Saturday, September 25, 2010

Surgical Education

It is predicted that over the next ten years, as the baby boom generation ages, that there will be a shortage of available general surgeons to address the expected surgical needs of this aging population. Indeed, many general surgery residency programs have been finding it difficult to fill all their categorical positions, that is those positions that lead to a finished general surgeon. As more and more of the population reach retirement age, it is anticipated that the incidence of GI cancers, breast cancer, peripheral vascular disease and many other maladies prevalent among this age group will increase and there is a growing concern that the already overworked specialty of general surgery will be unable to adequately meet the challenge.

The recently passed Healthcare Reform act has squarely attacked this growing problem with several new and innovative pilot programs. The Simian Surgical project, previously reported on these pages is one such program. Another pilot program, to be headquartered in Phoenix, Arizona, is the ICS Surgical Education Program. This ground-breaking initiative, funded by an NIH grant through the recently passed healthcare bill, has as its goal to seek out highly skilled young persons and train them as surgeons. Currently, it takes many years to train a general surgeon. Four years of college, followed by four years of medical school and, then, five to six years of surgery residency is the current pathway to becoming a general surgeon. The new, innovative program will streamline this pathway considerably.

Dr. Albert Scheinbach elaborates, “Recent studies suggest that highly skilled technicians can adequately perform the necessary surgery to prevent the shortfall of qualified surgeons that this country may face in the coming years. Our aim is to find the future stars of surgery at a young age, perhaps as young as nine or ten, train them in the most modern techniques, utilizing the most modern equipment available and prevent what could be tragedy for so many of our elderly.”

Dr. Scheinbach explained that the initial phase will be one of recruitment. Carpet advertising in the most popular and widely read graphic journals*, as well as recruitment in various projection oriented arcades should allow the program to find young men and women with appropriate hand-eye coordination to perform the many surgical procedures at the highest possible level. It has been clearly demonstrated that surgical skills are directly correlated to scores achieved on “Donkey Kong”, Super Mario Brothers” and “Need for Speed”. However, besides demonstrating the necessary hand-eye coordination the recruitment process will also require the applicants to be able to fill out the application; the prospective surgeon will actually have to have the skill to legibly write their name and address, including postal code, on the form that will be available with the advertisement. Once accepted into the program, a vigorous, but compassionate educational and training regimen will commence.

From the comfort of their own home the student will be sent a weekly package containing the training materials, including educational manuals and anatomic parts. An instructional audio CD written by James Weldon Johnson**, famous spiritual composer, will accompany the material and will provide the student with detailed directions to allow him or her to complete the required tasks. At the end of the semester the student will be expected to return all the body parts properly assembled and fully functional. Those that pass this portion of the training will be allowed to progress to the final examination.

The final exam will be administered by the surgical staff of the University of Phoenix, International Correspondence Division, and will consist of a didactic portion as well as an actual operation. Dr. Scheinbach explains:

“The home centered education portion is not considered completely adequate training to allow our students to enter the operating theater unattended. The candidate for graduation must demonstrate the necessary dexterity to be a safe surgeon. The final exam will consist of a series of simulated procedures utilizing a standard model, Operation*** and then a computer graphics module****; successful completion of this phase is followed by an actual operation. The candidate will be assigned a random operation ranging from a simple appendectomy to a pancreatoduodenectomy. These highly skilled young people will be required to perform the assigned procedure assisted by standard operating room personnel. A grade of 70 % on this portion of the exam will be necessary to pass and be issued a diploma. The graduate will be bestowed with the degree ‘Doctor of Surgery’.”

A spokesman for the Obama administration stated that the supposed complexities of most operations are exaggerated and overstated. We believe that any properly trained person, with the necessary manual dexterity and assisted by the computer modules that our team has developed, can successfully perform most of the surgery necessary for the aging baby boomer population. He added that, initially, these newly trained surgeons will provide service limited to Medicare patients. It is anticipated that as the program becomes established and the significant cost savings are realized private insurers will jump on the bandwagon.

The initial pilot program will have 500 participants with initial training expected to be completed by January 2012.

* “Teen Titans”, “Astonishing X-Men”, “The Incredible Hulk”, “Spiderman”
** “Dem Bones, Dem Bones, Dem Dry Bones” Lyrics and music by James Weldon Johnson
** “Operation” Hasbro toys recommended for ages 6&up
**** “Virtual Surgery, For the Beginner”

Saturday, September 18, 2010

After Horton

Dealing with Tragedy

It’s been decades since the near disaster; the time when all of our society hung by the thinnest of threads and only the strength and fortitude of one small boy saved us all from our short sightedness. As I look back over the years I am astounded and a bit saddened by what has happened to all of us that were engulfed by the events of the day.

Of course the exploits of the two heroes have been widely reported in the tabloid media over the years. Horton, the noble steadfast beast, remained true to his principles for a period of time, but even he was unable to avoid scandal.

