Monthly Archives: December 2006


What a delightful tidbit to post as my second year of blogging draws to a close.

I recently notified a charitable organization to which I’ve donated in the past that it appeared I had two separate account numbers, and the address on one account number was wrong. I received a prompt reply that included these sentences:

Thank you for informing us that you have two donor accounts under your name. Please accept our sincere apologies for this error and for the incontinence that this has caused you.



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Another thing you wouldn’t hear at a NASCAR race, or even at your local hardware store:

Niles: “Frasier, I played the most delightful party game last night with some of Maris’ friends. Tell me, if you were stranded on a desert island, what is the one meal you would want to have, the one aria, and the one bottle of wine?”

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Score 1, Anesthesia!

While I could write about another glorious post-call day, instead I must make record of the amazing victory achieved overnight.

I’d worked nearly continuously from 0700 Wednesday morning until 0200 Thursday morning, with a 30-minute lunch break and a 45 minute dinner break late in the evening. My last case was a laparoscopic appendectomy which began at midnight. The same surgical team was planning to follow that case with another “lap appy”, but it would be done by the other first-year anesthesia resident on call with me. I could potentially sleep from 0230 until 0800. (Our call day ends an hour later on Thursdays to allow the new call team to attend grand rounds.)

To my dismay, just as the junior surgeon was putting on bandages, I heard the surgery attending say to the senior on service, “Why don’t we just go ahead and do that incarcerated hernia tonight, if we’re all here? Just get it done, instead of leaving it for someone else to do.” This meant two things to me: 1) It didn’t seem like a true emergency if the patient could potentially have gone to the floor rather than straight from the E.D. to the O.R. The surgery team seemed to be adding it out of some bizarre sense of convenience. And 2) Unless the anesthesia team captain called the second-year anesthesia resident to do the hernia, I would get a mere 2-hours of sleep. There was also the off chance that my attending or team captain could try to block the case.

I suppose any sleep on call should be appreciated, so sleep I did. At 0415 my pager went off, summoning me to the pre-op holding area. Bother.

The patient was 77, but overall seemed realtively healthy and was not in any distress. I groggily interviewed him in Spanish, and when I examined his airway, I noted he was “Mallampati Class 4”, which meant it might be difficult to place an endotracheal tube.

Turning to my anesthesia team captain (a third-year), I asked if they could do this case under sedation with local anesthesia. She hadn’t thought of that, so we asked the surgery junior. “Oh, maybe so!” she said, further explaining, “We didn’t even see bowel entrapped on the CT scan, so it’s just going to be a little superficial operation…probably just a little omentum that we have to push back in.”

This angered me. This was not a strangulated hernia; not even a real incarcerated hernia. It was a little bit of fat poking through the abdominal wall, and we were about to start this surgery at 0430. The anger had at least two facets. First of all, if the patient were my grandfather (with a difficult airway), I wouldn’t want him operated on at that hour. Converting from local anesthesia to general could be dangerous, especially without support personnel around as they are during the day. The surgery team was essentially suggesting putting this man’s life in danger because it was convenient for them to do the case then and leaving the case for the next day’s on call team could be seen as “weak.” And secondly (on a more personal level), I was losing sleep over the whole ordeal, and neither my attending nor my team captain had raised the questions that should have been asked originally. Time to take matters into into my own hands. The surgeon had given me all the ammunition I needed…

“If this is a ‘little superficial operation’ as you say, and there’s no bowel entrapped,” I asked the surgery resident, “then is this really an emergency? I feel like we could be putting this man’s life in danger by attempting a difficult airway in the middle of the night.” She had nothing to say. She called her attending, and 5 minutes later, the case was cancelled and instead posted on Thursday’s “add-on” list.

As my head sank onto my flimsy, thin pillow at 0500 that morning, I didn’t care about the sub-optimal call-room furnishings, and I didn’t even mind the long, busy day. This was sleep I’d fought for and earned, and in the end we did the best thing for the patient. The sleep came sweetly.


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Bowling night

So I’m on call yet again tonight. I just finished a case about 45 minutes ago, and I hear there are a couple laparoscopic appendectomies on the horizon. 😦 Maybe I’ll get a little sleep afterward.

