Tuesday, June 5, 2012

Sudan Saga: Level Four Threats

South Sudan’s recent appearance in the news prompted me to post this series recounting my experience operating on the Nile riverbank in 2007.

At night, after the last generator shuts off, animals and bugs are the only sounds. There is no through traffic. So the rumble of a truck near your tent wakes you with a startle. Between the rumble and me was a mosquito net and a bamboo fence any wolf cub could huff and puff and blow down. I couldn’t see the truck, but imagined it was approaching the hospital gate.

Concerning was the second growing sound—voices in song. Song? More like chant—one of those marine corps numbers, but from a brigade of men with uncanny ability to harmonize. It was 3 AM. I lay frozen, listening, trying to guess the nature of the chant. I didn’t know the language so I was listening to the lilt and tone and energy, trying to count the number of vocalists (ten, at least) and judge their mood (buoyant, at best.)

The truck stops thirty feet from my tent and a tailgate drops. The song stops. Boots and quiet murmurs are the only sounds for half a minute, other than my pounding heart. I listen for weapons. Do they rattle during a march? Do magazines have to be slammed into an AK-47? Hammers cocked? Chambers loaded? Probably not, it wouldn’t make for a discrete ambush. They must’ve worked out the kinks of the Automatic Kalishnakov since 1947, or it wouldn’t be the world’s best loved assault weapon.

Ten minutes later, the truck pulls away and the voices begin again. The rumble and song disappear slowly, overtaken by crickets and cats and the hee-haw of the town donkey foraging in Bor’s burning garbage piles.

During my third week, the anesthesiologist and I were leaving through the hospital gate when I heard a few popping sounds behind us. I thought: firecrackers, fun! After about eight pops I wised up and looked in the direction of the gunfire. A bamboo fence obstructed my view, but I guessed the shooters to be about thirty yards away. I couldn’t tell the direction of the shots, and had no idea of the targets, the motive, the number of shooters. As we scuttled back to our compound, the frequency of ringing shots grew like popcorn in the microwave. Overhead we heard the whirring spins of ricochets.

We were chastised on arrival at the compound.

You aren’t answering your radio! You are to remain where you are when you hear gunfire!

I couldn’t hear the radio for the gunfire, and remaining under a rain of bullets seemed unsafe, I replied. What’s going on? Who is shooting? 

We don’t know anything yet, except that it’s happening very close.

That I knew. The pops were still ongoing. Worse, the gunmen were now moving in various directions. Pops could be heard in a 180-degree arc around our compound. Eighteen of us lived on the compound. Sixteen were now huddled behind the only stone wall on the premises, as the sound moved toward both ends. Two others were hiding across town at another aid organization.

I’d never been this scared. This put the drunk man with a stick to shame. Twenty minutes of shooting, no answers as to why. I became suddenly aware that I might feel a bullet before I heard its attendant pop, then I wondered if I would feel a bullet at all if it traveled through insensate tissues. Was I hit already? Could a bullet enter my back, traverse my iliac vein, and exit my navel without my notice? Probably. I discretely inspected my body for blood.


One of my mates crouching next to me had a beer in hand. I reached for it as one one grabs for the banister when a stair is missed. He nodded for me to keep it. I thought of my one-year-old daughter and an ache tore through my chest. I looked again for blood. None.

Stupid. What was I thinking, coming here? I looked around at my companions who, though in varying states of alarm, all looked calmer than I felt. None had children, I realized, except the Ivory Coast doc and the Congo logistician.

As the pops continued on, and no information was incoming, I had a growing craving I never could have imagined. I wanted a gun. I knew the lunacy of the idea, even in the moment. But the maddening uncertainty – this half a bloody hour of exposure, of waiting, of not knowing. If they stormed our compound guns ablazing, I wanted firearms, one in each hand, Butch Cassidy and Robert F*cking Redford.

Dr Chris, Dr Chris for ER! says my walkie talkie. I finish my beer in a swallow.

This is Dr Chris, go ahead.

Yes, Doctor, I am calling for you to review some patients here in ER with gunshot wounds. We have four patients. Can you come to see them please?

Pop, pop, pop. Pop. Pop…pop. Pop. Pop, pop. Whirrrrrrr. Pop, pop, pop.

