The Final Queue

“…and down the stretch they come. Top Bonito leads by three lengths and is pulling away; it’s Top Bonito by five. Under the wire Top Bonito wins by six; the newest Breeder’s Cup Champion…”

That was the day, Toppy thought. Everyone cheered and they put a colorful blanket on my back and took a million pictures. Oh well, the years pass by. I wish this line would move faster.

Toppy put his head back and let out a long whinny and then nudged the smaller brown and white stallion at his side.

“How’d you get here, Bud?” he asked the compact, but powerfully built horse, which looked up with eyes half closed, but didn’t say a word.

They shuffled forward as the brown stallion closed his eyes. In his mind he saw the bright sun beating down on the desert, hot wind at his back as he raced along the hard ground, the scent of fresh water filling his nostrils with excited anticipation. He took a quick look behind and saw his eight ladies carefully shepherding the four fillies and colts as he exhorted them to keep up. Sweat flew off his sleek brown back as his four white legs seemed to fly just above the ground. He could see it now, the patch of green and the powerful scents called to him. It was only a few miles ahead and they made it in a matter of minutes.

After a long drink he nibbled on some grass as Naomi nuzzled against his side. She was white and dark brown and his favorite. He wondered where she was… Finally, he looked up at his eager companion and shook his head.

“It’s not right. I had a wonderful family, running free, a hard life , but a good one; then one day…gone. Oh, and it’s not ‘Bud’. She called my Flash. I know it’s silly and she’s gone forever, but, still, it’s Flash.”

“Ok Flash. I’m Toppy, short for Top Bonito. What a career I had. The races were the best. Getting out of my stall, all the people, the cheers and my boss would be all smiles when I won. I used to let the others get a little lead, you know, give them some false hope and then, whoosh, I’d take off, zip past them all and win. I think I won twenty races over the years. But, those days are done. I wonder where we’re headed. A new ranch, I hope. I have to say the ride here was a bit tough, but it looks like something finally is going to happen.”

Flash looked up and gave his new found friend a funny look, shook his head and shuffled forward a bit.

“A ranch, a pen, fenced in, it doesn’t matter. Closed in is closed in; I’ll take the wide open spaces any day. Oh, it’s not all fun and games. Here, look at this.” He turned and showed his rump to Toppy. There was a long scar.

“That’s how I got my last two ladies. I had a brood of five mares at that time, with two young foals, two colts. We were having a lazy day and, all of a sudden, I was staring at a pack of coyotes, looking very hungry with their eyes on my two kids. Well, I wasn’t going to take anything from them. They started to circle, but I took the bold approach and charged at them; reared up and stomped the first real good. Two others jumped me from the back and tore into my rump. You can see my trophy there. Well, I gave a sharp kick and one went flying into a rock. The ladies had formed a circle around the two little ones; I charged one more time and those nasty beasts lost their stomach for the fight and scurried away. I guess I had an audience, because Naomi and her sister, Betty suddenly appeared and joined my brood. I saw another stallion in the distance giving me a dirty look, but he stayed away,; afraid to fight I guess. But, those days are gone now and here I am.”

Toppy let out a short whinny that almost sounded like a whistle. “That’s quite a story. I never experienced anything so exciting or dangerous. I guess the most dangerous thing that ever happened to me was the time old Buster, who used to pull the hay wagon around the stables, got stung by a bumblebee. Man, he just took off with that wagon behind him and almost ran over about six of us. I’ll tell you, there was hay everywhere.”

Flash nodded his head, but didn’t say a thing.

Toppy changed the subject. “Did you ever race out there in the wild?” As he made this query they shuffled ahead. He continued, “Of course, that’s what made me famous, racing and winning some big races. I remember the Whitney Handicap at old Saratoga one year. There I was, stuck on the rail, a wall of horses in front and at my side. I didn’t think I’d ever get through. I knew all the others were getting tired, but I was stuck; nowhere to go. The horse in front, Mighty Evan, was his name I think, was way ahead of the pack I was stuck in and I thought, no way I can catch him, even if I can shake free. Well, the tiniest hole opened up on the rail and before my rider saw it I took off, actually scraped y shoulder on the rail. See, if you look real close you can see the scar. Anyway, I shot through that little opening and up ahead I saw Mighty Evan start to drift out into the middle of the track. Well, I just took off like a rocket; that’s what the announcer said, and I just gobbled up that track with every stride. We were just past the sixteenth pole and I didn’t think I’d make it. I took two final lunges and we hit the wire together. I’ll tell you, it seemed like an hour went by, but they finally put up my number. What a race.”

