A Safe Spring

The post today has nothing to do with my usual topics. However, with spring upon us and summer coming I am writing to remind everyone to be vigilant around water as our children spend time at the pool, lake or beach. Drownings occur far too frequently. TV and movies depict drowning as loud events filled with splashing and flailing and screams. In reality, most children drown quietly, slipping under the water silently, only to be found later.

To illustrate this point I offer two stories.

The first involves my son. When he was much younger my wife and I would take our three kids to the community swimming pool. We would often socialize with other young parents while the kids swam, but I always kept my eye on our children, even though they wore life vests until they could swim independently.

One afternoon my wife took the kids to the pool while I was working. My son, who was about five at the time was on his little floating device while my seven year old was watching him. My wife was talking with some of the other mothers, but was also watching the kids. My son, in a single moment when my daughter turned her head away, slipped off his "floaty"and silently went under the water.

Luckily, my wife was there. She quickly excused herself, jumped into the water and pulled him out, unharmed. Three lifeguards on duty came running, profusely apologetic. Not one of them had noticed this near drowning. Thank God for my wife's vigilance.

We had learned the need for such attentiveness from a parenting magazine which had run an article about this  topic, making it clear that children drowning is a silent event. I talked about this near drowning  in the OR the following week, emphasizing the silent nature of this frequent cause of childhood death.

The following Monday one of the Nurse Anesthetists gave me a big hug. She said that because of what I had recounted in the OR the previous week, the child of a friend had been prevented from drowning. Once again this young child had slipped under the water silently. No splashing, no screaming, no calls of distress. But, because of what I had said, she was keeping a close eye on all the kids and she jumped in and rescued him, once again unharmed.

So, as spring and summer approach, those of you with young children or with anyone that cannot swim, listen up. Please pay close attention anytime they are in or around water. Do not take your eye off of them for even one second. Teach your kids to swim. Just because there are lifeguards on duty, don't become complacent. The lifeguards often don;t see everything and they are not paying attention to your kids only.

Inquisition

                        

Today I had the displeasure of sitting in judgment before a modern inquisition at one of the hospitals I attend. Although the Grand Inquisitor lacked the trappings of a Monsignor or Bishop, and without a physical executioner in the room, I was subjected to  round after round  of questions regarding my apparent disregard for system wide medical and post surgical protocols. Such protocols have been adopted by CMS (which oversees Medicare) and a large amount of money is tied to their proper implementation.

There are protocols pertaining to prevention of Venous Thrmomboembolism, antibiotic use in surgical patients, removal of urinary catheters along with a few others which rarely are an issue for me. The principal point of concern for the Inquisitors was my use (or apparent lack of use) of pharmacologic agents for VTE (Venous Thromboembolism) prophylaxis. Specifically, I had not used Lovenox in 3 patients who had undergone major surgical procedures.

One of the patients had a redo open hiatal hernia repair with a tiny nick in the spleen, another was an elderly lady with a complex medical history and carcinoma of the colon who underwent a laparoscopic right colon resection and the third had exploratory laparotomy for a small bowel perforation with generalized peritonitis and systemic sepsis four days after laparoscopic hysterectomy. In each of these cases I determined that there was more than the usual risk for bleeding and that anticoagulation, even with low dose Lovenox, increased this risk. Each patient was treated with sequential compression devices (SCD’s) and none developed a Deep Venous Thrombosis (DVT) or any other complication.

Before going before the Inquisition I reviewed some of the literature on VTE prophylaxis in the general surgery patient. The incidence of DVT in this population is reported to be in the range of 6-7% without any prophylaxis. Using sequential compression devices alone reduces the incidence to about 3% and pharmacologic prophylaxis with subcutaneous Lovenox, heparin or something similar reduces it to around 1%. The tradeoff with the anticoagulants is an increased incidence of bleeding complications. In each of the three cases cited I made a medical decision to accept a slightly higher risk of developing a DVT while minimizing the possibility of post-operative bleeding. At this point I should point out that I cannot remember the last time I had a patient develop a DVT. My standard approach to DVT prevention is to use sequential compression devices on nearly all my patients intraoperatively and post operatively. Pharmacologic agents are used whenever the risk is acceptable. Aggressive early ambulation is also employed. The last DVT I can recall was in a patient who had an uneventful laparoscopic cholecystectomy with a surgery time of about thirty minutes, discharge on the same day as the procedure, but readmission five days later with a DVT which involved the superficial femoral vein, but did not extend to the common femoral or iliac veins. This patient would not have needed any VTE prophylaxis under the current protocol, although he was treated with SCD’s during surgery.

