25 February 2008

25 FEB 2008 The cycle of dependence

This article from Stars and Stripes discusses the creation of a generation of beggars in Iraq. Children begging for candy and money is something I've seen in Europe, South America, the Caribbean, and in parts of the U.S. It is almost a defining characteristic of the third world to see the child's upturned face and open palm. In many cases, I can usually spot the parasitic adults waiting in the shadows to take whatever haul the children bring in. I used to give out candy, but it didn't always keep well in unpredictable conditions, and honestly I worried about making bad teeth worse! Now I usually give out crayons and scrap paper. In Haiti, it was amazing to see how overjoyed a child would be to get a single crayon with a rolled piece of paper around it. I think of the hundreds of dollars of unused toys there are in my home, and how just a single crayon seemed like a windfall to a poor child. The article makes the point well that the Iraqi government has to start providing for its own to avoid the creation of a beggar state.

(Thanks for sending me this article, PAC, you knew it would be right up my alley.)

21 February 2008

21 FEB 2008 Balad continues to help children

21 FEB 2008 Balad continues to help children

I found this sad story about Iraqi children who came under mortar fire while they were playing soccer. Though nothing could be done for the boy who was killed, but the ones who survived received state of the art treatment at the Air Force Theater Hospital. It is a foul act of the insurgency that in an incompetent attack against the base they only achieved the death and injury of children. It is fortunate for the children that the skill of vascular surgeon T. and the rest of the crew was there for them.

I look forward to a day of peace.


16 February 2008

17 FEB 2008 Blog Carnival SurgeXperiences Edition 115: Full Metal Scalpel

Welcome to Edition 115 of Surgexperiences!!

This edition is

Full Metal Scalpel: The love-hate relationship between surgery and war.

(Source: Kubrick, Full Metal Jacket, 1987)

What I realized most as I reviewed the excellent submissions this week, is that surgery, both for the patient and the surgeon, is very much like war. There is an urgency to fight against a foe who may kill if left unchecked. Both are activities with high contact and there will be blood. Both are better, far better, when over.

(Pictures featured below are from the National Museum of Health and Medicine Exhibit: Battlefield Medicine 101: From the Civil War to Vietnam Photo Gallery.)

Empyema patient treated with rib removal / open packing, WWI

From the anesthesiologist and oboist who brings us: Notes of an Anesthesioboist: Job posted at Notes of an Anesthesioboist, we hear, "I only have indirect experience of the effects of war, from the fringes...but the effects of war are far-reaching. Hope you're able to use the post. :)" This is a touching view of life after war for one veteran who has given much to us.

Trench foot sufferers, WWII

Next is a thorough and fascinating review of amputation surgery by rlbates: Amputations, Prosthetics, and War posted at Suture for a Living.

Civil war below-the-knee amputation

An engaging post from Sleeping Leo discusses the urgency of hemorrhage, a killer on and off of the battlefield. As dire as the fight for life can be, we who care for the traumatized are luckier to see this struggle for survival than the irreversible calm of death.

Plasma given to wounded GI, Philippines

Everyday Nurse teaches us that giving anesthesia isn't as easy as it may sometimes look and at times has been likened to a soldier's role in the battlefield.

Jeffrey Leow presents GIGO and the CABG posted at Aggravated DocSurg. We learn here that the statement "no war plan survives the first bullet fired" applies well to surgery as well as war.

British Army dressing station WWI

Fortunately, we have evolved so many tricksy ways of surviving the slings and arrows of trauma and a few wonders of anatomy are revealed by Anesthesioboist.


Visit Surgical steel (well, metal anyway) posted at The Sterile Eye, saying, "Some metal bands turn to images of war and destruction for shock effect. Others turn to surgery for help." Read about some very curious surgery related band names.

Filming Herniorrhaphy, Walter Reed Army Hospital, 1918

Street Anatomy has found for us a treat that maybe best reserved for those with the stomach for blood.

life of a surgeon

bongi presents callous posted at other things amanzi, noting that the constant exposure to blood can result in extinction of that stimulus, just as after you tap a cat on the forehead several times, he will stop blinking. War can result in the same immunity to the sight of blood.

Ortho residency remarks that the intensity and closeness of surgery residency, a war of its own, forces us to shed our shells and reveal our inner quirks.

Recovering after action in N. Africa, Walter Reed Army Medical Center

IntraopOrate notes how this intensity and closeness can suggest to the mind the close bonds of family in some humorous ways.

Nurse and Doctor, 131st general Hospital, England, WWII

bongi presents other things amanzi: i r surgeon posted at other things amanzi, which discusses the importance of "hierarchy in theater" which is just as important on the battlefield.