I came here to help desperate people, not to drink beer and cower. But. If I am shot crossing the road, there is no surgeon in a 700-mile radius to operate on the four victims, or on me. I miss my family.

I will come when the shooting stops. Tell me about the victims. Where are their injuries? Have you started IV’s and drawn blood for cross matching? He gives me a rundown. And what do you know about the shootings? Why are they shooting?

These patients are not from the shootings you hear, says the ER assistant. I think I hear him suppress a chuckle, as only a Lost Boy has the right to do in this situation.

My companions huddle around as we listen in pure puzzlement.

These four patients have been shot while traveling the road to Juba many hours ago. They just arrived as the shootings began here. We don’t have information about the shootings happening now.

Attacks on the only road out of town, and gunfire in town. To me, this adds up to generalized armed pandemonium. War has enveloped us.

The popping ceases. I wait five minutes.

Dr Chris, Dr Chris for ER.

Yes, yes, I am coming.

Dr Chris, I am just calling to inform you that we have a new patient. This one has been shot just now, and…

I am coming.

Arriving in the ER I found three gunshot victims on gurneys and two on the floor. I performed mass casualty triage for the first time in my life. The scene was a bloodbath, the decisions urgent, and my own fear of being shot substantial. The volley of gunfire yards away ended just minutes prior. The best available explanation of the recent incident came from one of the victims, a drunk 23-yr-old minus a proximal tibia, searching in vain for a comfortable position on the concrete floor. Local police were the shooters. A crowded street were the victims (including drunk boy on floor and a 14-yr-old riding a bicycle, now dead.) The inciting incident (note my herculean efforts to be impartial) involved boys told not to perform a weekly ritualistic dance (because fights always ensued), the confiscation of drums, a successful mob reconquest of said drums from the police station, warning shots into the air, mob response, and so on.

The other four victims had been shot in a crowded minibus which had tried to outrun a gauntlet of bandits on the only road out of town. We operated on four of the five. The urgent one had five gunshot entry wounds in his back.

A few nights later, more gunshots. In the pitch dark. 3AM. By sound they are further away – two city blocks, if there were such a thing. I hear rustling on our compound, searching for cover or information, I presume.

Do I get on the ground? If so, why? I’m diagramming geometry in my head. Why is a body lying on the ground any safer than one standing, or trying to get back to sleep on a cot? That rule applies to grenades tossed your way, I decide, not random gunfire in the neighborhood. ZZZZZ.

I was getting used to local shootouts. Paralyzing as they were in the moment, great relief came in later learning the motives. However unsettling the circumstances of the gunfights, no violence seemed to be directed at our group or the other humanitarian aid groups. [Yet. See later episode.]

Then they stormed our compound.

By they I mean scary f*ckers, heavily armed. At the time, I couldn’t have told you to which team they belonged.

I was on my way to make rounds when they kicked in our only door. I caught my first view between buildings. The front guy held his AK ready to fire, swinging it in a wide arc pointing at everyone present. He moved like a wolverine, breaking from the pack, for our warehouse.

I’d gotten accustomed to seeing the AK’s everywhere: Slung on backs, checked at the hospital gate. I’d not yet had one pointed at me by a fast-moving soldier.

Behind the wolverine, came a grimacing soldier carrying – in fire position – an RPG launcher, which also took its turn pointing at my chest. My eyes made an Alfred Hitchcock pan-zoom onto the rocket-powered grenade. The point of the missile had lost its paint and seemed rubbed shiny, as if long-overdue for a target. I wondered if it was sharp enough to enter my chest before exploding. Would it bounce off and spin around my feet like a ground-bloom flower? Would it pass through me and the water-sanitation engineer and continue on to Somalia before its report?

Then I saw the scariest thing yet: the leader. Leather-faced and wiry, talking to none of the pleading people from our compound, he barked short grunts at his men, who feared him as much as I did. A pistol hung from his hand as if connected, with a nonchalance telling twenty-two years of war stories. He looked old enough to have been a child soldier in the first civil war, before the brief peace of the seventies. His body moved with athletic grace while his eyes, liquid fury, moved with urgency. I could not have imagined the discomposure he struck in me by his mere appearance. I’d never seen, up close, a man who’d lived war his whole life.