Armed with my research I entered the arena to face a grim panel of Inquisitors. Memories of my fraternity initiation passed through my mind as I took my seat near the head table.

“Do you have anything to say about the cases under review before judgment is passed?” the Grand Inquisitor queried. I must add that the “Committee” had reviewed the cases under question the previous month, in my absence (I was unable to go to the meeting because I was in surgery). It was only after I protested their arbitrary ratings, particularly a Level 4 (worst rating possible) for the patient with peritonitis and small bowel perforation, that the Chairman of the Committee invited me to address the eminent council.

“Yes, your eminence” I started. “I take great exception to your scoring, particularly on the first case…” I then went through each case and explained my reasoning behind the medical decisions which were made.

“You are living dangerously,” the Grand Inquisitor admonished.

“You’re careening down the highway out of control and will undoubtedly crash,” counseled another Inquisitor. “Patients must have Lovenox or they are doomed…doomed.”

“It is heresy and blasphemy,” shouted the Grand Inquisitor, pounding his fist on the table and tearing his clothes. (Not really, but it would not have surprised me if these words had been uttered.)

I don’t know what the outcome of this inquisition will be. I’m sure a certified letter will arrive in the near future and I will be commanded to do 10 hours of penance by taking some sort of CME in SCIP and write “I will use Lovenox” a thousand times on a blackboard as part of SCIP detention.

But should it be that way? Shouldn’t I, as surgeon on a case, be the best individual to decide the risks and benefits of each therapeutic intervention, particularly in the immediate postoperative time period? It should come down to judgment, weighing the risk of bleeding relative to the risk of DVT or pulmonary embolus for each particular patient.

“Which would you rather have, bleeding or pulmonary embolus?” was one of the questions I was asked.

Of course, the answer is neither. But, it was presented as if it had to be one or the other, a flawed statement according to the laws of logic, but that is a whole different subject.

And, if my judgment regarding the risks of different therapies is not necessary, then why do my Medical consultants constantly write orders such as “Lovenox 40 mg SQ daily, if OK with Dr. Gelber?”

And, in the bigger picture, why am I chastised for attending to a very ill, septic, complicated patient on a Saturday afternoon, operating on her, and saving her life?

I have nothing against pharmacologic anticoagulants. The Committee cited three cases out of hundreds of surgeries I had performed at that facility over the months. The cases “fell out”. All three were fairly complex cases. Certainly, in the myriad other operations I have performed I have ordered Lovenox when appropriate.

 I know the answer to the questions I raise above. The answer is Money. These “core measures” are tied to Medicare reimbursement. If the hospital is not compliant then it loses money. Thus, the nursing staff lives in terror lest one of them forget to contact the doctor to have him or her comply. Excellent nurses have been fired for failure to make such calls; three strikes and you’re out. Pharmacists have taken it upon themselves to discontinue antibiotics in septic patients because they are “SCIP patients.” I know of two such incidents which occurred in a span of 2 weeks, both patients suffering.

And I am called before the Inquisition board to explain my heresy. Welcome to “modern medicine”.

Only ten years until I can retire.

Conversation with the Minotaur, Part Four

            

Can you tell us anything about your sex life?

The Minotaur stopped an stroked his chin for a few moments, he started to speak, stopped and then started again.

No one has ever asked me that before. I’ve not been one to kiss and tell and for the most part there is very little to tell. I was locked away in the Labyrinth at age twelve and spent endless years in solitude. Before the Labyrinth I suppose I was involved in a few childish pranks with the other palace boys. We would spy on the female servants as they bathed or occasionally cavorted with some of the royalty or guards, but I was locked away before I became aware of what sex was.

However, after my escape I made my way to Egypt and was declared Nev, god of the surf, when I emerged from the sea. Well, I was still a very young man at the time, at least when speaking about immortal beings, and I had all the normal appetites one would expect. And, as a god, I was a temptation to everyone. Those Egyptians took every opportunity to mingle with their deities.

