? He said: “Sure, I’m going to go have a seat until X-Ray arrives.

The word came that X-Ray was backed up 45 minutes. In surgical time that means an hour plus.

*2^nd Note: The Anesthesiologist (Chief of Anesthesia) and the Chief of GYN hated each other.

At some point while we were waiting, the Chief of GYN took off his gown and gloves and headed for coffee and a Bagel. Nobody saw him leave and I was alone at the table with a camera in my left hand and a probe in my right.  Within 5 minutes after Dr. GYN left, I announced that I had found the sponge.  I asked the GYN doctor if he wanted me to go ahead and take it out.  <crickets> The anesthesiologist called for Dr. GYN then said: “Where the fuck is he”?  At that point I’ve got the sponge and ready to finish the case when Joe Gas Passer said: “Ace step away from the table” I said: “I’ve got the sponge”. Nurses raced to the doctor’s lounge and the 2 tired MDs put on gowns and gloves and one took the probe, replaced it with forceps and pulled out the sponge.

Something I had done hundreds of times at Stanford.

In the locker room afterwards I said to  Jack Gas passer: “We’d still be waiting for X-Ray if I hadn’t found that sponge. Much to my surprise he responded: “You assaulted that patient”. I had the next day off and spent the day mountain biking in the hills above the lake feeling good about finding the sponge.  When I got home, I got a message saying not to come in tomorrow as I had been suspended for practicing medicine without a license.  This was all to make the GYN guy look bad.  I went from everyone’s Hero to unemployed overnight. No good deed goes unpunished.  I saved the patient an extra hour under anesthesia (which I thought was most important) and I saved her unnecessary radiation.  Something she’ll never know.

No good deed goes unpunished.

THE 303.2 POUND CYST

I had heard about this case. I was a popular guy with the ladies in the O.B./GYN residency program.  When I heard about a woman with a 303.2 pound cyst coming to town, I had to make myself available in the neighborhood when the 13 hour operation was going on.

How do you grow a 303.2 pound cyst? It helps if you’re an agoraphobic person. (fear of the outdoors)  Many grossly obese patients that hit the upper 3 digits don’t like going outside.  They find it hard to bathe normally and tend to neglect medical attention.  If you weigh 550 pounds; who’s going to miss 303.2 pounds?

It turned out that the patient had what was called a “Dermoid” cyst. It’s a type of ovarian cyst.  They’re quite disgusting cysts usually about the size of a ping pong ball. This one was bigger than almost everyone in the room.  What makes a dermoid cyst so disgusting is its composition.  The garden variety dermoid cyst is a collection of synovial fluid, teeth and hair.  The trick is to excise the cyst without cracking the egg or breaking open its contents.

When you have one that’s 303.2 pounds, it is like removing a human from a Boa constrictor. Yes I got to witness the delivery of this monstrosity up close and personal as they needed strong Biceps to remove the specimen.

As I recall, the cyst was about 2.5’ long (That’s feet) and we took a gurney into the O.R. with the patient’s abdomen open. We gowned and gloved then put a sterile drape on the gurney as not to contaminate the surgical field and people on the O.R. table side pushed, while yours truly with help caught this creature and centered it on the gurney.  Another drape was used to cover the cyst and away we went.  It may have sounded simple but you have to remember that losing that much weight will affect your enzymes. Blood loss was almost a secondary concern.

Hopefully the patient is alive and going for walks in the park. It should be easier without carrying an extra 303.2 pounds in your belly.  I was there and would have bought the Tee-shirt had they sold them.

A New You

(sometimes the old you is better)

I used to love Meg Ryan’s appearance.

My least favorite field of surgery is “Aesthetic” surgery. Sometimes it’s done by a Plastic surgeon (Which is misleading. I’ll explain) and sometimes an ENT (ear, nose, throat) surgeon. Depending on the surgery, I would not hesitate to choose one over the other.

 PLASTIC SURGERY

The term plastic surgery has almost nothing to do with the word “plastic”. The closest it comes to plastic is when they use a material called “Silastic”.  A material designed for surgery that is minimally reactive to the human body. Its main component is silicon.  But the stereotypical paradigm of “plastic surgery” is that you make a plastic mold and change the face of a James Bond Character. That only works in the on the silver screen and on X-files.

It has nothing to do with plastic molds. The term plastic comes from the root word “Plasty”. As in Arthroplasty, the repair of a joint. The term means to “repair”.  So plastic surgeons specialize in more fields than most surgeons.  Many hand surgeons are trained as plastic surgeons.  As I said above: “I would pick one doctor over the other depending on the surgery”.  If I broke a guitar finger, I would go to a plastic hand surgeon. Many would be referred to an orthopedic or “bone” surgeon.  Most Plastic Hand guys only do hands. Orthopedic surgeons that don’t specialize in hands, also do knee replacements, hip replacements, knee scopes etc.…

For the sake of this article, keep in mind that what might appear as appearance altering is not as it seems.  A woman may have a plastic surgeon reduce the size of her breasts because it’s causing here low back pain.  Yes guys, the perfect woman with a thin waistline and DD breasts are an anomaly, but they’re also destine for low back disc surgery if they are not altered to fit the frame of her body.  I do not see this as “Aesthetic” surgery.  There are other examples like removing deformities to just make people look normal.  (Not special).

