Saturday, December 26, 2009

Inadequate Coverage

The End of Print Media?

To the Editor,
I am writing to you to register a complaint regarding your newspaper, The Houston Chronicle. I’ve noticed that recently the coverage provided by your publication has been inadequate. The exposure in recent months has been unacceptable and has left glaring gaps that are intolerable. Actually, I’ve noticed this deficiency since the fall of 2008.
During the most recent Presidential Campaign I have to say that your newspaper met my needs in a most efficient manner. I rarely found any significant areas left uncovered and nothing of importance ever was missed by your pages. However, starting around the time of the 2008 election I began to notice glaring deficiencies. At first I tried to ignore the obvious lack of coverage, but after a while I found it impossible to overlook.
So, I decided to change. After looking at all the possible substitutes I settled upon The Wall Street Journal. Admittedly, this paper also may be lacking in some departments compared to the Chronicle, but no other paper surpasses the quality of its coverage. Since I’ve made the change there are no more gaps and my time utilization efficiency is greatly improved.
Now, every Saturday, when I change the paper at the bottom of Isaac and Rebecca’s cage I am thankful for The Journal. The paper overlaps perfectly, so that when one layer is removed the layer underneath is pristine and ready to receive whatever may fall its way. I am also using fifty percent less paper each week and, thus, am helping to preserve one of our most precious natural resources.
As an added benefit Isaac and Rebecca, two Eclectus parrots native to the Solomon Islands, are speaking in much clearer tones and their words seem to make more sense. Of course they have been clamoring for more luxurious accommodations ever since I left the “Homefront” page staring up at them.
And so, dear Editor, it is with a heavy heart that I am cancelling my subscription to the Chronicle. The reduction in the size of your pages was the final straw. I may miss “Dear Abby” and “Blondie”, but I believe that the benefits to our planet and to the aching in my back far outweigh any potential negative effects.
I thank you for your consideration.


David Gelber MD

Sunday, December 20, 2009

Christmas Carols

Christmas Carols
A Message for the Season

This Christmas season brings memories of growing up in the quiet village of Scotia New York. The winter holiday season was always highlighted by the Lincoln Elementary School carol sing. This was a mandatory school event which featured all the students of the school assembling in bone chilling cold to offer heartfelt renditions of a variety of Christmas classics.
The songs were always Christmas songs, some with religious themes and some with wintertime and seasonal themes. There was never any apology made to non-believers and there was no such thing as political correctness and, as far as I know, no student was ever excused because “we don’t believe in that.” So, we took turns lining up in front of our freezing parents, singing our little hearts out and, afterwards, we were treated to Christmas cookies and other delights.
Thoughts of this annual event came to me the other day as I posed the question to the operating room crew: “What is your favorite Christmas carol?”
My assistant across the table offered up “O Christmas Tree”, a wonderful song that speaks of the steadfast, faithful and unchanging nature of God. The others in the room were stumped and did not give an immediate response. Years ago while I was reading the autobiography of Harpo Marx there was one anecdote recounted where he and some of the very literate people of his day asked a very similar question; only their question was “name the best song of all time”. Their collective answer was “Silent Night”.
I really believe that “Silent Night” is a beautiful song that captures the holy nature of the newly born Jesus, but it really does not do justice to the events surrounding that wonderful Christmas Eve.
Christmas Eve started as thousands of other nights had begun, quiet, cold, mundane. But, all of a sudden, for no obvious reason, the shepherds in the field have this quiet solitude rudely interrupted. An angel comes to announce a birth, the birth of a Savior. Then, the night sky suddenly becomes bright and is filled with all the Heavenly host announcing the birth of a new King, but not just any old earthly king. This is the King of the universe, a baby, God’s own Son, sent to save the world. This is an event that was anything but silent. It was and is, rather, a reason for shouting; shouting with joy as the angels announce a new order for our world, one that promises Peace and Goodwill.
The shepherds leave their flocks and investigate and what do they find? The baby, lying in a manger. Perhaps at this moment there is silence as they, along with Mary and Joseph, ponder the cosmic implications of this singular event. The silence is brief, however, as the shepherds leave and spread the news to everyone that can hear, all the while singing praises to God. Definitely, the Christmas story is not one of silence.
My response to the question, “What is your favorite Christmas carol?” results in a tie. My first favorite is “Hark the Herald Angels Sing”. This song brings all the joy and exaltation of Christmas, while also summarizing all the hopes for mankind that Jesus brings. It is best sung with all the power and force one can muster; a true celebration of the true meaning of Christmas.
My other favorite carol is “The Little Drummer Boy”. It is a relatively modern song, written in 1958, but it carries a message that I think we all should heed. Christmas is about giving. God gave this world the greatest gift imaginable, his only Son. But he didn’t just send his son to live among us. Jesus came for one purpose: to reconcile a wayward, sinful people to their Holy God. It is this great spirit of giving all that you have that “The Little Drummer Boy” presents. This spirit of giving and hope is the true message of Christmas, a message for the Christmas season and all the year.