His gang was still filing through our only door. I was vacillating between the cover of our stone building and proximity to the blocked exit. Were they here to loot? We had fuel, medical supplies, radios, trucks, cash, food, beer, and whiskey – everything an army could want. What was their mission? Would they kill unarmed men and rape the women, as per the habit of soldiers since the dawn of time? The stories I’d heard from our patients opened my eyes to vicious possibilities I’d never dreamed. I trembled, and my heart ached for my wife and child.

I had previously considered myself a soft-core adrenaline junky. Part of the reason I’d come here was to enjoy some fear. But presently I was learning the difference between the kind of fear I enjoyed (class IV whitewater) and pants-pissing terror.

Monday, June 4, 2012

South Sudan: Level Three Threats

South Sudan’s recent appearance in the news prompted me to post this series recounting my experience operating on the Nile riverbank in 2007.
  
The operating room is better known as the operating theatre in most of the English-speaking world. Cool, huh? Room is pretty boring. Wouldn't we all prefer to perform in a theatre, perhaps in a ruffled shirt and cape a la Shakespeare? 

Lo, suffering patient, have bullets rent thine flesh? Tell me, then, where thou most hurtest?

In my first two days, we received six gunshot victims. One had been hit just above the elbow. His skin had exploded, splitting in three long strips which spilled dead muscle and bone chips. We had no x-ray machine, so initial assessment meant flipping and flopping the deformed limb to estimate the location of the fracture. In the operating theatre, which was an inflatable tent, I washed grime out of the exit wound, and stuck a couple  fingers in the mess to get the lay of the land.

War surgery and orthopedics were both out of my usual scope of practice. So, I was improvising - because that's what you do when you're the only doc in hundreds of miles.

You reach in the exit wound and push the muscle around, far from the shattered proximal humerus (different patient).

You’re feeling the pectoralis, playing it careful, scooping out dead meat and blood clot two fingers at at time to prevent infection. Ouch. You feel a bone shard cut through your rubber glove and your epidermis. Your blood mixes with the patient’s. You sigh and look at the young man, calculating his HIV and Hepatitis odds. You feel a little like hanging up your scalpel and coming home. You remind yourself that you calculated these risks in calm circumstances months ago. You tell yourself it’s fun learning orthopedic anatomy on the job. Of course you’re going to gash yourself now and then! And obstetrics? You never did a C-section in your whole residency – of course you’re gonna enter a bladder or two! Sure, you’re helping these people!

Between cases, I sit drinking water, trying to dry the sweat out of my scrubs. A nurse comes into the OR tent. She’s never been in here before. She looks serious.

Have you heard of the problem in the maternity ward? she asks.

No.

I came to inform you.

?

The C-section from last night. Her husband just came onto the ward. He is very angry. He says he did not give permission for her surgery.

Consent? The patient gave consent. We saved her baby.

I know that, and you know that. But I wanted to inform you…Anyway, it has been difficult to explain to the husband.

I’ll come explain it, after the next case.

Perhaps you had better not, she says.

?

The husband is drunk and carrying a large stick. There are two other men with him. They were threatening people in the maternity ward and asking for the doctor who cut his wife.

I slump in my chair. (I have been told that a C-section is considered a failure of motherhood. A man disgraced by a C-section-having wife may return said wife to her father and demand full recompense of the cows paid in dowry.) What price does a surgeon pay for performing surgery not authorized by the head of household? Is the angry husband a tribal chief? Mayor of Bor Town? Is there a mob of irate Sudanese charging the guards of our hospital gate? Am I safe in an inflatable operating suite, or in the canvas and bamboo fortress of the mission compound? Is the man carrying a stick because he checked his AK-47 at the gate? My next thought is of home.

 The nurse leaves. I am alone in the operating tent. Hanging against my belly like a moist sponge is my passport/money pouch. I’m subconsciously assessing my readiness for flight. My South Sudan travel pass is in the pouch. We carry our passes at all times since a Polish volunteer was arrested a few days ago for walking Bor’s dirt road without his pass. The pouch also carries photos from home. I unstick them from one another and transport myself to my backyard where my wife and child are face to face laughing at one another. I try to keep my mind there, in my own backyard, safe.