They say Solomon had 700 wives and 300 hundred concubines in his life, I had that many in a month. They came to me in every size, shape and combination. I was young and foolish and, as a god, I didn’t think I should refuse any offers. Women came, men came, and some came that I wasn’t sure about. Everyone wanted a part of me. But, it was all meaningless. After the first few months I grew to hate it. Why? I think it was because not one of my many consorts truly cared. I think in that time I had enough sex for ten lifetimes. In and out, up and down, standing up, sitting down, this way and that, it all became so tiresome. So, I put a stop to it and spent my time on activities which were far more godly: righting wrongs, passing judgment, helping those who were less fortunate. By the time I left Egypt sex was a mere memory and it stayed that way for many, many years.

So you became celibate?

Well, sort of. I was turned off to humanity. But I did spend time among the cows, off and on. I guess it’s the bullish part of that has this attraction for the Elsies. ( I think Borden stole Elsie the cow from me.) The feeling however, was not mutual. Look at me. I’m human from the chest down. The Elsies are used to cavorting with stern, virile, amply endowed complete bulls, not a half human, less than average sized mutant. Even  though I lived among cows for years, the Elsies never gave me the time of day and the true bulls treated me with nothing but contempt. Talk about sexual frustration.

Celibacy became the norm and I really didn’t mind. And then came Biz, my wife. She combined the best of everything. She was the wolf-girl in the circus I joined and it was love at first sight. She was beautiful, hairy, shapely, kind, intelligent and we had years of wedded bliss before she passed away. Our sex life was one of true love, which made it passionate and a million times better than all the thousands of encounters I’d had in Egypt.

Since she’s been gone I haven’t been with anyone else. The buffed, waxed, simonized women of today just don’t do anything for me. Give me a woman with some hair and maybe I’ll be interested. But, no one could ever replace my beloved Biz. Maybe, I’m just getting old.

Conversation With the Minotaur, Part Three

Why Now?

Do you mean why, after thousands of years of lurking in the shadows and going in and out of a variety of Labyrinths, am I making such a splash in the public forum?

Precisely

Well. Why not now? I’ve got a story to tell and I decided it was time to set the record straight. Your mythology books paint me as a vicious monster, devouring innocent youths and maids. But, as I’m sure you can surmise, I am everything but a monster. The world today is falling apart at the seams. This is nothing new. Hatred and war and death have been around since the first man and woman. Now, however, things are different. You have the means to destroy yourselves and this world.

Maybe I’m naïve or maybe I have an inflated opinion of myself, but I thought that my experience, my personal witness of events from long ago might make a difference. It did take a bit of persuading by some of the people responsible for my being here, but they are one hundred per cent correct. The world needs to know the truth. So, here I am, an eyewitness to Moses, Jesus, Dracula and so many more. I’d like to say that I know the way to the promised land, that I can lead the masses away from the paths of certain destruction, but I am not a god, I’ve failed miserably every time I’ve tried to be a great leader, I’m only a humble monster.

What do you have to offer, Minotaur?

My witness. Witness to the truth about God, humanity and history. Is there any truth to the current Greek and Roman Mythology? I can tell you. From Moses to the beatnik generation I’ve been there and seen that.

We can all learn from history and from humanity. We can learn that there are some truly noble men and women among god’s creation, but there are far more villains and scoundrels. The depths of depravity that humanity can reach is both astounding and disgusting. I’ve lived through the evil of war, murder and the Holocaust.

On the flip side there are men and women who have sacrificed themselves so that others my live. In my life I’ve seen both the amazingly good and the exceptionally bad.

Just come visit me and I will tell you, listen to my lecture next week at the University, read the book that will follow and learn the truth. That is all I ask. And, after you’ve learned what I have to offer, look at this world and try to make a difference, try to make it a better place.

This is an excerpt from my interview with The Minotaur the week before his fateful lecture at The University. This lecture was where he first revealed the events of his remarkable life; events which are recounted in the book “Minotaur Revistied.”

 Read about the Minotaur's amazing life in "Minotaur Revisited", his own story told in his own words. Now available on Amazon.com, Barnes and Noble online, Kobo books and other online venues.

 “this novel… has been embraced by both history buffs and casual readers, faith based and nonreligious bookworms” Wordsmith Journal March 2013

Another Night Clinic

                    

Another full moon…another Night Clinic. At least they fixed the front door and Miss James is with me again.