Triage station, France, WWI

Cut on the dotted line reminds us to question the beliefs we are handed, even when they are stated strongly.

surgery in general

bongi presents other things amanzi: stories of guns posted at other things amanzi, saying, "slightly more in the line of your topic. an old post about the warzone we live in." Unfortunately, war zones don't have the monopoly on the threat of firearm violence.

Bongi presents salt water wells up posted at other things amanzi, and reflects on the fact the surgeons may be called upon to share the tragedy and intimacy of bad news shared.

Buckey Surgeon too acknowledges that surgeons may be privy to the intamacy of death, a burden that can occur in or out of a war zone.

Operating on a wounded captive, Korea, 1950

surgical training

Jeffrey Leow presents Acrobot Surgical Robot Makes Students as Good as Surgeons - Medgadget - www.medgadget.com posted at Medgadget.

But, IntraopOrate wisely raises some worries that the invasion of the robots, like many high-tech advances applied to both surgery and war, my strip away some of the human factor. We must remember to apply the same wisdom and compassion even if our high-tech toys have moved our touch further from ground zero.

Evacuating wounded with a JEEP, WWII

That concludes this edition! Submit your blog article to the next edition of
surgexperiences using our
carnival submission form. Past posts and future hosts can be found on our blog carnival index page.

Technorati tags:

, .

I did receive some posts that were tough to categorize. I add them here because I do appreciate the participation.

Rob Moshe presents
Live Your Best Life By Serving Others posted at Rob Schaumer, saying, "This is not necessarily a fitting post for your carnival. Once the project starts, each day I will recognize a fellow blogger that "Helped""

Freddie L. Sirmans, Sr. presents Can The US Prevent A Starvation Crisis? posted at Can The US Prevent A Starvation Crisis.
Raymond presents My Experience With Lasik Eye Surgery - Thoughts About Laser Vision Correction - Is It Worth The Cost and Risks? posted at Money Blue Book.

Sutocu presents Weight Loss Surgery: Preventing the Health Risks posted at 4kg in 7 Days, saying, "If you have been watching your weight go up and you are worried about the rising pounds, you may be wondering whether weight loss surgery really works. Is it possible to prevent future weight gain by putting yourself on a well-known weight loss surgical operation?"

15 February 2008

15 FEB 2008 Wheelchairs for Iraqi Children

15 FEB 2008 Wheelchairs for Iraqi Children

Today M. and I read a wonderful story about Brad Blauser, a American contractor who has organized to donate wheelchairs to disabled Iraqi children. As I watched the report, so many aspects resonated with things I had seen in Iraq. There are such poor services for handicapped children in Iraq. A disabled child is likely to live their life, tucked away from the world in a bed or on a couch. There is great value to the Iraqi culture's focus on the private life of the extended family. In some ways this precious oasis protected by the strong bonds of family is something that we experience far less in the US. However, families often reported to me that their disabled family members were essentially at a dead end with no expected future of interacting with the world outside of the family home or any chance starting a family of their own. For children in particular, this is tragic because they long to follow siblings and friends into the larger community.

Providing wheelchairs to these needy families makes a huge difference in these children's lives. I aggree with Mr. Blauser's observations that these children unable to walk went nowhere unless they were carried by a family member. On the day of our Iraqi clinic, there would always be one or two disabled children bundled in the arms of a parent, patiently waiting in our office. Our ambulance driver J. and Iraqi doctor A. would go out to the fortified gate of our base and pick up the children who were coming for visits each clinic day. Once a father came to us with a child whose legs had been shattered in an explosion, and had healed into bent, twisted limbs. He also had lost the nerve function to his legs and couldn't move them. Over time the unused muscles had contracted and given the legs their useless alignment. Nothing we could do could restore the nerve function to his legs. We did teach his father exercises to stretch his legs and try to regain some flexibility. The only thing we did that was of any use was to give the family one of the hospital's older unused wheel chairs. His father told us that without the wheelchair, he was sure that his son would have spent the rest of his life inside the home where he would die of sadness. We felt so helpless since we couldn't fix the damage to the boy's legs, but it was a measure of relief to know that a simple wheelchair that we took for granted could have a positive impact.