The scrub assistant, John, then appears. He tells me not to worry, that the man’s anger will pass. His manner is truly comforting, as he understands the situation – the context – better than I. He also knows that Akot, the nurse in charge of the operating theater, is taking care of business in a culturally-appropriate way.

Akot and John have been at my side working long hours at local wages in the operating theater. They never complain, though we operate at the pace of a visiting surgeon trying to finish as much work as possible in a sea of surgical candidates. They are proud of their work.

Akot is almost fifty. I don’t know how he became such a phenomenal nurse since nearly all his adult life was spent as a soldier in a civil war. But I am glad that this nurse is acting as a warrior on my behalf. I learn later that Akot, catching wind of the drunk, stick-wielding, doctor-hunting trio, marched alone to the maternity ward, disarmed the men, called them stupid and ungrateful in front of all the new mothers and babies, and shoved them out the hospital gate. He returned, wordless, to finish the day’s operating schedule.

After a couple of local gunfire incidents (see upcoming missives) Bor Town was put under curfew. No activity in the streets sundown till sunrise. Hospital employees were being beaten on their way to work. A soldier who didn’t speak the local language would stop a nurse in dawn light, they would exchange useless words, and a rifle butt would break the language barrier.

This put some pressure on the operating schedule toward the end of the day. I’d squeeze in a quick case in the afternoon, we’d run into some snag (no sterile gauze, blood donor has wandered off, etc.) and now I’m sewing like Betsy Ross on the Third of July. Getting home, for me, was a matter of darting across one dirt road. But that road was seeing more and more boots every day, and the OR staff had much farther to walk.

On the day of my scheduled departure, our field coordinator placed a satellite call to headquarters about my plane ride – the first leg of six in my long trip home. He was calling to find out when to expect the Cessna. There was no answer – in South Sudan mission headquarters. He then called on short-wave radio. The only staff member at headquarters was a radio operator. The whereabouts of the rest were unknown. The streets had been seized by an early morning convoy. All movement was prohibited, said a megaphone. Information trickled in throughout the day. A city-wide spot-check for weapons held the town in a complete shutdown, including the pilot hired to collect me. Staff were all okay, though confined to wherever they happened to be when megaphone man rolled in.

I had grown accustomed to late planes. Nearly every one leaving Bor was delayed – cows on the landing strip, mud on the departure strip, plane needed elsewhere to transport a patient, etc. So I made rounds again, then cracked a beer. Our chief logistician, a jolly Congolese man of limited English, found me drinking at lunchtime and asked about my plane. I explained the situation at our headquarters.
  
The instability is, is, is…It is coming, said the man from the Congo.

I couldn’t imagine more disheartening words from a guy whose home country is the only place more shit-hole destitute and violent than the one I was trying to depart. My plane came two days later. You know you’ve been in a sketchy place when you kiss the ground after your plane lands – in Nairobi. I arrived in Phoenix to start my new job two days late.

Saturday, June 2, 2012

Level Two Threats and Threats of Unknown Magnitude

South Sudan’s recent appearance in the news prompted me to post this series recounting my experience operating on the Nile riverbank in 2007.


Arriving in Sudan from Kenya, I was greeted in the tiny airport by a young man called Lazarus. The whole airport was a single crowded cement room serving as receiving terminal, immigration, baggage claim, and customs. A stern man smashed my passport and South Sudan travel pass with an inkless rubber stamp. Lazarus then asked for my passport and disappeared. Meanwhile, I was subjected to the post-flight security check. As the same rubber-stamper man was rummaging through my luggage and asking questions, I realized I had no idea what I was carrying.  The Belgium office had given me an overstuffed sportbag to deliver to the mission.

"What is here?" asks security man, in Darth Vader's voice.

"Gifts," I bluff. "Medical supplies."

"What gifts?"

"Books. Mumble, mumble. Sweets. Murmur." He opens a box I'm sure contains hand grenades, and finds a few paperbacks. Bored, he sticks a dime-sized sticker on my luggage and points outside. I exit the sweaty building and find no sticker checker and no Lazarus with my passport. I act cool, standing among soldiers and a dusty tumult as if I own the place. Soldiers? Wasn't there a peace accord? It was in my briefing papers, which I read on the plane. I put on my sunglasses, wondering how one acquires news in the Sudanese bush.