I walked through the main entrance and saw the new sign “No Werewolves Allowed” handwritten in black and blue magic marker. I see Miss James hasn’t lost her sense of humor.

“Good Evening , Miss James,” I announced as I placed my backpack on the counter behind the nurse’s station. “Are you ready for another action packed full moon?”

“I’m ready, Dr. Barnes,” She replied. “I’ve got my garlic, a crucifix and a pack of silver bullets all right here in my pocket.” She looked up from her desk and displayed a wide grin.

“That’s just fine, nurse, but, the garlic and crucifix are only for vampires and the silver bullets aren’t much good unless they are used with a gun. No matter, I’m ready to get to work. Anything waiting?”

“Headache in room three.”

Good, something simple.

I glanced at the chart. Twenty three years old, male, no significant past medical history. I knocked as I opened the door.

“Good Evening, Mr. Dallas. I’m Dr. Barnes, what is the problem that brought you here tonight.”

The patient was clean shaven, with short brown hair and brown eyes; eyes which stared at me as I walked towards the exam table where my patient lay sprawled out. Those eyes looked up at me, filled with tears and fear.

“Oooh…uh…it’s going to explode…Oo…” and his voice trailed off and the eyes closed.

“Mr. Dallas, can you hear me?” No response. I grabbed his wrist and felt for a pulse…nothing. I punched the red emergency button on the wall as I felt for a femoral pulse, which was present, but weak. Miss James burst through the door, crash cart in tow. I pulled the ambu bag from the wall and connected it to oxygen as Miss James hooked up monitors and handed me an endotracheal tube and laryngoscope.

Something simple?

“Tube is in,” I exclaimed as I connected the ambu bag and began steady rhythmic squeezing.

“IV is in,” Miss James countered.

I glanced at the monitor. Sinus Bradycardia with a rate of thirty. Miss James took over “bagging” Mr. Dallas while I made a quick surveillance. Left pupil reactive, right pupil dilated. No reaction to any stimuli, painful or otherwise. No sign of trauma anywhere. I picked up the red phone and called for an ambulance. Miss James continued ventilating our now relatively stable patient. His blood pressure was holding steady at 110/40, heart rate was now 50 and oxygen saturation was 100%. Two minutes later the ambulance arrived and Mr. Dallas was whisked away to County General Hospital for more definitive care.

“Another full moon?” Miss James commented rhetorically.

I just shrugged my shoulders. We went back to the break room to collect ourselves. I washed my hands and doused my face with cold water. Miss James took a drink of some Mylanta.

“Things like that always give me heartburn,” she stated. “Give yourself a few minutes. All that’s waiting is a simple…I promise… sore throat.”

I sat at the table and fixed myself a cup of hot chocolate. Over the years I never could develop a taste for coffee. Tea was OK, but only after a fine meal, not at work. I perused the newspaper while I sipped on my cup and waited for my epinephrine level to fall.

Astros lost again, no surprise…government wants to raise taxes…gang wars threaten to erupt…everything’s depressing, nothing to give the average Joe hope. Oh well, time to get back to work.

I picked up the chart to Room 1. Fourteen year old boy, Michael Drubitz, sore throat for two days, Temp 101, everything else normal. I knocked on the door and walked in.

“Good Evening, Michael. I’m Dr. Barnes,” I began with my usual introduction. I turned to the woman who was seated next to my patient. “Good evening, Mrs Drubitz?” I asked, never assuming an adult with a child is the parent.

“I’m Sheila, Michael’s mother.”

“Pleased to meet you. What is the problem Michael is having?” I asked, turning to the young man.

“My throat hurts. I can barely swallow,” the boy answered. I noticed he was flushed and he looked a bit listless.

“He started feeling sick three days ago, at school. I kept him home yesterday and today. He had fever of 104 this morning. He’s had strep throat five times since January. He gets sicker each time.”

“Let me have a look. Open your mouth wide, Michael.”

I pushed on his tongue with the wooden tongue depressor and saw two huge tonsils, touching each other in the back of Michael’s throat, yellowish exudates coated each one and the surrounding mucosa looked red and angry. A simple case of strep throat.