Hark! The Herald Angels Sing

Hark! the herald angels sing
Glory to the new-born King!
Peace on earth and mercy mild,
God and sinners reconciled!
Joyful, all ye nations, rise,
Join the triumph of the skies;
With th' angelic host proclaim
Christ is born in Bethlehem!
Hark! the herald angels sing
Glory to the new-born King!

Christ, by highest heaven adored;
Christ, the everlasting Lord;
Late in time behold Him come,
Offspring of the Virgin's womb.
Veiled in flesh the Godhead see;
Hail, the incarnate Deity,
Pleased as man with man to dwell;
Jesus, our Emmanuel!
Hark! the herald angels sing
Glory to the new-born King!

Mild He lays His glory by,
Born that man no more may die,
Born to raise the sons of earth,
Born to give them second birth.
Risen with healing in His wings,
Light and life to all He brings,
Hail, the Son of Righteousness!
Hail, the heaven-born Prince of Peace!
Hark! the herald angels sing
Glory to the new-born King!

Come, Desire of nations come,
Fix in us Thy humble home;
Rise, the Woman's conquering Seed,
Bruise in us the Serpent's head.
Adam's likeness now efface:
Stamp Thine image in its place;
Second Adam, from above,
Reinstate us in Thy love.
Hark! the herald angels sing
Glory to the new-born King!

Little Drummer Boy
Come they told me, pa rum pum pum pum
A new born King to see, pa rum pum pum pum
Our finest gifts we bring, pa rum pum pum pum
To lay before the King, pa rum pum pum pum,
rum pum pum pum, rum pum pum pum,

So to honor Him, pa rum pum pum pum,
When we come.

Little Baby, pa rum pum pum pum
I am a poor boy too, pa rum pum pum pum
I have no gift to bring, pa rum pum pum pum
That's fit to give the King, pa rum pum pum pum,
rum pum pum pum, rum pum pum pum,

Shall I play for you, pa rum pum pum pum,
On my drum?

Mary nodded, pa rum pum pum pum
The ox and lamb kept time, pa rum pum pum pum
I played my drum for Him, pa rum pum pum pum
I played my best for Him, pa rum pum pum pum,
rum pum pum pum, rum pum pum pum,

Then He smiled at me, pa rum pum pum pum
Me and my drum.