It might make you more desirable but for the wrong reasons.

But there are plastic surgeons also known as “Aesthetic” or “Cosmetic” surgeons. These guys make your boobs bigger, your nose smaller and your waistline smaller.  Sadly, they prey on the insecure.  I’ve gotten in fights with plastic surgeons as I feel (for the most part) they’re nothing but enablers.  Ladies, if you’re a AA bra size, pumping a quart of salt water into bags in your breasts is not going to make you a better person.  It might make you more desirable but for the wrong reasons.

Sadly, they prey on the insecure.

If you have Barbara Streisand’s nose, and you feel disfigured, I can see that as being a psychological cure. (Keeping in mind a large nose is better than a botched nose job) For that matter, I would go to an ENT doctor who works on noses all day. Would you let a tractor repairman tune you’re Ferrari?  I wouldn’t even let a Porsche repairman work on my Ferrari.

pyramid scams

But feeding on the insecurities of the rich is what is known in pyramid scams as reproductive residual income. Let’s start with taking that hump off of your nose.  Then after getting more dates you consider having silastic put in your chin. They say that chin implants are the single most therapeutic cosmetic surgery that “Aesthetic” Surgeons perform. I would think it would be the nose job, but if you have no chin, then you all of a sudden you have one of those Kirk Douglas chins, it gives you something counseling can’t.  “Courage”.  In our culture people with no chin appear weak.   So now you’ve gotten the courage to divorce your perfectly fine yet normal husband because the big hitters at work think you’re attractive. You’re no longer plain Jane.  So you take 6 weeks off and go for the big one.  You have D/DD breast installed. Now you’ve had the “Trifecta”. You’ve had the triple crown of Cosmetic surgery.

you’re still plain Jane.

But under those fake tits, fake chin and modified nose, you have to hide your secret. Mentally you’re still plain Jane.  It makes you even more insecure. (Or deniably crazy)  If anyone knew the truth, you would be found out.  I will say that if your spouse insists on you having cosmetic surgery, they don’t love you as you are. If you feel you must have cosmetic surgery, you don’t love yourself the way you are. (How can you expect others to love you?)

I will make one exception.

And this borders on fixing a deformity.

Most Aesthetic surgery cases could be avoided if the patient learned to love their appearance for what it is. I will make one exception.  Some might consider this cruel, but others might see it as compassionate, but I’ve done “Otoplasties” (Ear Jobs)on 7- 9 year old kids.  When a kid is born with elephant ears, I think one of the kindest things you can do for him or her is take that thousand bucks you were saving for the Cabo vacation and get your kid’s ears bobbed.  Kids are cruel. Taking a little bit of cartilage from behind the ear will keep your kid from growing up being called Dumbo and ridiculed.  I always felt like I was doing kids a huge favor and perhaps altering their future (for the good). Next to giving them a normal name, it’s one of the most humane and compassionate things you can do for a kid born with ears that stick out like Alfred E. Newman. (Mad Magazine) I would also include any anatomical anomaly that would subject a child to being called a freak.  Yes go ahead and have those webbed toes separated.  It’s OK to get rid of that sixth toe.

FINALLY THE TWO OPERATIONS I LOATHE

The Facelift and the Tummy tuck. The facelift is the ultimate resistance to aging. Its vanity at its peak. It comes with severe risks like nerve loss and the chances of a bad outcome are high.  They say a good face lift is one where you can’t tell you’ve had surgery. I agree.  So why have it?  I can pick with 90% certainty who has had a facelift and who hasn’t.  Rarely do I see someone who I feel “NEEDS” a face lift.

The Facelift that looks like you’ve had a facelift is often too tight and you can often see those ugly knots where your cheek muscles have been sewn together to actually lift your face. Again, we all age and nothing is more hideous than a 60 year old trying to look like a 30 year old.  Remember the song: “Hey 19”?

Finally the worst of the worst. The Abdominoplasty and Liposuction. This is an operation that is often used to replace exercise and healthy eating.  Cosmetic surgeons say: “Oh we only do this after you’ve tried all of that”.  Hey that’s bullshit! The only circumstance for justifying an Abdominoplasty is if you want to trade in the stretched out skin (after weight loss) for an ugly scar.  That’s it.  Many women are disappointed to know that they’ll be confined to a one piece bathing suit after having various incisions sewn up.

The sad part is; after the first person says, ooh that scar is really ugly, don’t be surprised if the patient gets depressed and starts binge eating and the fat cells come back.

Hey: “Shampoo, Rinse and Repeat”. It’s called reproductive residual income. Plastic surgeons are there to “repair” not make you something you’re not.