“It doesn’t look too complicated, Mrs. Drubitz,” A few days of antibiotics and he’ll be up and around like nothing ever happened.

“Are you sure, Dr? We never had anything like this until we came here.” She observed. “At our old home, he never got sick.”

“Changes always affect us. And this Houston climate seems to predispose to things like this,” I responded, as I prepared the prescription for a Z-pack. He doesn’t have any allergies, does he, Mrs. Drubitz?”

“Just to water,” she answered.

“Excuse me, did you say water?” I asked, more than a touch of disbelief in my voice.

“Yes, water,” she answered in a matter of fact tone, as if it was a common condition.

“What happens if he is given water?” I asked with a bit of trepidation, wondering what I was getting myself into.

“Why the same thing which happens to all of us,” she replied.

“Which is…?”

“We get wet and then we melt,” she replied.

“You melt?” Why me?

“Of course. It happens to all of us. I know you’re thinking, she thinks she’s some sort of wicked witch, which I’m not, by the way. Let’s just say that back home any contact with plain water has dire consequences. Look at this scar” and she held up her hand to reveal a circular scar about two cms wide on her palm, “drop of water fell there three years ago. Almost burnt a hole right through my hand. Luckily Michael here was able to get it off before it caused permanent damage.”

“Just exactly where do you hail from, Mrs. Drubitz?”

She stared at her son for moment and then looked me in the eye.

“We’re from, uh, Poland,” she said.

“Uh huh,” I murmured. “Well, Mrs. Drubitz, take the medication as prescribed. Does Michael have a family doctor or pediatrician?”

“Not really,” she admitted.

“Here’s the number to the Clinic at the University and also one for an Ear Nose and Throat specialist. He’s had enough infections that he may benefit from consultation with an ENT to see if he needs his tonsils removed.”

“Thank you so much, Dr. Barnes,” she said effusively as she shook my hand, I noticed her hand was cold and felt a bit damp, like shaking the hand of a frog.

The two left, but as they were walking out I noticed that Michael had left what I thought was his cell phone on the exam table. I chased after them, but they were nowhere to be found.

Oh well, I guess they’ll be back if they really want it.

I looked up and saw a bright shooting star at that very moment, racing away from the earth. It looked like it had just been launched from the park a few blocks away.

I wonder, nah, that can’t be true.

I smelled my hand, the one that had shook Mrs. Drubitz’ hand. It smelled of alcohol.

“Anyone else waiting, Miss James?”

“URI in two and diarrhea in four, and the Goddess of the Night dropped these off for you.” She showed me a box of cookies thickly coated with powdered sugar.

“How is she doing anyway? She makes the best butter cookies.”

“She looked good. Finished her first round of chemo. She said her breast is already better.”

“That’s great,” I responded as I scarfed down four of the best cookies I’d ever had. I quickly dispatched the two waiting patients and sat down for a few moments to relax. My respite was short lived however as there were several loud shouts and I heard the door slam. We went out into the waiting room and found four teenagers lying prostrate in the waiting room. They were wearing gang colors and they were drenched in blood. Two were conscious and the other two were out, although both were still breathing.

“Just what we need,” I blurted out, making no attempt to hide my exasperation. “Better call an ambulance.”

“Right away, doctor,” Miss James replied.

At that moment there was a bright flash, followed by the loud boom of thunder and then another and another. The lights flashed on and off, came back on for a moment and then went out.

“The phones are dead, Dr. Barnes,” Miss James shouted, “and I can’t get a signal on my cell.”

I looked at my cell phone and saw the same thing: no signal. All of this transpired over a period of thirty seconds at the most. It was now pouring rain and we had only emergency lighting.

“We’ve got to do something fast for these two boys,” I said, stating the obvious. I looked at the two conscious boys. One was holding his leg with a dirty towel which was drenched with blood, while the other had a handkerchief tie around his head and another around his left arm.

“You with the bandana,” I screamed at the least injured of the four, “help me get your buddies into the exam rooms.

“I ain’t doin nothing for those ugly 57’s,” he hissed with hatred in his voice. He jumped up and bounded out the door into the teeth of the torrential downpour.

One less bit of trouble I thought, although I silently scolded myself for having such a thought. I turned my attention back to the other three problems at hand.

“Miss James, do you think we can get them into the exam room, at least.”