Wednesday, December 9, 2009

On Surgery

One Surgeon's perspective

This blog is called Heard in the OR, a place I spend many hours most days, rummaging around inside people’s bodies. I hope that you will get a glimpse into what can be the bizarre thoughts of one surgeon and I hope you enjoy what I have to say. I welcome any and all comments.
For more than twenty years I have made my living as a general surgeon. This is more than a job, perhaps even more than a profession; it is best described as a passion. The surgeon is called to be passionate about what some would call the unthinkable, the extraordinary, the epitome of arrogance. “Arrogance”, one may say, “how can that be?”
What a surgeon does can only be called arrogant. The surgeon takes an incredibly sharp instrument, slices through living human tissue, and in the course of the operation decides what organ is offensive and is to be removed and what is innocuous or important and is to remain. Or, the surgeon may rearrange our tissues, taking what was once God’s perfect creation and altering it for a, presumably, nobler purposes. Man nobler than God? “Impossible”. Such is the arrogance of the surgeon.
Of course, I don’t in any way imagine any man, surgeon, priest, baker or used car salesman to be nobler than God. It is one of the consequences of living in this fallen world that we need surgeons. Diseases and the specter of Death having been released with the first taste of the forbidden fruit create a need for physicians and surgeons to help keep these evils at bay.
What is it that makes anyone do such a thing? How is it that out of a typical class of one hundred medical students some will choose to pursue a career in surgery. And, after years of rigorous training, of getting out of bed at three in the morning to attend to an anonymous individual who had the misfortune to be hit by a bus, shot, stabbed, suffered a perforated intestine or any number of maladies that can’t tell time, this endeavor remains a passion, something done for the reward of seeing the sick and injured walk out of the hospital alive and whole.
I’ve often considered that what surgeons do for a living would be reason for incarceration if it was done away from the operating theater. In general, cutting people open with sharp objects is considered socially inappropriate and frowned upon by legal authorities. To avoid this hazard the operating theater was developed and we surgeons try to limit such endeavors to that location. Theater is an appropriate description; surgery used to be performed in just such a way. Students and professors would observe the operation from seats in an amphitheater; sterility not a prime concern in those days. Even after the research of Joseph Lister introduced the concept of asepsis to surgery, thus eliminating the open spectacle, the operating room still had observation decks, frequently seen in old movies, but rare today.
So, we surgeons, haughty actors of the medical world, ply our trade before a smaller, but captive audience: anesthesiologist, circulating nurse, surgical technician, surgical assistant and the occasional student. But, the star and center of any operation is not the surgeon; rather it is the patient. Above all, the patient is given the most attention, loving care with every detail of the procedure geared towards carrying this individual to a successful outcome.
Before any operation time is spent evaluating, examining and explaining the operation to the patient. A very common question I hear is something like this: “This is routine isn’t it?” Most of the time the answer is that a particular operation is common, hopefully straightforward, but I never consider it routine. Every operation requires proper planning, attention to detail and the utmost care. And, with every procedure surgeons have a single goal; to perform the right operation, at the right time, with proper technique so that our patient returns to their normal life as expeditiously as possible.
A general surgeon spends 5-6 years in residency after medical school studying and practicing every aspect of the profession so that at the end of his time he believes he is fully and properly trained. This residency provides the necessary basics; how to evaluate a patient, plan surgery, carry out the operation and provide post-operative care. All those years certainly seems to be enough time to learn all that needs to be learned. But, in reality, the practice of surgery is a lifetime of learning. Every day brings the potential for something new, an unexpected anomaly, a new presentation of an old disease, a situation never previously encountered; one that may only echo a vague memory of an article read in an old journal.
So, in our arrogance, we are humbled. It is this humility that separates the good and very good surgeons from the great surgeons. Because, every person that picks up a scalpel has to have the arrogance, the confidence that says I can do this better than anyone. If this belief is missing and the surgeon believes that another surgeon can do the job better, then it is in that patient’s best interest to be referred to that other surgeon. If humility is lacking, the patient may suffer.
What about humility? Physicians quickly learn that, despite our best therapeutic efforts, the human body can be a frustrating and unforgiving subject. Invasion by micro-organisms, tumors, external forces and foreign objects or even by the body attacking itself can rapidly overcome all our good intentions. We do all we can to give our patients the greatest chance for complete recovery and, happily, we are successful in the vast majority of cases. But, every individual is unique and every individual demands our unflagging attention. It is something I am reminded of everyday. The truly great surgeon is never so arrogant as to believe that something can’t be wrong. It is an unfortunate truth that patients sometimes become sick after surgery; that our best efforts may not have been good enough. When this happens we start to look for a reason; all our searching usually leads back to the original operation; something bleeding or not healing as expected, an infection or a wide variety of other potential complications. And so, it is the surgeon’s humility that allows him or her to say, “something’s not right, I need to figure this out and solve this dilemma.” It is this attribute that comes with experience and is the single, most difficult thing for the young surgeon to learn.
Arrogance and humility, truly an oxymoron, but no two words give a better description of what we surgeons are made of. It takes a truly unusual, dedicated person to follow the trail that at the ends bestows the title “Surgeon”. I have followed this path for twenty years and have always enjoyed the challenge. I hope you are informed and entertained by my words as I record them in the months and, hopefully, years to come.