Lazarus returns and shoves me into the back of a Rangerover festooned with mission logos and decals bearing a cartoon AK-47 with a big red circle-slash. No weapons! is the message. But for whom? Volunteer surgeons? Water/sanitation volunteers? Hitchhikers?  Armed bandits on the road?  Sorry, we didn't see the sticker. Please proceed.

Lazarus drives me a hundred yards - back to the airstrip I'd just landed on. There I await a pilot to shuttle me into Bor Town, my destination. Surrounding the strip are cows, mud huts, tall bushes, and soldiers. More soldiers. It looks like the opening scene of Platoon with a hundred or so troops filing into the bellies of monstrous white personnel carriers.

This is the uncertainty part - the unsettling business of seeing heavily armed men and wondering what their orders are, their alliances are, and hoping they understand my express neutrality. Where are they going, to my village? (Yes, stay tuned for upcoming episode)

When I land in Bor and pile into another Rangerover, our path is immediately blocked by another group of armed men. This group is more rag-tag than the airport soldiers. Their truck is swerving and bouncing toward us, camouflaged boys overflowing, clinging outside the truck, their machine guns aimed skyward. We let them pass on the one-way road and sit silent as they brake and unload in a tumble behind us. Hoots and howls. Laughter. A commander jumps down from the truck cab, shouts a few words, and gathers the boys. He waves us on and my heart re-starts.


I laughed at a persistent mosquito buzzing outside my net all night. In the morning, there he was on my pillow, too bloated to fly, smiling like after Thanksgiving dinner. Later that day I'm operating and feel a bite on the back of my neck, but am unable to address due to my sterile hands. During the case, I also feel the typical warmth of blood against my lap--nothing unusual for a bloody case. After the case, though, I realize my operating gown is not waterproof, but simple cotton. My boxers are soaked and I'm blood-stained from navel to knees. Maybe I should've worn a condom? How do you practice safe surgery around here? I shudder, and tell myself the HIV rate here is probably lower than in Kenya, since the Sudanese are all returning from twenty years in refugee camps. Wait, would that be higher risk? Thank goodness I got my Hep B updated. I assure myself that intact skin is an effective barrier to disease and I throw away my underwear and wash off my blood-soaked knees. Under dried blood I see scabs I'd acquired boarding a Rangerover.

In the mess tent at lunchtime, I enter to find the water-sanitation volunteer shooing a bat out the door, nudging it with the front of her sandal.

"He seems tired," she says. "I don't want to hurt him, but I don't want him in here while we're eating."

"Tired?" I say. "The f**ker has rabies, are you out of your mind?" I fling him out with a stick and drop a cinder block on him. I stuff him in a cigarette box coffin and chuck him in the latrine. Now I'm thinking about all the wildlife in our compound, the cats in my tent, the rats from the table cloth. I'd been vaccinated for rabies, but not for plague. I'm wondering if the flies in the latrine will carry bat saliva to the frogs. Would we be the first mission evacuated for rabid frogs?

[Wilderness medicine lesson for readers: a live bat on the ground in daylight has rabies until proven otherwise.]

 I was only in Sudan for a month, camping, operating, and periodically fearing for my life. Imagine living there your whole life. Camping, fearing, your whole life. I learned yesterday that MSF evacuated from Darfur due to attacks and injuries, and I felt sick while trying to get the details. I thought of the Sudanese I'd gotten to know, the OR crew, nurses, and medical assistants, our cooks, my patients, who so readily befriended me - who protected me! (See level three.) Where do they go if we abandon our mission? Back to the refugee camps where they've lived most of their lives?

Most of my patients arrived at the hospital on foot. The only patients I recall arriving by wheels were a busload shot by road bandits (there's only one road out of Bor) and a group of civilian gunshot victims hitching with soldiers.