I was down on the floor with one of them, feeling a very thready pulse, while my shapely companion was attending to the other, doing her best to check his blood pressure in the dim light.

“I think it’s 70 over…”

At that moment there was a flash of blue light, short bang and a cloud of smoke, followed by the appearance of a man, dressed in tight black Spandex with a red “S” on the chest outlined by a hexagon of silver scalpels, wearing a tight black skullcap and a black surgical mask. He was solidly built with broad shoulders, bulging biceps and pecs, a six pack abdomen and muscular thighs and legs. Miss James’ jaw almost hit the floor when she saw him.

He was accompanied by a petite woman wearing a loose robe and a headband. She also sported surgical mask, but hers was pulled down around her neck and she had a stethoscope around her neck and wide belt with many little compartments around her narrow waist.

“It’s Captain Surgery,” a booming disembodied voice announced.

“Da Da Da Daaaa…” an invisible band played.

“Stop with the music,” Captain Surgery commanded and the music trailed away. “OK,” he continued, “let’s get these guys patched up.”

 “I suppose you’re Lieutenant Flea?” I quipped.

“Cloud,” she stated in a flat, deadpan voice.

“Dr. Cloud,” the Captain added. “My trusted Anesthesiologist.”

He then hoisted the two unconscious victims up above his head, one with each arm, while Miss James, Dr. Cloud and I helped the third boy into one the exam rooms.

“Excuse me, uh…Captain, there isn’t any power and there is no OR here; no lights, no nothing,” I stated, trying to prevent starting up on something we couldn’t finish properly. “Are you really a surgeon?”

He looked at me with a look that was almost pity in his eyes.

“Have faith, Doctor, Captain Surgery (Da da da daaaa…, he glared and the music stopped) has been in much worse circumstances.”

I saw him lay the first lad on the exam table. His eyes glowed as Dr. Cloud descended upon the boys head. Captain Surgery started to glow with a purple light and when I looked back at the boy’s head he was intubated and being ventilated by Dr. Cloud. She had her finger on his temple and she began to speak loudly:

Heart Rate 140

BP 76/30

O2 sat 100%

Cardiac output 2 liters/minute.

CO2 45

The Captains eyes continued to glow as he murmured, “Lacerated Liver, transected right Renal vein, transected peripheral nerve, perforated duodenum, approximately two liters of blood in the belly. OK, here we go.”

I watched in awe as the black gloves he wore morphed from fingers to scalpel and clamps. A long incision was made. Sparks flew from the gloved fingers as each vessel was neatly cauterized and the incision carried deeper into the abdomen. Blood spewed forth and was expertly sucked up by a suction apparatus that had appeared from the belt around his waist. The blood was routed to the head of the table where it passed through a filter which was around Cloud’s waist and then returned to the patient. I also saw antibiotics infuse along with fluids and various anesthetic agents. All the time Cloud never took her finger off his temple and continued to rhythmically announce physiologic parameters.

Captain Surgery worked in mostly in silence, only a rare murmur escaped from his lips. His eyes glowed and emitted light which illuminated the field in the darkened room. As he ran his fingers over the abdominal structures he mumbled each by name.

“Liver segment four lacerated with bleeding branch of hepatic artery and portal vein.”

Flashes of light and wisps of smoke emanated from the surgical field as his fingers danced over the injured organs at lightning speed.

“Vessels sealed, hemostasis achieved,” he announced. “Renal vein repaired and the kidney remains well perfused and functional. Duodenum repaired and buttressed. Final scan, all injuries addressed.”

 A torrent of clear fluid flooded out of his left hand as the abdomen was irrigated.

“Time to close,” he announced.

 I watched as he ran his hand up and down the wound which left the fascia closed. He infused a blue fluid into the wound and then ran his hand along the wound again, closing the skin. Finally, a clear fluid was applied and then dried, sealing the wound closed. The entire surgery had lasted only about twelve minutes.

“He’ll be good as new in a few hours,” the Captain announced. ‘On to the next victim, I mean patient.”

He went to the next table, once again eyes glowing as he scanned the patient. Cloud had the patient asleep in seconds and began her litany of vital signs and physiologic parameters.

“Look bad, Captain?” I heard her ask. “BP is forty.”