If you want to learn more about Mr. Blauser's program, his website is here:


and here are stories from ROCwheels, a partner that helps produce the wheelchairs donated to Iraq, and other sites in need around the world:


12 February 2008

12 FEB 2008 Friends at HumanKind

12 FEB 2008 Friends at HumanKind

I had the good fortune to be included in a wonderful blog, HumanKindMedia. C. and L. over there have made the amazing leap from wishing to do something to make the world better, to actually doing it. They seek out and publicize news of individuals who have looked at hopeless situations of tragedy, and have decided to roll up thier sleeves and take action. It may see impossible to for any one of us to make a difference. But together, we can change the world. People like C. and L. serve as catalysts to network individuals together and act as force multipliers. Here is the link to piece I wrote:


10 February 2008

10 FEB 2008 Toggle makes it through another, under duress

10 FEB 2008 Toggle makes it through another, under duress

M. showed me today's Doonesbury. BD is standing by Toggle's bedside as he wakes up from surgery.

It brings up a vastly important issue: The selection of music during an operation. It is an interesting topic about which many of us feel passionately.

Some want the room quiet while they operate. Other prefer rousing music. For others, it depends on what is going on. They will say "stop the music" if things become dangerous. Later they will say "turn on my closing music" when the case is all but done and they want something lighthearted to bring them home.

One study showed that surgeons were more efficient when they had their choice of music playing.

Others have taken the approach that music pleasing to the patient should be played to gain a holistic energy for healing and this has been shown to decrease anesthetic needs.

I have delegated music choice to the circulating nurse. My tastes are so eclectic that I can appreciate just about anything. As long as there is not silence in the room, I'm happy.

Two genres I wouldn't choose are Christmas music and religious music. Christmas music pisses me off because it is wrong when it is not in season. During the Chrismas season it makes me feel like I should be with my family rather than in an operating room. As for religious music, I'm just afraid my patient will get the wrong impression that they are being called to join the heavenly choir.

Anything else will fly in my OR. Many of the surgical techs have iPods and I love hearing what they listen to. It really is a window into the heart. I think that if the tech is hearing music that he or she likes, they will stay energetic and engaged in the case.

Sometimes the circulator will insist that I pick the music and they usually regret it. Below is the playlist of my O.R. disk. (I'm not an iPod person. It was hard enough to give up cassettes and I'm just getting comfortable with CD's.) The list should give you an idea of why I'm rarely solicited for music choices a second time. Not only will this disk keep me in my game during the operation, it prevents me from falling asleep and sliding under a truck on the drive home after the operation at 2am.

Blur: Song 2
Green Day: American Idiot
Offspring: Come out and play
Violent Femmes: Blister in the sun
Clash: Rock the Casbah
Drowning Pool: Bodies
Marilyn Manson: Beautiful people
Alice Cooper: Feed my Frankenstein
Garbage: Supervixen
Cracker: Low
Smashing Pumpkins: Bullet with butterfly wings
Stone Temple Pilots: Flies in the Vaseline
Nickelback: How you remind me
Pearl Jam: Daughter
Fatboy Slim: The Rockafeller Skank
Lit: My own worst enemy
Butthole Surfers: Pepper
Linkin Park: In the end
Cypress Hill: Insane in the brain
Seven Mary Three: Cumbersome
Wheezer: Hash pipe
P.O.D.: Alive
Sublime: Santaria

09 February 2008

9 FEB 2008 Worth the wait

9 FEB 2008 Worth the wait

(Source: Sushi Encyclopedism, 2007)

Hi Friends!

My life is happily boring again! If I don't write often, it is because things go along as usual. I commute to work, I come back home, M. the boys and I have dinner together. It is how it should be.

Last night, however, was a chance to celebrate my return home in a way I had been dreaming about for months in Iraq. M. and I went to Le Reve for a dinner to celebrate our reunion. This restaurant is the home for our stomachs and our favorite restaurant anywhere in the world. We couldn't go right after my homecoming because Chef Andrew Weissman and his wife M., who also works the dining room, had closed the restaurant for a spell after the happy arrival of a new baby. Since I am a solo practitioner, almost no moment is protected from the off chance that a baby back at the hospital will need help, but I called on the help of trusted civilian colleagues to cover the hospital for the weekend. Our dear friend N. had the boys join his son for a sleepover. From what I hear, they tore up Dave & Buster's.

Temporarily freed from the needs of the hospital and our children, we arrived at Le Reve, excited for the meal that awaited us. We were tucked into an intimate little table near the wall that runs along Pecan Street. M. was a vision of beauty bathed in the warm diffused light of the restaurant; her bright eyes worked like a tonic on me. Over the next five and a half hours, we were treated to amazing tastes of beautifully constructed delights: tuna with wasabi roe over Chinese long beans, foie gras on duck breast paired with a tasty Sauternes, and the mind-blowing caramelized onion tart with Chevre. After dinner Chef Andrew was kind enough to sit with us and we shared stories about children. He even showed us how to grate fresh wasabi rhizome on a sharkskin rasp. This was a generous lesson given the rarity and high cost of fresh wasabi. In addition to rolling the roe in the horseradish-like ingredient, he had also made a spicy ice cream out of it. It was after midnight when our minivan was pulled around for us. Fortunately I had eased off the wine a couple of hours before and we had a safe ride home through the darkened streets of San Antonio with our happy bellies dancing.

