Saturday, March 19, 2011

Monsters and Heroes

In the practice of surgery it is common for individual surgeons to try to establish a niche, an expertise that sets the surgeon apart from his colleagues. Some General Surgeons become expert in bariatric surgery, which is weight loss procedures, while others may specialize in surgery of the head and neck. In the spirit of increasing specialization I’ve decided to concentrate my surgical practice in the area of tending to the powerful and famous.

I must clarify this, however, by stating that I don’t refer to such trite and mundane figures as Presidents, royalty, sports stars or movie stars. These media driven figures offer no special challenge to a surgeon’s quest for greater challenges; the search for endeavors that tax ingenuity and skill. The individuals I plan to offer my services are the truly powerful: superheroes such as Spiderman and Superman; along with the elite of horror: Vampires, werewolves, and Frankenstein’s Monster. Such powerful individuals present special challenges which my unique skills and innovative talents are particularly well suited.

For instance, let’s start with Superman. Here is an individual, a refugee from the now annihilated planet Krypton. On Earth he displays near invincible superpowers, extraordinary strength, invulnerability to all weapons, defiance of gravity and many other traits. But, is he immune from disease? Does his reported highly dense molecular structure eliminate the possibility of gallstones or an enlarged prostate? I doubt it.

But, surgery on such an entity poses problems never encountered in the typical residency program. After all, how can even the finest surgeon begin to operate on a being that is impervious to knives, bullets, nuclear weapons, fire, and everything else? This issue actually was addressed in one of the Superman stories. The obvious solution was to have Kryptonite in the OR to diminish the invulnerability of the Man of Steel. From my perspective, however, this method lacks the necessary refinement inherent to most operations. It would be far better to incorporate Kryptonite into the surgical instruments that would be utilized during any operation. The smaller amounts of Kryptonite would make for an operation that is more controlled and safer for the patient.

What about other superheroes? The Fantastic Four, composed of Reed Richards with his ability to stretch to amazing lengths, his wife Sue Storm, who can become invisible and generate force fields, Johnny Storm, capable of becoming a human torch on command, and Ben, aka “The Thing”, super strong and composed of solid rock, each would require special precautions and instrumentation should they need surgery. And, with the way they are out and about, fighting evil Dr. Doom and such, they are high risk to suffer serious trauma. I’ll bet they can’t get health insurance, even under the impending Obamacare. But, I digress.

Surgery on Reed Richards probably would require a very sharp scalpel to compensate for his extreme elasticity; a laser could be more appropriate to cut through the elastic tissue. However, once the injured or diseased organ was repaired/removed, reconstruction would be greatly simplified. The problem of excessive tension on a repair or anastamosis becomes moot in such a being.

Sue Storm’s special powers would require that she be maintained deeply under anesthesia throughout the procedure. Should she become “light” it’s possible that any level of consciousness could trigger a reflex activation of her powers and she could become invisible. I don’t know about other surgeons, but I would find it particularly daunting to try to operate on an invisible patient. Of course, during residency I did have the pleasure of operating with a surgeon who was nearly blind, but that is not germane to the current discussion.

Johnny Storm in the anesthetized state presents no particular difficulty. For my purposes, however, I would need to exercise caution if I were to use fluoroscopy during an operation on him. This is because I have a habit of yelling “Flame On” when I want to fluoroscope. It would be a pity if the OR crew was incinerated because of a lack of caution or slip of the tongue.

Finally, there’s “The Thing”; lovable creature whose skin is solid rock. Once the incision was made utilizing a jackhammer or, perhaps a diamond tip saw, I suspect the operation could proceed unhindered. If, however, his internal organs were also silicon based, surgery in the usual manner may not be possible. A mason or stonesmith may be better equipped to deal with such a situation.