Flash gave his new found friend a weak smile as they shuffled forward a bit. After a few moments he responded, “Oh, once in awhile I’d hook up with one of the other stallions and we’d have a go at it. If it was one of those lazy days and we didn’t have to search for food or water, we’d meet up with another little herd, just to chat and get acquainted. The mares always liked that sort of thing. The older colts and fillies would always race each other and then after a while, I’d look into the other stallion’s eyes and he’d nod his head and that was it. We’d take off together and just go, all out, as fast as we could. I really never cared who won and I always kept half an eye on my family, just as my competitor would. But, the race was always exhilarating. To be that free, to do what we were meant to do; those were the best times.” Flash closed his eyes for a moment and Toppy thought he saw a tear in his eye.

All of sudden Flash threw his head back and let out a loud snort, catching Toppy by surprise.

“Don’t you smell it?” Flash cried out. They were nearing the front of the line.

“I don’t smell a thing”, Toppy answered. The horse in front of them was being led through a sliding door into a closed room.

Flash tried to kicked against the fence that was penned them in and a bunch of men came running and poked him with a sharp prod that sent searing pain through his lean, muscled body. He reared up on his hind legs, his brown body shimmering black against the late afternoon sun, his eyes blazing red and his mane flowing in the light breeze. His legs came crashing down on top of two of his assailants and he let go a kick just as he received another blast from the prod which caused him to crumble to the ground. He felt his legs being bound and a hood was thrown over his head. Toppy watched as twenty men dragged his new friend through the door, Flash now awake and trying to kick, shaking his head back and forth, the old wound on his rump flowing with bright red blood as he disappeared. As the door opened Toppy caught the scent; a distinctive odor, foul and fetid; the smell of death. He realized it wasn’t just Flash’s death he sensed, but the end of thousands, maybe millions of horses; old, useless, nuisances, discarded.

But, he was a champion, they wouldn’t do this to him. And, for the first time in his life he became afraid. And deep inside, his champion’s heart started to beat again, loud and strong within his deep chest. As the men approached he stood quietly, just as he had done all those times in the gate, waiting for the start. He was still, as if he was waiting for something, waiting for the flag to fall and the gate to open. As the men came closer, he sat back a bit, as if crouching. When they were almost there a bell rang in his head and he took off. He burst out of the queue, turned to his left and raced away. There was a tall fence up ahead, at least eight feet high, with barbed wire at the top. Behind him dozens of men were giving chase. He planted his feet and took off with a mighty burst of power and sailed over the fence, his rear feet clipping the sharply pronged wire that ran along the top.

The men stood looking through the fence as he raced away, his head held high, sniffing the air for some clue that might tell him which way to go. The other horses in the line reared and bucked, but the men already had them penned in and they were unable to follow. Some of the men continued to stare through the fence as Toppy raced away, the horse feeling that, perhaps, he had captured some of the exhilaration that Flash must have felt through so much of his life.

No one knows what became of Toppy, the former champion who was destined for oblivion. Some say he was hit by a train and others say that he tried to jump across the river and drowned. All that is known is that no one ever found his body and some say that about a week later a new horse appeared on the range in northern Nevada, a dark bay stallion, tall and regal looking. They saw his silhouette against the pale harvest moon just before he raced away, five smaller mares in tow. But, of course, it’s just a legend.

Pure fiction of course, or is it?

The wholesale slaughter of wild mustangs and retired racehorses is not fiction and continues even now. Our government sanctions this action as these noble animals that have entertained us, helped tame this country and fought besides our soldiers in times of war are considered an unwanted nuisance or a commodity to be divided into various parts for profit; systematically destroyed for a few final dollars to be squeezed from a splendid beast no longer considered to have of any other value.

There are thirty thousand wild mustangs being held in government pens awaiting either adoption or eventual demise. Only an estimated 25,000 mustangs roam free, mostly in Nevada. Mustangs are rounded up into pens at the request of the cattle and sheep industry who believe that the wild mustangs use up valuable range, taking away grazing land from their sheep and cows. This ignores the fact that the mustangs mostly live on land unsuitable for domesticated sheep and cattle.