“Two gunshots; colon, superior mesenteric artery, just missed the spinal cord, second bullet went through the small bowel and right kidney. But, Captain Surgery (Da, da, another glare from the Captain’s eyes and the music stopped abruptly)is on the case.”

Once again the violet light engulfed his body and he went to work, his eyes shining, his fingers dancing, blood splattering here and there and then…silence, a few flashes of light and he started to close.

“BP’s ninety, Captain, heart rate’s down to ninety five and oxygen delivery is normal. Great save.”

“Thank you, thank you,” the Captain said with a bit of humility. “now on to the final lad.”

This time Cloud ran her hand across the patient’s abdomen which numbed him from the waist down. Captain Surgery reached his hand towards the gunshot wound, made a clean incision which exposed the injured artery.  The index finger from his left hand deftly encircled the artery above the injury while his left fifth finger controlled the distal artery. His right index finger ran up and around the injured segment and, when he was finished, left the artery perfectly repaired with an excellent, bounding pulse. He ran his right hand up and down the open wound and then pulled it out. The swelling disappeared and the wound sealed itself up.

“All three of these fine young men should be up and around in a few hours, doctor. Have them follow-up at the University clinic next week. They’ve received antibiotics and have been infused with extended pain relief. Well, Cloud, our work here is done. Wherever there is injury and disease, Captain Surgery (Da, da, da , daaaaa) will be there.”

“Always the dramatics,” Cloud whispered to Miss James.

“Did you say something, Dr. Cloud?” the Captain asked.

“I said you’re a virtuoso,” she replied.

 “It’s a living, “ she remarked as she packed up all her equipment.

At that moment the lights came on, the three gang members were all up and walking around and I saw a white light emanate from the Captain, which left his black, spandex outfit spotless. Every speck of blood and fluid washed away.

“Uh, Captain,” I asked, “shouldn’t you have a cape.”

“No capes, no capes; nothing but a nuisance, getting caught in doors,  dragging on the floor, and picking up all sorts of loose debris and germs. And, do you know how expensive they are to clean?”

He paused for a moment.

“Now remember, if you suffer from serious injury, broken bones, ruptured colons, ulcers, gallstones, hemorrhoids, cataracts, ear wax build-up or, well you get the idea. Just whisper my name, Captain Surgery (Da, da, da ,daaaa) and I’ll be there.”

There was a flash of light, a puff of smoke and they were gone.

“Do you believe that, Miss James? Vampires, werewolves and now this. I don’t think they pay us enough. That Captain Surgery (Da, da,da, daaa) is quite remartkable. ”

Miss James let out a big sigh. “I hope he comes back.” And, she sighed again.

“Muscles, brains and superpowers are not everything, nurse,” I commented. Then again, maybe they are.

“Look at the time; this shift is almost over. Anyone else waiting?”

“No, Dr. Barnes.

“Good, I could use some breakfast.”

And we left together as the day shift arrived.

Living through Cancer and Learning to Talk About It

By

Cameron Von St. James

My wife’s battle with cancer was hard on me, as her spouse and caregiver.  However, she has said on more than one occasion that she really has no idea what I must have gone through during this time. I hope that through this, I can give some more insight into what its like to be a caregiver for a loved one with cancer.

I remember seeing her cry when the doctor told her she’d been diagnosed with mesothelioma, and I remember wondering how we would make it through this. Heather had just given birth to our daughter, Lily, three months earlier. What was supposed to be the happiest, most joyful time in our lives quickly turned into one of the most fearful and stressful.

The biggest emotion I felt at first was anger. I was angry at the world for putting my family in this cruel and unfair situation. I was so angry that I was reduced to communicating with others through outbursts of profanity. I wasn’t happy with myself for doing that, and I really wanted to stop. However, it was easier said than done. I wasn’t able to be the rock that Heather needed until I got my anger under control, and realized how selfish I was being. I began to understand that the last thing my wife needed was to see just how scared I really was. Fortunately, I was able to get it under control and be the strong husband that she needed. From then on, I did my very best to be nothing but a source of hope and optimism for my family.

I did my best, but I was still overwhelmed because I had so much to do. On top of my job, I had to take care of my wife and daughter, our home and pets, and all of the travel arrangements we had to make for medical appointments and treatments. I learned quickly to prioritize and organize my to-do list, and to take it one item at a time.  I also learned to accept the help that our friends and family members were offering us. We were so blessed to have that kind of help and support in such a difficult time.