The sordid affair with Miss Maisey producing a bastard child eventually drove that pachyderm to a lifelong addiction to peanuts. Although he protested loud and long, claiming that he had only the noblest intentions, the product of their illicit union could not be denied. Horton did acquit himself to some degree over the years, raising his elephant bird son, eventually sending his unique offspring to veterinarian school before the lad was tragically crushed while caring, ironically, for an elephant at the Miami Zoo.

Horton overcame the subsequent depression and, after a stint at the Betty Ford Clinic, went on to star in several movie adaptations of his life and win an Oscar nomination for Best Supporting Actor for his role as lead elephant in Tarzan and the Leopard Men. After penning his memoirs he settled down in The Bronx, where he continues to live with his wife, Esther. In a recent interview he was quoted:

“I’ve lived a long and full life with enough adventure for ten elephants. I have to say that through it all I’ve remained true to my principles treating everyone equally, with compassion and the right amount of love and kindness. And, for those of you that have tried to wrong me over the years” he added while popping a peanut into his mouth, “I have to say, be careful, be very careful, I won’t forget…I’ll never forget.”

The other hero of note was Jo Jo, only a young boy at the time. But, it was his timely “YOPP” that saved us all. Of course, he was celebrated in both print and electronic media and his fame spread. Only a few years later he went on tour with his rock group, “Jo Jo and his Yo-Yo’s”. They played to packed houses for two summers straight and there song “Yipps and Yopps” stayed at number one on the Billboard charts for five months straight.

After a few years, however, his star began to fade. Addiction to heroin plagued him and less than ten years after reaching the pinnacle of success and fame he was found dead, with a needle in his arm, at a crack house on 17th Street. His band tries to carry on without him and you can still see them on Thursdays, here in town at Lena’s CafĂ©.

Mother Kangaroo tried to rise above her role, claiming that her only crime was ignorance and that Horton should have been more forthright and insistent regarding his claims. She said in the weeks that followed the events that she feared for the safety of her young son, that a crazed, wild elephant posed a great danger to the jungle. She realized later that it would have been better to humor Horton at the time, but she was trying to set a good example for her son; that it is always best to confront danger, rather than hide.

She eventually, after her children were grown, had a brief affair with a Tasmanian Devil, before marrying the Lorax and finally settling down. They formed the nonprofit organization, “Green Against Pollution” which championed “Green” technologies and fought against waste and exploitation of our natural resources. Mother Kangaroo’s most successful campaign was against the use of beezle nuts and beezle nut oil, citing the considerable smoke that could pollute the air when this oil is used for cooking as well as the dangers of intoxication when excessive quantities of this particular nut are ingested.

Her son, Angus Kangaroo, made a name for himself some years after the near tragedy. His book, “Momzilla, Life in the Pouch”, hit number one on the New York Times best sellers list and stayed there for sixteen straight weeks. He eventually came out and spoke out strongly for “Kangaroo Rights”, battling years of built up prejudices against Kangaroos and their many marsupial relatives. His second book, “I have a Pouch and that’s OK”, although not selling as well as his debut, received much critical acclaim and raised awareness about the plight of marsupials everywhere.

The greatest tragedy that followed our near demise was the suffering of the Wickersham Brothers. The guilt of having nearly destroyed an entire civilization was more than the three of them could handle.

The eldest, Hiram Wickersham, was found hanging from a beam in his jungle apartment only three weeks after the events. The note only said “I’m Sorry…I’m Sorry”.

Elrod Wickersham, the youngest, immediately hit the talk show circuit, claiming that he never wanted to boil that dust speck, as was widely reported. He was only going along with his brother’s wishes and claimed that he never intended to go through with the horrible deed; that he would have stopped them before it was too late; that he also feared for his own life and that if he interfered he would have found himself belly up in a boiling cauldron of beezle nut oil. Of course, he became an outcast from society, never able to clear his name and eventually joined a monastery in Perth.

Ambrose Wickersham, the middle brother, earned even more notoriety in the years to come. He never apologized or denied any wrongdoing in the Whoville affair. In fact, in the aftermath not a word was heard from him. Two years later he was photographed throwing stones at an elephant in the Houston Zoo and it was only a short time later that his hatred for all elephants came to light. It seems that the Wickersham’s father was crushed to death by one of the elephants in the “Outback Circus”, part of a combined elephant/monkey act. Although an investigation proved the death was an unavoidable accident, Ambrose was never able to forgive the elephant and harbored a lifelong enmity towards all elephants, be they Indian or African. Only a few years ago he died in a manner similar to his father. He climbed into the elephant enclosure at the Sydney Zoo and taunted the residents until they charged him and he was trampled. The death was ruled a suicide by the Sydney Coroner’s Office.