Unwanted thoroughbreds are routinely packed into crowded rail cars or trucks and carted away to be inhumanely shocked, trussed and bled to death. Ferdinand,1986 Kentucky Derby winner , a failure at stud was sold to Japan and reportedly slaughtered in 2002; a gallant champion ending up as dinner for someone’s pet poodle. Just imagine if Secretariat, the iconic champion and Male Athlete of the Year in 1973, had been treated so cruelly; the outcry would have been heard in the far corners of the world and, even, in Washington DC. Ferdinand was only a few ticks of the clock shy of such greatness. Attempts have been made to pass legislation to protect these magnificent equines from such tragic ends, but these bills have repeatedly died in the Senate.

It’s time to look for alternatives to the slaughter, to let the wild mustangs be free and to care for the horses whose only crime is that they aren’t fast enough or young enough to be useful to a greedy, impatient world.

The link below lists numerous web sites that rescue unwanted horses. I’m sure they would appreciate any and all support.

http://www.horseworlddata.com/rescue.html

Saving Turtles

Brighten Your Day

“…As they raced around sharp turns and up and down steep hills, all of a sudden they stopped. Before she could protest, David had jumped out of the car. She saw him bend down and pick something up and put it at the edge of a stream that was running along the road. “What was…” she started to ask. But, before she could finish, he said “Turtle… it was a turtle that was stuck in the road. I thought it needed to be rescued…” Future Hope, ITP Book One

In Future Hope Major David Sanders, the main protagonist, is racing along at about 600 km/hr when he suddenly stops, jumps out of the car, rescues a turtle from being trapped in the road and then goes on his way. The practice of saving these slow, seemingly helpless terrapins is one that I have participated for years.

I have lived in the Houston, Texas area for about twenty years. I have rescued turtles stranded in the road about six times over these years. At first I never thought much about it. The first liberation came about nineteen years ago. Our oldest daughter was about 1 ½ years old and my wife was six months pregnant. We were driving down Space Center Boulevard, just before the NASA complex when we saw a large turtle at the side of the road.

There was a high curb and it was obvious that the turtle would not be able to navigate the climb and was not smart enough to saunter down the road fifty feet to a point where there was no curb. I stopped the car, thinking that my wife, who was closest, would jump out and flip the beast up over the edge. She gave me a sharp, incredulous look, never said a word, but I immediately got the picture. I walked thirty feet back to the turtle and took a good look at the “helpless” animal. The shell seemed a bit rounded and its mouth had a hooked “beak”.

Vague recollections from childhood, particularly of springtime along Collins Lake warned me to be careful. Every spring a similar sort of turtle made its way into our backyard and deposited her eggs in the sand of our tether ball court.

“I think that’s a snapping turtle”, I told my wife. As a surgeon, I value all my fingers, so naturally I was a bit reluctant to try to grab the stranded turtle with my bare hands. Luckily, we had an infant in the car and with the infant came a diaper bag large enough to hold enough baby changing implements for a week. Being a resourceful surgeon, I located the changing pad and a blanket. Casually, I walked back to the turtle and nonchalantly tried to cover it with the blanket, a trick similar to one I’d seen used on thoroughbreds that were reluctant to enter the starting gate.

The turtles head shot out with surprising rapidity and latched onto the blanket. Not a complete loss; with the turtles jaws firmly clenched on the blanket I was able to turn him around so that, at least, he was facing the curb. Now, how to get him out of the road and over the curb to safety. The changing pad presented a solution. I started to slide it underneath his backside; the head shot back and took a chunk out of the pad. This rescue, it turned out, became major operation. I threw the blanket over his head and deftly slipped the pad under his hind legs and lifted him out of the road. From that point he was on his own. However, he must have made his way somewhere, because on our way home we stopped to check on him and the vicious monster was gone.

I’ve saved five other turtles over the years, but that was the only snapper. The others were painted turtles and one was a spiny soft shelled turtle. For some reason, I assume that a lost turtle is looking for a body of water, so I try to put them close to a stream or bayou.