The worst part for me was the two month period I wasn’t with my wife and daughter. When Heather had her surgery in Boston, we sent Lily to Heather’s parent’s house in South Dakota. Heather needed time to recover following the operation, and she needed a full-time caregiver. I had to work, and we both knew I wasn’t able to do that and take care of her and Lily at the same time. We made the decision to send Heather to her parents’ house after her surgery, while I remained behind to work. I didn’t see them more than once in the entire two months they were away.

I did see them once, after I left work on a Friday night and made the 11-hour drive to my in-law’s house in the middle of a snowstorm.  I arrived, exhausted, on Saturday morning after having caught a few hours of sleep in the car while waiting for the plows to clear the roads. I spent one wonderful day with them, before I had to leave on Sunday to go back to work on Monday morning. It was short, but worth every minute of the difficult travel.

I learned a lot as a spouse and caregiver to a cancer patient. I learned that I have to accept help from time to time to make it through difficult situations, something that I was not very good at doing before this experience. I also learned to never regret any of the tough decisions that cancer forced us to make.  Rather, we learned to take comfort in the fact that we retained the ability to make choices at all, as they gave us some small amount of control over a situation which was almost completely beyond our control. Heather’s been healthy for more than six years now, despite the usually bleak prognosis for mesothelioma, and I can only hope that our story of triumph through tough times can be a source of hope and comfort to those currently battling cancer today.

Best Advice

I've just finished my blog and review tour for "Minotaur Revisited." It was a great success with many excellent reviews, comments and so much more. 

I will post the new reviews on my web site one of these days, but the words to describe my story were:

"uniquely written", "entertaining",  "the book kept me spellbound from beginning to end.", "fun read" and many more. 

Below is an article I wrote as a guest post which was not used:

I was asked to write about the best advice I had ever received. In all my life I don't remember any one individual sitting me down and saying "David, this is the key to happiness or success." However, along the way there have been people who have taken a special interest in me and offered words of encouragement or shown by their deeds the way to navigate this maze we commonly call life.

Start with my father, a physician, specifically a urologist, who dedicated his life to his family and his profession. We sailed together, he admonished me to "put the ball in the basket" during the many hours I spent honing my basketball skills, (my younger days were filed with a dream of becoming a basketball legend), but mostly he set an example, the first of many.

I was a keen observer in those days. Never a big talker like some of my brothers, I was more like Harpo Marx at the Algonquin Round Table. For those of you unfamiliar with New York City of the 1920's, the Round Table at the Algonquin Hotel hosted the wittiest literary minds of the day. Alexander Woolcott, Dorothy Parker, George S. Kaufman and others met, schmoozed and cavorted at that spot. Harpo Marx, the silent Marx brother of movie fame and a second grade dropout , was accepted into this crowd as “the designated listener”, a silent pair of ears among a crowd of brilliant talkers. Such is the way I often felt amongst eight brothers loudly vying for attention.

Beyond my childhood, there are two individuals that gave advice by their words and deeds. Sigrid Gelber was my adopted sister in medical school. We were thrown together during our first year by the vagaries of the alphabet. We had the same last name, but were unrelated. If I could be called quiet, she was anything but. Loud, outspoken and opinionated, with a thick  Brooklyn accent, we were opposite in every way. She made me laugh, forced me to live a life apart from school and took the phrase "live life to the fullest to heart." She had survived osteogenic sarcoma at age 17 and firmly believed that every moment we are given on this earth is precious. She shared this gift with me. In her case, it was far too true. She died of breast cancer at the young age of thirty-five.

After medical school came residency in surgery. The Chairman of our department was Dr. Anthony DiBenedetto, affectionately known as “the Chief.” More than anyone, he taught me the importance of hard work, dedication to my patients and attention to detail. He made me into the surgeon I am today and much of what he taught carries over into my writing.

Finally, there is my wonderful wife of twenty seven years, Laura. She introduced me to the Gospel of Jesus Christ. I was raised Jewish, but was really secular. Laura strongly believed in the truth of Christ's perfect sacrifice and, through perseverance and conviction, brought me to see the truth of this faith. This truth I have incorporated into my life and much of my writing.