Valad Vlad-I-Koff, the eagle that cast our home into the vast field of clover actually came out unscathed. He claimed that he was trying to save us by hiding us from the vicious mob and deranged elephant in one place where we would be safe, the field of clover. I almost believed him at the time, but later eyewitness accounts refuted his claims. Still, he became a successful businessman, starting “Eagle Courier Services”, a company that specialized in overnight deliveries. Rumors abounded a few years ago that the company was involved in delivery of illegal drugs and merchandise, but these allegations remain unproven and Valad sold the company only last year and retired to Palm Beach, Florida.

As for me, the Mayor, I have weathered the years, staying in my position as Mayor of Whoville for forty one years. The near disaster led to a call for more safety measures and plans were made to construct a bright beacon that would make our presence known to the smallest being in the outside worlds. In addition, work was begun on a powerful amplifier, something to make all the outsiders aware of our presence. Political infighting stalled all these projects and then the faltering economy and shrinking tax base forced us to abandon them completely. I never married, as my child hood sweetheart, Cindy Lou, chose to marry that professional baseball player instead. I heard that he has mistreated her terribly, but I can’t say for sure.

So now I spend my days walking in the park, feeding the ducks and reminiscing over those old days. Every day I stop and admire the statue of Horton that sits in the middle of Whoville Park. The ears and trunk have turned green over the years, but the statue still stands as a reminder to all the generations of Who’s, reminding them and us of the fate that we narrowly avoided.

For those of you that don't remember "Horton Hears a Who" here is a link to the text of the story by Dr. Suess

Saturday, September 4, 2010

Airport Security

I recently had the pleasure of flying from Houston to Albany, NY, the occasion being a visit to my parents. As always, I arrived at the airport more than an hour before my scheduled departure time, even though I only had a carry on bag. These days you never know about the line to pass through the security checkpoint. Thankfully, the line was pretty short and I was able to spend my time sitting by the gate, instead of standing in line.

As I approached the security checkpoints, I performed the usual preparatory actions: had my boarding pass and ID in hand for the security guard and then went through the ritual partial disrobing. I put my laptop computer, wallet, keys, cellphone, watch, belt, shoes and my bag in the gray plastic bins and prepared to pass through the metal detector, clutching the waistband of my pants, lest they unceremoniously slide down to my knees. I managed to pass through without setting off any bells and whistles, sat down to get myself dressed and while doing this thought about this ritual I had just experienced.

I suppose it makes sense to separate metal objects I guess, although these days I think most explosives are made of plastic of some sort. Taking the belt off is necessary because most belts have some metal in them and could set off the metal detector. Removing the shoes is in response to the shoe bomber, Richard Reed, although I suspect there are some shoes that could serve as terrorist weapons without any hidden explosives.

I thought about the “Shoe Bomber” and removing one’s shoes. Shoes at the time were a fairly good hiding place; something ubiquitous and unassuming. The requirement that shoes now be removed and scanned seems to be a perfectly reasonable response to that past event. But, wasn’t there recently an “Underwear Bomber?” It seems to me that an appropriate similar response to this new threat is called for. Unless this issue is properly addressed underwear will remain a viable option for transporting bombs. I realize that it is not practical for every passenger to remove his or her underwear while passing through security. The time for each passenger to remove their underwear and then dress would be way too long. Plus, I could see some people wanting to go through the line even if they weren’t flying anywhere. One solution would be to make it illegal to fly while wearing underwear. Of course, objections to this plan would inevitably be raised by the pro-underwear crowd and it is likely that the ban on flying with underwear would probably be found to be unconstitutional by the current Supreme Court.

Perhaps, random underwear checks could be done. Every tenth person could be required to submit to a thorough undergarment inspection. Passengers who objected to such violation of their personal space could be given the opportunity to declare that they are sans underwear, which could be confirmed by a quick peek which would add a mere few seconds to the security process. Women wearing thongs also could make such a declaration. After all, no respectable bomb could fit inside a thong.

There are a few other flaws in the current screening procedures. I’ve recently learned that terrorists are finding newer and more clever ways to smuggle their explosives aboard. Apparently, plastic surgeons are being recruited to perform breast augmentation on would be suicide bombers, utilizing breast implants filled with explosives. If this is true then a new line of security becomes necessary. Personnel with special training and very experienced in examination of the breast would become necessary to discern the subtleties inherent in an explosive breast implant.

With the changes that have come in health care I see this as a new and potential lucrative revenue stream for general surgeons and gynecologists who have suffered decline in income as reimbursement has fallen for traditional health care. In addition, there will be a need for proctologists as terrorists go beyond shoes and underwear and start carrying their explosive devices inside body cavities. In order to perform complete exams only proctologists capable of palming a basketball would be qualified.

It is possible that future screening procedures will require several stations. I can just hear the chatter: “Right arm up over your head…Left arm up…bend over…next…hey captain, come check these out…next”. I think retired doctors would be best suited to such work.

These security measures may seem drastic to the typical lay person. But, dangerous times demand appropriate and effective methods to outwit the evil forces that lurk in the shadows. These few modest proposals would go a long way towards deterring these desperate, would be assassins and would help make our skies safe for us and for our children.