There was one turtle that I couldn’t save. Driving home from work one day I saw what appeared to be a turtle and pulled into a nearby parking lot. However, I found that I was too late. The turtles back shell was smashed and the poor critter was already gone. Unlike television cartoons that depict turtles jumping out of their shells, their shells are actually modifications of their skin and are an integral part of their bodies. A smashed shell is almost always a death sentence. Ironically, this turtle had suffered his demise right in front of the Pasadena Animal Rescue Center.

There is usually nothing too fancy about the rescue process. Except for that one snapper, I usually just pick the lost turtle up and look into their soulful eyes as I carry them to relative safety. As I think about it, they probably don’t really care where they go. Turtles have the luxury of carrying their houses with them, most aren’t very picky about what they eat and I don’t see them as being strong on family ties.

No, wherever they are they seem content; turtles are the ultimate hobo. If they survive the first few minutes of their life; that mad dash to the safety of the water, they can grow to be the carefree vagabonds of the amphibian world. Unless, that is, they get stuck in the road. So, while you’re out driving keep your eyes open. And, if you see a hapless turtle struggling at the side of the road, pull over and give it a second chance. You won’t get paid and it is unlikely you’ll be featured on the six o’clock news, but, you will feel good about yourself and wear a smile for the rest of the day.

The Watchdog

Have you ever wondered why, in years past, people didn’t always die if they developed appendicitis or intestinal perforations or any of the intra-abdominal maladies that continue to plague us today. I do a large number of surgeries for these and other similar problems; I find it hard to believe that before abdominal surgery became fairly routine everyone died if they developed such surgical emergencies.
Watchdog is defined as “a dog kept to guard a property” or “a watchful guardian.” Our bodies have all been built with such a watchdog. God, in his infinite wisdom, created us with a marvelous, but unsung organ called the omentum. Never heard of it you may say. Most people outside of medical circles are oblivious to the existence of the omentum, but to those of us who make a living rooting around peoples insides this amazing organ keeps us and our patients out of trouble.
What’s the omentum? Almost everyone has this organ, but it is almost never mentioned in high school or college textbooks on anatomy. We all learn about the liver and pancreas and our intestines as part of high school biology, but the omentum is the guardian to all these vital organs. Just inside our abdominal cavity, laying like an apron draping over our intestines is the omentum. Structurally, it is a sheet of fat, blood vessels and lymphatic tissue that literally is an apron, providing a protective cover to our abdominal viscera.
Most of the time all it is called to do is lie dormant, ever vigilant, but quiescent. But, when the need arises it springs into action. There have been numerous times I’ve operated on a patient and followed this remarkable organ to the exact location of the offending process. It seems to have a sixth sense that causes it to move in and seal off diseased areas in our abdominal cavity. Invading bacteria are kept isolated and what could have been a massive infection, becomes a localized and often a very minor annoyance.
Take, for example, diverticulitis which is a very common condition these days. Diverticuli are small protrusions that can develop on our colons where the inner lining of the colon bulges through the outer muscular coat, akin to the inner tube of a bicycle popping out of the outer tire. These diverticuli can become inflamed and rupture, which allows the bacteria inside the colon to leak out into the abdominal cavity. A catastrophe and life threatening emergency one would think. However, here comes the omentum to the rescue. Like the “Blob” of movie legend, this organ will adhere to the area of perforation, sealing the hole and preventing potential life threatening spread of the contaminants. The diverticulitis often is diminished to a minor episode of pain in the lower abdomen, frequently treated successfully with oral antibiotics as an outpatient.
I’ve had patients come to see me with symptoms typical of appendicitis that have been present for nearly a week. Typically, appendicitis that has been ongoing for such a time would have developed an abscess or severe peritonitis. Yet, there is the patient, sitting up, smiling with only minimal discomfort. What do you think is found at surgery? A very nasty, inflamed, gangrenous appendix with the omentum encircling it like a gift wrapped present waiting to be delivered to the proper recipient, in this case, me, the surgeon.
The omentum has been described as an organ that brings new blood supply to areas in need. In fact, it is often utilized for just such a purpose. Plastic surgeons may use it to reconstruct areas damaged by cancer, radiation therapy or severe infections. When I encounter a difficult intestinal problem, a difficult perforation or something similar, I frequently use the omentum to help remedy the situation. And, when it is absent, having been removed or utilized for some other purpose I am often hardpressed to find a suitable substitute to replace this remarkable organ.
It must be true that in the days before surgery the “watchdog” saved many lives. Inflammatory processes leading to abscesses and often death have been described since the time of Hippocrates. Often these patients died of their disease, but many recovered uneventfully. It is almost certain that these recoveries were due to our marvelous omentum. It is no wonder that general surgeons call the omentum their best friend and ally. It has truly earned its title, “The Watchdog”.