As I was writing a medical article, I came across a wonderful piece about the dedicated nurses in our hospital in Balad. It was written by Dan Clare, a reservist who is a public affairs officer. In civilian life, he takes care of the troops too, working for the Disabled American Veterans. I especially recommend that you check out the fifth part on the Intermediate Care Ward nurses that details Nurse R.'s experiences taking care of a boy and reuniting him with his mother. It brought me right back to see familiar faces in the article and to hear about events that are burned in my brain. I have no doubts that there are new faces living new stories at the hospital, even as I write this.

I'm sure many of you were aware of this sad story, but I viewed this clip showing children conducting a gross preversion of close quarters combat training. It is purported to be an Al Qaeda training and recruitment video, and it jibes with some of the examples of child soldiers I saw in Iraq. In the video, some of the kids are smaller than the AK-47's and RPG-launchers they carry. I can remember twelve and thirteen-year-old children being brought to the hospital in Balad after having been captured while participating in Al Qaeda operations. One way that our base was attacked was when militants would pay children trinkets or small sums of money to launch a mortar at the base at an appointed hour. Al Queda would be gone by the time the launch was detected, but the unwitting child would be left holding the bag. Children were also used as spotters for vehicles or trigger-men (trigger-boys?) for IED attacks. My friends in Baghdad took in injured kids as young as nine-years-old who were found armed with AK-47's. It is a disgusting and heinous betrayal of trusting, vulnerable youth.

We must remain vigilant in preventing use of child soldiers. There is much experience with the damage caused to the child soldiers in Africa. I recommend an incredible but heartrending book by Ismael Beah called "A Long Way Gone" detailing his recruitment to fight as a child in Sierra Leone. It takes years after the trauma of war for a child to recover, if they survive. International law in the form of the Geneva Conventions forbids the recruitment and employment of soldiers younger than 15, but even that age is too young. We must be wary of recruiting US children who are too young, vulnerable, and impressionable to make an informed decision about their capability to serve. The No Child Left Behind law includes a provision that compels high schools to provide military recruiters with children's names, addresses, and phone numbers. As recruitment needs are stretched for our military, many of our hometowns are finding that graduating high school children and high school dropouts are forming the newest ranks in the war. I know that our strong US military has long been carried on the backs of brave young men and women who had to mature on the quick when they threw themselves in harm's way for our great nation. However, as our enemy stoops to despicable acts of despoiling the young, we will remain strongest when we take the moral high road and protect the safety and future of our youngest citizens. As a parent and one who has chosen a life in the service of children, there is no other conclusion I can find in my conscience.

Take care,


04 February 2008

4 FEB 2007 I'm not the only one

4 FEB 2007 I'm not the only one

A friend referred me to a very informative article on the continuing incidence of injured kids in Iraq


I worked frequently with one of the authors, Phil Spinella, when he was a pediatric intensivist at my hospital in Texas. Here is the abstract of the original scientific article:


It is a persistent and concerning problem. I really do fear that children, the most vulnerable victims in war, are also the ones least likely to get help when they are injured. Not to mention the fact that they have a tough battle ahead if they have persistant disability from their injury.

I don't have the answers, but I think that Iraq clearly needs to build up its system of healthcare.


03 February 2008

3 FEB 2008 Call for submissions: SurgeXperiences #115

FEB 2008 Call for submissions: SurgeXperiences #115

Hello Friends!

I am proud to announce that I will be hosting the SUN 17 FEB 2008 edition of the Blog Carnival


A Blog Carnival is a collection of blog entries from different bloggers gathered in one location by a moderator. The opportunity is open to all authors, and is a way to draw new readers from across blogs with similar interests. The entries should be roughly based on a chosen theme, but this guideline is rather loose.

In two weeks, I will publish here the submissions I receive. The topic is:

(Source: Kubrick, Full Metal Jacket, 1987)

Please send me your impressions of the effect of war on surgery, of surgery on war, and any observations, musings, or comparisons from inside or outside the theater of war.

Please submit your entries here, or if it is easier, you can email them to me here.

Now while you are considering participating, (and I hope you do!) Take a moment to visit the current surgeXperiences blog carnival here at Notes of an Anesthesioboist.

Here is the catalog of past surgXperiences editions.

And if you wish to host a future edition, please do! Here are guidelines on how to do it, and you can contact Jeffrey who runs the show here.

Take care!