There are a host of superheroes that developed their prowess after being infected, exposed or inoculated with some type of radioactivity, cosmic power, powerful serum or other transforming material. Spiderman, The Incredible Hulk, The Silver Surfer and Captain America fit into this category. They present the common problem of protecting the surgeon and OR crew from contamination originating from the patient during the surgery. Current gowns, masks and gloves are no match for gamma rays and other types of radiation that likely is percolating through the veins of these sometimes reluctant heroes. The obvious solution is lead lined garb. However, such OR dress could greatly encumber the surgeon and lead to suboptimal results. These patients seem to be perfect candidates for utilizing robotic surgery. The robot’s multiple arms would be safe from any noxious agents and the operation could be carried out with minimal fuss. Once again, however, adequate anesthesia would be absolutely essential as the robot bears a striking resemblance to some of the more dastardly super villains.

There are numerous other superheroes that present other potential surgical concerns, but I think I’ve covered some of the more important modern day heroes. It’s time to move on to the other end of the spectrum: Monsters.

Folklore, books and film are filled with tales of werewolves, vampires, zombies and such. Just as with the superheroes, monsters would require specific modifications of traditional surgical procedures should an operation become necessary.

Vampires are all the rage these days. Vampire novels, movies paraphernalia and clubs are encountered on a daily basis. Are these forlorn creatures monsters, heroes or both. I am not here to render judgment; vampires actually would pose few serious impediments to surgery.

They live on blood, so nutrition is not an issue. Apparently, the blood can be consumed enterally or parenterally. They are universally described as pale creatures suggesting they are chronically anemic and would well tolerate hemoglobin levels that are very low. Indeed, after being NPO for eight hours before surgery it’s likely that they would have very low circulating blood volume and low blood pressure, diminishing the likelihood of serious blood loss, even during the most complicated operation. Opinions on the effect of sunlight vary, but it would be prudent to operate in a room without windows to minimize the risk of the patient disintegrating into dust halfway through the procedure. Protection of the OR crew must also be considered. An accidental needle stick causing mingling of vampire blood with the surgeon’s could lead to transformation of the surgeon into a state of being undead, like the vampires. I don’t know about other surgeons, but my disability insurance doesn’t cover such an occupational hazard.

Werewolves present an entirely different set of challenges. Tradition has been that werewolves can only be killed with a silver bullet, although more recent research suggests that it is necessary to completely dismember the subject to completely eliminate their existence. Thus tradition suggests that silver instruments would be most effective for such creatures. Elective surgery should not be scheduled during a full moon, unless a qualified veterinarian is standing by.

Moving on, “The Blob” was a creature that came from outer space with a taste for the consumption of humans. Any attempt to undertake surgery on such an entity should entail caution. This beast would have no remorse at consuming the surgeon, nurse or scrub tech. Surgery could only be performed using hypothermic technique. Such lower temperatures render “The Blob” compliant and eliminate the danger of being consumed. The anesthesiologist would be vital in such a situation, as he would be charged with keeping the patient’s body temperature low enough to prevent untoward complications, but not so low as to kill the patient. IV access might be an issue, but I suspect a catheter placed anywhere into the patient would be adequate.

Zombies would not present any special challenge. They are dead already, their flesh is rotting and, in general, there are no operations that are actually indicated in this patient population.

Finally, no discussion of Monsters would be complete without Frankenstein’s Monster. A being born of dead body parts, knitted together and then instilled with life that originated with the powerful electrical charge of a lightning bolt. It has been stated, at least in film, that “The Monster” cannot be killed; that having been created from dead body parts, his life goes on indefinitely. Surgery becomes straightforward in this situation. Rubber gloves protect the surgeon and crew from any electrical surge, as they already protect us from the electrical charge of the cautery. Any injured parts can be replaced from the local morgue, although neurosurgery may require some delicacy to prevent radical alteration of “The Monster’s” sweet personality.

There are other heroes and monsters that live among us, in literature, film and politics (monsters only). Surgeon to such famous and powerful beings may not be financially lucrative (is any surgery financially lucrative these days?), but the experience, publicity and subsequent fame should be fodder for books and TV appearances for many years. And, when it becomes time to retire, a tell all book would sell millions, if not billions of copies. “Does Dracula really sleep with a nightlight?”