Without Color

Hope for our Future

There has been much discussion recently about the comments of our current Senate majority leader, Senator Harry Reid, regarding President Obama’s skin color and oratorical gifts. Away from the public eye Senator Reid observed that Pres. Obama had the necessary physical and verbal attributes that would allow a black American to win the election for President of the United States. These statements shed a negative light on the Senate majority leader.
Personally, I don’t think that Senator Reid is racist and I don’t think that his comments were intended to be a racial slur. Rather, he was most likely looking at our current president with a political eye, summing up the electorate’s state of readiness to accept a non-caucasian as president. Even still, there is something disturbing about his “politically incorrect” words.
It is sad that our society still looks at any subject, be it economic, educational, athletic or political in terms of race. Playing the “race card” remains a powerful ploy, appealing to society’s collective sense of guilt over past injustices. Although there has been progress over the last fifty years, society as a whole is a long way from being color blind.
In a perfect world Barack Obama would have won the 2008 election because he was intelligent, articulate and judged by the electorate to be most qualified to lead our country over the coming four years. The shade of his skin and the quality of his speech would not be mentioned, being completely irrelevant to the voters. It is likely that for large segments of the population this is true. However, there are far too many Harry Reids in our world; not truly judging individuals solely by their appearance, but still allowing such things to color their opinions.
Of course it is impossible to completely separate appearance from our evaluation of anyone or anything one may encounter. For instance, if one were conducting a job interview and the prospective candidate appeared dressed in a dirty T-shirt and cut-off shorts the interviewer’s initial impression may be altered in a negative way. It is possible that such an individual may shine so brightly in other ways that he could overcome such a sloppy appearance, but it certainly would make it more difficult, particularly if an equally well qualified person appeared neatly dressed in a suit and tie.
Overall, our society has made great strides, particularly over the last two generations, towards overcoming racial prejudices. Nobody bats an eye if an interracial couple is seen together in public. Our society seems to be going out of its way to accommodate, celebrate and heap approval on anyone that is deemed to be different. There seems to be a collective feeling of guilt over years of injustice, such that differences are not only acceptable, but also demand approval and, sometimes, special favor such as affirmative action.
Still, the fact that such approval can be viewed as arising from society’s collective guilty conscience carries with it a sour taste. This is because it remains no different than Senator Reid’s comments about our president. Those that give their approval simply because individuals are different or a member of a minority group continue to relegate the minority to a subconscious state of inferiority.
I hope the day comes when people are judged by their attributes, good or bad. Describing a person as black or brown or white should not be a means of separation; rather such description should be only for the purpose of distinguishing that person from another, in the same way as one may be described as short or tall. I would be very surprised if the Senator Reids of the world would have said that former New Jersey Senator Bill Bradley would have been electable to the presidency because he is tall.
Years ago I made a decision to stop characterizing my patients in terms of race. It used to be that in the medical record I would usually begin my history with a phrase such as “35 y-o black male…” Such a description has been the norm for medical records for many years. Although race occasionally is a factor in some disease processes, I decided that categorizing my patients on the basis of race was inappropriate and did not contribute to the patient’s care in any meaningful sort of way. As a result of such thinking my entries now read “35 y-o male…” I don’t think any of my patients have suffered because of the change. It is, however, unfortunate that there are still some situations where race may be important. For instance, a psychiatrist likely would consider a patient’s race an important factor in making a proper evaluation.
I hope that there will come a time when a person’s inherent differences are only that: differences; distinguishing features but nothing more. It seems we are working towards such a goal, but ever so slowly. I suspect that with each passing generation the idea of one world composed of individual people will come closer to fruition and we will truly be a world “without color”.

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.

Sincerely,

David Gelber MD

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.

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.