One woman started her two-day walk after being shot in the back and elbow during a raid on her village. Her two young children were abducted by the raiding tribe. On her walk to the hospital she came upon her infant child, killed, and left behind on the footpath. The exit wound of her gunshot was in front - a broad opening you could put your head in. Her intestines were gathered in a cloth strapped around her waist where they bounced for two days on her walk to us. I unwrapped them and tried in vain to return them to her abdomen. I had to sew a saline bag over them to keep them contained. I did not bother with her elbow.

In the middle of the previous paragraph I mentioned that my patient was shot then saw her dead child shortly after. In the sentence following, I moved on and gave technical details. That's how I handled these horrors in real time too. I'd never conceived so much pain and loss in one place. At home I'd ruminate one patient tragedy all month. Here I spent a few minutes fixing what I could before the next misery out-did the one before.

I have photographs I can barely look at, and one memory I can barely re-tell, of another woman who walked days for hospital care. She started walking the day after failing to deliver a baby boy who was sideways in the womb. Family members had tried mightily to deliver the boy, but all that came was an arm.

But I also have photographs of parents protecting their children against bad odds. Of loving brothers and sisters. I lost my direction in the middle of this piece when I learned of the mission evacuation, so I'd like to show some nice pictures: 

Monday, January 30, 2012

LA Fitness


I joined LA Fitness spring of 2008. Not only did I get in great shape to watch the Olympics, but I was inspired to pursue a second career in the motivation industry.

On sign-up, I was led around by a tan sales kid with a mouthful of veneers atop a suit-full of DHT. He oriented me to the free weights and machines, to the cardio, the cardio-video, and the cardio-video-audio: Tune to 90.4 for Fox News, 91.2 for ESPN, etc. (Instead, I’ve been watching Fox and tuning audio to NPR. The net effect is like seeing Guiliani in drag – makes me run fast.) The sales kid also brought me by a dark room where spinning was going on; shielding my eyes I peered in looking for Rumpelstilskin. Instead I found a peddling frenzy of women on stationary bikes taking commands from a whip-cracker with 2% body fat, 8% silicone, 4% collagen, and 60 mL of botox.

Kid’s club was a nice surprise. Day care at the gym! I promptly dropped off my girl. We both cried a little when the kinder-marm implanted a GPS chip in her neck.

I brought home a schedule of group exercise offerings. Went a little crazy the first week, signing up for high-impact aerobics, low-blow kick-boxing, aqua fit, power yoga and Tai Chi. This last one was disappointing. I expected I would learn to froth a latte, not slow-mo Chuck Norris moves. At the bottom of the group exercise schedule was the abs sub-section: mat pilates, the six-pack workout, Brad Pitt’s 25-min abs, step plus abs, the Spartan 300 training regimen, and Adobe Photoshop abs – a tutorial in digital fitness.

An iPod is essential gym equipment now. I remember gym membership in my self-conscious college days: scared shitless some turbo would ask me for a spot I couldn’t lift off his chest. Now? I'm sporting a sweaty knit beanie, iPod on eleven, bumpin’ fists with the key-chain identity scanner kid and the fresh towel-hander-outer, and scared shitless some turbo will ask for a spot. Hence the iPod. When turbo loads another plate and looks my way, I close my eyes and start poppin’ and lockin’ my way to the far side of the gym.

I quickly learned that I can communicate effectively with my gym bros without hearing anything but Madonna blaring on my headset. I now know the universal iPod gym sign language for:

  • R U done, bro? (Shrug. Point at bro)
  • Can I work in a rep? (Shrug. Point at self)
  • Move your towel, bro! (Point at towel. Shrug)
  • Miss, can you please apply some hand sanitizer to my moist parts, as I am a carrier of MRSA? (Shrug. Point to armpit)
Inspiration:

I unplugged my ear-buds in mid-workout the other day. (Confession: yanked out the headseat doing curls and acted like I meant to.) I pocketed the tunes and listened to the ambient chatter. Wow. This is what has changed most since the last time I was a gym member: most of the souls in the place are personal trainers, motivational speakers, or spinning instructors. I was energized by second-hand encouragement! Suddenly I was at a cocktail party with Tony Robbins, the Gazelle guy, and Jillian Michaels.

