The most persistent problem I encounter is not nerve pain or slipped discs. It’s the tenacious misconception that someone can be “too old” for spine surgery when it’s truly needed. Many years ago, it was true that age played a significant factor in a person’s ability to tolerate and recover from surgery. Surgeries were once highly invasive, and recovery could take months. But over the decades, spinal surgery techniques have improved ...

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Recently on Twitter, I asked this question above. The 130 (2.5 percent) of 5,213 respondents who said they would allow a CEO to make a skin incision highlight the unscientific nature of Twitter polls. Restricting voting to surgeons only is not possible. Many people asked me why I asked the question because surely no surgeon would ever have allowed it. Here is ...

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This was the first time that I was unsure of how to respond when a patient cried.  Usually, as a medical student, compassion and understanding helped make up for obvious gaps in our knowledge.  It just comes with the territory.  But this time was different: I could not understand why the patient was crying, because it was a reason I had yet to consider in my short medical journey. The patient ...

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Many physicians would like to use their skills on the mission field, but have a hard time finding an option that fits into their busy schedules. Several years ago, I looked for a medical mission, but I couldn’t find one that would work for me, so I came up with the idea of setting up a medical mission experience in my own town. A local mission meant I wouldn’t need to ...

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Setting: An impersonal, windowless conference room within a hospital Characters: A nurse in charge (NIC), a department chair (DC) and me (ME) *** NIC: Thank you for joining us to discuss the report you made of unprofessional behavior in the operating room. We’d like to start by letting you know that in this institution, we have a culture of informality. When I first got here, I found it unsettling that doctors were called ...

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"Billroth spent long hours dissecting cadavers and planning on surgical interventions. He was able to pioneer abdominal surgery with careful preparation and strict adherence to meticulous antiseptic technique. Animal experimentation and cadaveric-rehearsed surgery emboldened the Viennese professor; perhaps the abdomen could be entered. Nothing short of a 'godlike creative spirit,' as Mukherjee calls it, would suffice when it came to intestinal ...

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After many years of training, I have graduated from residency and am now a board-eligible general surgeon.  I was one of more than 1,000 candidates who attempted to take the American Board of Surgery (ABS) Qualifying Examination on July 16, 2020. What should have been a major milestone rapidly devolved into a nightmare, as examinees were locked out of sessions, falsely accused of violations, and unable to attain certification due ...

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Papa was a seasonal farmworker. This job was noted to be “slave work” by the American locals. Still, he traveled from Jamaica to Florida and toiled in fields to send money home to his wife and eleven children for several years. Unable to read and write, he required assistance with letters that expressed gratitude for the barrel of food and the need for school fees and uniform fabric. Eventually, Papa ...

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I am a voyeur of human anatomy. Not in a perverse sense, but rather as part of my profession. In a single day, I can watch a heart beating in its chest cavity in one operating room, walk two doors down to view an exposed brain, and then cross the hallway to an abdomen incised down the middle to expose the organs and viscera inside. I see joints replaced with ...

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The warm rays of the sun serenade me as I drive to work eager to begin another shift. I find a parking spot on the first floor of the garage don my N95 mask and walk towards the hospital. First, I must stop by at the neighboring building and have my temperature checked. Today it is 97.3. I am awarded the sticker for the day; my boarding pass into the ...

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An excerpt from The Surgeon's Obol. July 1, 8 p.m. "Isabella Isaksen," I said with an arm extended. "Most people call me 'Izzie'." "Mike Gunderson," came the reply. Most people called him Gundy, but he didn't feel the need to let me, the goddamn intern, in on this. And ...

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I have been an academic surgeon in a large medical center in New York City for the past 20 years.  The current climate of scrutiny to systemic racism and bias (including prejudice against all “different” populations) coupled with our own struggles with growth and equitable distribution of resources has highlighted a disturbing trend. It is and has been customary for as long as I’ve been practicing medicine to relegate patients with ...

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Yeah. I said it. As an anesthesiologist, especially as a cardiothoracic anesthesiologist, there are few things I am more interested in than how well or how poorly your heart functions and why.  And a cardiologist can help me obtain a lot of vital information in that regard.  But there several things a cardiologist cannot, and I argue, should not do, when it comes to the perioperative care of patients. First, a cardiologist's assessment ...

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"This pandemic presents a unique opportunity for senior anesthesiologists to see the benefit of accommodating the health care needs of our workforce. Just as I tried to avoid the teratogenic effects of certain cases when pregnant, we should consider the most effective ways to protect senior anesthesiologists from a life-threatening infection. When the pandemic has passed, anesthesiologists of all ages can ...

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When I was in Sweden, I heard this phrase several times: “There is no such thing as bad weather, just bad preparation.” They said this when we asked them what they did with their children in dead of winter. The proud parents made it very clear that no matter what the weather, when it is time to go outside for recess at school, or to get out of the house ...

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I never expected to have a friend from Alabama. My upbringing in Brooklyn, New York, didn’t include anyone from the South, and this was a time in American history when the South was in turmoil. I recall black and white images on our family’s TV showing federally enforced integration of schools and communities, swelling civil rights marches, and disturbing scenes of riots and attack dogs used to intimidate ...

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Recently surfing the far reaches of Netflix for a program on World War II that I hadn’t yet seen, I found a low budget serial documentary dealing with air power in war and in peace. The producers profiled individuals who had contributed to the eventualities of the airplane as a weapon of war or, conversely, as a beacon of man’s progressive evolution from terrestrial prisoner to celestial astronaut.


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Many states are beginning to reopen, and hospitals are once again scheduling elective surgeries. The question on many patients’ minds is, “Should I undergo elective surgery right now?” Although 31 percent of people have chosen to delay care and 50 percent of people over 65 have decided to wait to receive care during COVID-19, according to a Kaiser Health News roundup, making this decision will depend ...

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I have a major issue with MAC. To be more specific, I have a major issue with how we communicate the concept of MAC to our patients, anesthesia care team members, and proceduralist colleagues. MAC stands for "monitored anesthesia care," and we tend to throw it around and use it interchangeably with a lot of other terms:

  • Sedation
  • Procedural sedation
  • Conscious sedation
  • Twilight anesthesia
  • Light anesthesia
The fact is, these entities are not ...

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I am a female surgical resident. I signed up for this. I chose four years of medical school, five years of residency, two years of research, a year of fellowship, and finally attending surgeon life. I’d choose it again. And I want this road to be hard. I want my training so tough that I don’t wonder while a patient’s on the table if I’m good enough. I want to know ...

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