Wednesday, November 27, 2019

Giving Thanks

I need to scribble  something  here to obliterate that image of a transorbital intubation in the previous post.  Jeez...that image gives me the willys. What was I thinking?  It's no wonder I got blacklisted by a couple of referral sites for being too grotesque. Blame it on poor judgment instilled by far too many years in the trenches. What comes to me, I suppose, not every time, but often enough, are the inelegant vignettes of trauma that have pitched a tent in my hippocampus.

So it's time to move on.  I'm wishing a festive Thanksgiving to all those who peruse my foolishness. I'm humbled by your readership and it simply  amazes me that someone is always viewing my foolishness-especially those who visit the middle of the night when all should be sound asleep.

I have so much to be thankful for, especially the patients I cared for in days gone past. They did more for me than I did for them. One thought that never escaped me was the notion that all those nasty ailments lurking out there in the world are equal opportunity afflictors. Anyone could be stricken down any time. It's really just a matter of chance accompanied by good fortune that I was fortunate to remain healthy and  vertical for so long.

Glioblastomas are out there in the world  and occur at the rate of about 4 per 100,000 people. I owe so much to those patients that suffered and ultimately succumbed to this terrible neoplasm. It could have just as likely been me with the glioma, but someone else took  all that pain and suffering to spare me of this terrible fate. I owe them a deep debt because it could have me.  I don't know how many times I uttered a silent thank you to these patients and tried to do something special for them. I am eternally grateful to these patients who took the hit for me.

This gratitude fills me with a sense of helpful sharing and a strong disdain for the greed and financial preoccupation of healthcare today. Oops... don't get me started on that one! The respect and peace that nursing has filled my soul with cannot be  derailed by dollar signs. It's what's left in your heart when the day is done that really matter, not your bank account.

Anyhow, for some genuine foolishness here is a link to a post I wrote some time ago

Happy Thanksgiving! I treasure your loyal readership. It  means more to me  than you know!

Tuesday, November 19, 2019

Transorbital Intubation - An Artful Airway

Just when I thought the days of art in medicine were extinct,  the above image made it's appearance in my email courtesy of a long time reader. This  patient had extensive facial surgery for an invasive tumor and her maxilla and eye were sacrificed in the process. In a subsequent procedure, the creative anesthetist used this artsy approach in securing her airway. Instead of passing the endotracheal tube pharynx-larynx-trachea, the path was eye socket - pharynx, (or what's left of it) - trachea. Very clever, but how in blue blazes can the pilot balloon be visualized when it's deep inside the patient's face. Art in surgery always has a down side

Whippersnapperns live in a data driven, evidence based world of healthcare, but I know of  a different world where art played a dominant role  like the transorbital airway gambit shown above. Medical arts buildings dotted the landscape and old school surgeons pulled the art card to explain complications or pathology beyond their understanding. I do think the "medical arts" terminology when applied to physician offices  was so much less pretentious than the "institute" label trending today.

Unlike the group practices of today, most vintage surgeons were solo practitioners operating with minimal oversight. These surgeons of bygone years shared something in common with Picasso and Monet, they worked alone and relied on their ingenuity as much as scientific principle. "Based on empirical reasoning, I'm going to take out this lymph node over here and maybe the one over there too," was a typical intraoperative response.

Artful surgery could carry a heavy price for the patient. Someone cobbled together a procedure to "cure" Parkinson's Disease that involved harvesting cells from the difficult to access adrenal glands and injecting  them intracranially in hopes they would generate some much needed dopamine. The aggressive surgery resulted in lots of complications with poor long term results. Artful, but dangerous and usually ineffective.

A more benign example of surgical artistry involved the use of surgical instruments. Orthopedic surgeons found a novel use for Satinsky vascular clamps in that they were perfect for nabbing errant bone chips. I've written about the creative use for grooved directors in a previous post. They make great tongue depressors, templates for duct filets, guiding suture, and as mini retractors. Artistry in surgery always has an unsavory component and burying the sharp prongs of a towel clip in an unsuspecting abdomen to test the level of spinal anesthesia always shivered my timbers.

Unfortunately, patient's bodies make for a poor canvas and scalpel wielding surgical artists often come up with an unintended surprise on their hands. I wonder how that patient above felt about breathing through her eye socket. Breathing is a whole lot different than seeing.