The thought of a second career is really growing on me. Lacking the gift of gab, though, I think becoming a motivational speaker is out. But I am certain I’d make a great motivational listener. Or impersonal trainer. I could text instructions to my clients:

Looking good. 2 more reps. Nice. 1 more. Strong. Now THREE more, let’s go. U can do it!!!!!!!!!! ;) CP

All my life I’ve dreamed of running a marathon. (That's a lie. The dream began with Bruce Jenner’s historic achievement: being the first non-cartoon character to grace a cereal box.) With my mature outlook on fitness however, I've stopped aspiring to the marathon because it’s too far and takes place outside. Plus my only motivation was to compare life’s other challenges to my marathon. “Sure, planking is hard, but it ain’t no marathon. I know, I ran one. Did I ever tell you about when I hit the wall?”

So, no marathon. Ever. I am committed. However, I also remain committed to the illusion that I am training for a marathon while watching Greta Van Susteren. Here's how: I always wear a competition number and always line up 6 dixie cups of agua on the cardio dash-board. I alternate dumping them on my head and tossing them into my gaping maw. 

My outfit: I haven’t got workout shorts yet. Just the 80’s cargos exposing seven inches of thigh above the knee. Balancing this fashion anachronism is the whale-tail that develops by the end of my run – cargos down, boxers up and in. I wear my Medecins Sans Frontiers (that’s Doctors Without Borders to my non-francophonic friends) tee-shirt for three reasons:

  1. I hope someone will spark up a humanitarian reminiscence: Hey, I know you! says the child on the Thera-ball, You amputated my snake-bit leg!
  2. I hope someone will speak French to me. *
  3. Performance enhancement. MSF reminds me of drunk teenage Africans with AK-47’s. I run faster.
No takers on the tee-shirt conversation at the gym. However, the one time I wore my wife’s MSU tee, I was halfway in the front door when greeted by an enthusiastic solidarian:

Him:           Dude! MSU!
Me:             It’s my wife’s shirt.
Him:           Dude, too bad!
Me:             *placing ear-buds*

I had more on the topic but I just got a phone message and I gotta get back to the gym to pick up my girl. Apparently the Kid’s Club day care doesn’t include nights.

(written in 2009)

* Conversation at Safeway with a stranger inquiring about my MSF tee-shirt:
Stranger:     Parlez vous francez?
Me:             Je ne speak no French, but I am a big fan of their fries and that movie where Nicole Kidman makes out with Obi Wan Kenobi inside a sequined elephant.



Thursday, January 12, 2012

Can You Hear Me Now?



A typical exchange at work:

Beep beep. [Me, squinting to read callback number]
[Me, wandering the halls looking for a phone]
[Me, dialing]
[Me, waiting]
Four east can I help you?
Hi. Porter here. [Pleasant tone of voice] I was paged?
One sec…[muffled] Did anyone page Dr Porter?
[Me, standing in a hall, attached to wall by a curly handset cord from the forties, waiting]
Nobody says they paged you.
What unit is four east, anyway?
Rehab.
[Me looking at my pager again, tilting to better capture light in the corner of the LED readout]
Did I dial 5117.
No, this is 6117.
Thanks – g’bye. [Me quickly hanging up and redialing]
Recovery room. This is Dale.
Hi. This is Porter. [Less pleasant tone of voice] I was paged.
Umm. I’m the only one here. There were some residents here before.
Ok, thanks. Bye.
Beep beep.


Same exchange at my previous hospital:

Chirp.
[Me, walking toward my destination, looking at text message on my cell phone]
Colectomy Hgb 12.2 – stable






(Note that the second exchange was complete. The first was entering round two in a match of undetermined length.)

My new hospital is one big faraday cage.

The inefficiency of returning to communication modes of the seventies is staggering. At my last job I cursed the residents who had iPhones because the AT&T coverage was lame - we couldn’t talk phone to phone. But at least we could text. At my new job, I’m as land-line dependent as Marcus Welby.

The huge advantage of the inter-doctor text message is the ability to refer to the message again, instead of referring to my memory (of a phone conversation) or to the thigh of my scrubs where I wrote the patient ID number.

I just googled improve cell service in my hospital. I learned of the cellular repeater, which sounds brilliant. I wonder what they cost and how effective they are. Imagine the potential for expediting and improving patient care through accurate, timely, portable, re-accessible communication. Planning to discuss with our director of communications tomorrow.