Last Friday my home fellowship group went bowling at a place called Harlem Lanes in, you guessed it, Harlem. After a strong start with a couple spares, I quickly fell behind the pack. Maybe I should have gone with the 12 lb ball instead of the fourteener.
A couple pictures from the evening…
(From left to right) William, Jan, Katherine, Jonathan, Andy
Dessert afterward at W&K’s. William, Andy, Jonathan, Jan, Ezer, Katherine


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And to think that I saw it…

The day seemed to have an unexciting end. I finished my last case around 5:15, did a couple post-op notes, and then walked out of the hospital at 5:45. The subway station is just a block away from the main hospital building.

Once downstairs beneath the street, however, I noticed a small crowd of people. Their attention seemed focused toward the middle of the crowd…where a woman was lying on the ground and others were performing CPR.

I worked my way into the circle, set down my bag, and said I was a physician and offered to help. Turns out the fellow doing chest compressions was a medicine attending, and there was a GYN fellow there too. The girl giving breaths had witnessed the entire episode: the patient had said she didn’t feel so well before passing out. The girl eased her to the ground, and they weren’t able to find a pulse.

I asked the medicine doctor to hold compressions while I felt for a carotid pulse. No pulse. “Resume compressions,” I said, “no pulse.” I was perplexed, however, when I realized the attending was giving five compressions for every two breaths the girl gave. The basic life-support I learned had ratios of 15:2, whereas the newer guidelines are 30:2. The thought is that since it takes several compressions to even get a blood pressure, it’s better to go for longer stretches. The compressions themselves may also help with air exchange.

I felt like I should say something, but then I thought, “This is a medicine attending. Maybe he knows something I don’t know.” In retrospect, he was probably just rusty on basic CPR. Soon, I noticed the patient was starting to make respiratory efforts, so I reassessed the pulse (which I couldn’t palpate). Soon, the EMS personnel arrived and attached monitors, started an I.V., and gave supplemental oxygen before wheeling her off to the Emergency Department less than a block away.

Thinking about the whole experience, a few things strike me…

  • It all happened very suddenly. I was simply walking to catch my train, minding my own business, when all of the sudden I was caught up in this episode.
  • It was more than an episode. This lady had some form of pulseless cardiac arrest. This was life or death.
  • I felt very helpless without my monitoring equipment. No EKG, no pulse oximeter, no blood pressure cuff, no I.V. access, no cart full of medicines.
  • Despite not having monitors, I was still able to gather a lot of information about the patient, from feeling for a pulse, to watching her respiratory efforts, to assessing her color.
  • I probably should have taken charge, especially when I realized the medicine attending clearly didn’t know what is the standard of care.
  • It’s kinda weird how the whole thing didn’t rock my world more than it did. I would attribute this to the nature of anesthesiology: we take care of potentially life & death situations daily.

For someone whose heart may have stopped (she had regained a slow rhythm by the time the EMS service arrived) she didn’t look too bad. She was breathing, and she didn’t look too cyanotic. I hope she does okay.

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Thumbing through my Van Gogh coffee table book a few months ago, I was startled to see a picture I recognized. Ordinarily it wouldn’t be a surprise to recognize a painting of one of the world’s most famous artists, but the painting was familiar for different reasons.

This is where the mystery begins. The picture is called “The Langlois Bridge” and was painted by Van Gogh in 1888. And it used to hang in my grandmother’s back bedroom 20 years ago.

Now, either Joy was the proud owner of a million-dollar painting, or it was a reproduction of sorts. The former seems rather implausible. If it were the case, how did she buy it? Why did she hang it in the back bedroom, rather than in a place of honor? And where is it now? So perhaps it was indeed a replica, and not an original Van Gogh.

And yet, there’s a nagging sense that the work in my memory was not a print but actual oil on canvas. Could it be a painted reproduction? Perhaps even Joy herself, who is known to have painted a ship on rough waters, was the copycat artist?

Even more significant than these musings and vexations, however, is something new I’ve learned about my grandmother who died nearly four years ago. She must have liked Van Gogh, either to buy a reproduction of his painting, or to spend hours doing one herself. Because Van Gogh is one of my favorite artists, the discovery of a new little connection with Joy makes me happy. (See these posts which mention her.) By the time I had reached adulthood, Joy was beginning to develop dementia; she would later progress to Alzheimers Disease. My relationship with her was, and will always be, that of child and grandmother.

And although I won’t have the chance to ride the L with her, or discuss her favorite Van Gogh paintings over a cup of hot tea, or stroll through the mall with her again, I have the sense that in the same place & time, we would have been friends.


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Jonathan recommends…

While trying to research the origins of the word duplicitous, I discovered this website. I haven’t had time to really explore it, but after a matter of seconds I knew it was a website I’d love!

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