Thursday, November 24, 2011

Grateful on Turkey Day

When not celebrating with family, I spend Thanksgiving in a hospital. There I’m reminded what a generous and caring culture America is.

I spent one Thanksgiving sharing the meal with the Native American staff of a tiny rural hospital in the four corners of the Southwest. I walked into the break room and found the only anglo child present wearing a feathered headband of construction paper. My first thought: well, this is uncomfortable - who let that kid dress up as...Then I noticed the Native American children wore, indiscriminately, headbands and pilgrim hats. The staff were festive and welcomed me wholly. I soon forgot I was the minority guest on a reservation, who’d brought nothing to a potluck. The turkey, fry bread, and irony were delicious. That was a classic Thanksgiving.

Today’s was classic too. I hadn’t thought much about how to get a meal on a 48-hour shift spanning a holiday. Vending machines, I figured. But an invitation to a meal was announced overhead. A local motorcycle club, fully dressed for the road, brought and served a turkey meal for patients, nursing home residents, visiting family, and staff. The relief and gratitude of hungry diners, especially out-of-town family, was palpable.

Hours later I’m stuffing stuffing again, thanks to the gracious ICU staff.

Hospitals and holidays combine well to show me America's best face. Makes me grateful.

Tuesday, November 22, 2011

Favorite Case

What’s your favorite operation to do?

Whenever a non-medical person asks me this, I suspect he/she views surgery as an art form or a sport, where intense people develop a knack and passion for watercolor landscapes or the fast-break.

I want to supply a passionate response:

Gallbladder! Because, as one great physician said, it’s better to die on your feet than to live on your knees, with jaundice…

My answers routinely disappoint, especially when I’m honest. I file through operations and organs in my head searching in vain for the standout. Learning various lap colon techniques was awesome, but telling non-medical people that the colon is your favorite area? Nope. You’ve just underwhelmed them, grossed them out, or convinced them you’re creepy. Conversation over.

Instead, I try to keep the conversation alive:

I enjoy advanced laparoscopic techniques. You know, using small incisions to access the abdominal cavity and inserting a camera…

Oh, that sounds very interesting.

It is. It sure is. Very.

So, did you try the crab cakes? They’re great.

Yes, they sure are. Very.

Recently, though, I realized I processed the favorite surgery question incorrectly. For me, the fascinating part is not the operation but the exploration – the sorting, the diagnosing, the solving of crimes and mysteries.

Here is my new answer:

I live for the mysterious abdominal catastrophe. Viva la gangrene!

Indeed, I’m particularly fond of cases which begin at the scrub sink, taking bets with the resident:

What do you think, Chief? What are we going to find?

Perforated sigmoid. Totally.

Really? A six-pack says it’s not. I mean, a latte. A double grande caramel macciato says it’s ulcer.

You can’t exactly fill your operating schedule with acute mysterious catastrophes. It’s poor form to book a gunshot wound two weeks in advance. Nor can you develop a subspecialty in the look-see, unless inclined to take call at nine hospitals at once, consulting only for operative trauma and those emergent non-trauma belly cases in which the CT scan hasn’t clinched a diagnosis.

Those are the interesting ones, however. Bullet paths that make no sense. Abdominal cavities full of turbid fluid, a fibrinous slime coating every surface, and no visible perforation.

Opening a belly full of deadly mystery is indeed a fast-break. A clock is ticking, people are watching, and you must perform – now. This basket counts.

The exploratory laparotomy is also a puzzle. Often most of the picture is immediately apparent – something’s leaking, but what? You just need to root around for the few remaining pieces to have the whole picture.

Then there are the brainteasers. Obstruction, but no mass, no band, no hernia. Dang. Should I remove this twisty scarred part? Or, this whole intestine looks awful, but I can’t take it all out – it’s a necessary organ, after all. Or, everything looks normal. What explains the pain and the fluid? Can we just close up and report that everything under the hood looked just fine?

Solving these mysteries is supremely satisfying. Finding them unsolvable is even more intense. And deciding on the spot how to proceed is a commitment with consequence. It’s crazy thrilling, and I hope my new answer conveys the thrill. If not, I’ll work on my timing and delivery.