Elise loves this book. The protagonist is a girl who, due to a desire to fit in with her friends, denies her love of lima beans. Camilla awakens with stripes on her skin, and no one can explain it. The doctors are called in, then the specialists. The scientists and experts come next, but all are stumped. ...

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I walk into my fifth operating room of the morning. “Good morning, Mr. Jacobs. My name is Dr. Michaelis. I will be the anesthesiologist helping to safely get your breathing tube in as we get your surgery started today.”  He nods and closes his eyes. That’s all he can see of me. My eyes. I am wearing my PAPR (powered air purifying respirator) and mask. For the second day this week, ...

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I hugged her for the last time on March 15, waving goodbye as she drove away from my apartment complex. On April 15, I got a call that my friend was dead. She had unceremoniously taken her own life, unable to overcome the crippling feeling of hopelessness that plagued her after repeatedly being prevented from fulfilling her dream. The details of her death are devastating and tragic. Imagine being in ...

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The COVID-19 pandemic is fundamentally changing medical practice across the country by allowing telemedicine reimbursement, where it was previously limited, and by leveraging video conferencing technology to conduct business and educational meetings in order to comply with social distancing guidance. Necessity is resulting in innovative ways to interact with patients, colleagues, and now with prospective trainees as residency and fellowship interview season begins. While in-person interviews are a trademark of ...

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The first five liver transplant recipients were all dead within 23 days. The year was 1963, the surgeon was Dr. Thomas Starzl, and the operations were actually deemed a success for their surgical complexity. Since then, liver transplant (LT) has evolved from an experimental, often fatal procedure to the standard of care for end-stage liver disease (ESLD). Compared to the 0% 30-day survival rate of LT in 1963, the most ...

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Fat. One tiny word. One voluptuous, full-figured concept. Several weeks ago, amidst a conversation regarding the risk factors for cholelithiasis (i.e., gallstones) during a chief concern small group session for preclinical students, my preceptor ushered in an aurally convenient yet unsettling mnemonic utilizing alliteration that has apparently been in the works among medical education for a while now, known as “the 4 Fs”: female, fertile, forty, and … fat. Yes, you read that ...

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When people used to ask me what a typical day entailed for me, I would gladly share the early starts, the long days on my feet in the OR, and on-calls where anything would happen. I would laugh at how I must have a bladder of steel and cry over some of the saddest stories which came through the front door. No matter the stories, though, one thing was a ...

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The world is paused. But is it? Just because the world is experiencing a pandemic does not mean that the rest of the world’s ailments all of a sudden go away.  Their priority may fall in ranking, but they persist. Health and disease continue. I ate lunch and had severe abdominal pain shortly thereafter.  Perhaps a bout of bad acid reflux, I thought, but the pain persisted into dinner, and when ...

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Growing evidence suggests that the novel COVID-19 virus can be aerosolized.  To adequately protect employees, providers require not just “droplet,” but “airborne” precautions and the appropriate healthcare worker personal protective equipment (PPE). Appropriate PPE mandates an N95 mask. News reports for weeks have described hospitals working without the necessary protection for health care providers. This is the case in Boston-area hospitals, which are running short on these masks. One of the city’s ...

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Traffic is non-existent. Schools are closed. Restaurants are only offering take-out and delivery. Parking lots at strip malls are empty on weekends. Only a limited number of people at a time are allowed inside the grocery store.

Welcome to the post-normal era since the COVID-19 pandemic hit the scene in Northern California.

One day we will look back at this time and realize how much it changed everything. Simple ...

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I am an anesthesiologist. I am trained to stay calm when everything surrounding me is going downhill. In the OR, I am the anchor. The steady hand, the ready plans. I work with skilled CRNAs who are an integral part of the team.  We do critical care medicine every day. We don’t run from the chaos. We are always ready to fight the good fight. We don’t scare easily, but ...

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The conversations we’ve had with physicians this week confirmed that the primal fight-or-flight response has kicked in as physicians across the nation recognize the COVID-19 pandemic as an imminent threat to the survival of their practices. Some are reacting from a place of fear, while others are proactively evaluating options and making strategic moves. In surgery, there exists a time-honored adage: all bleeding stops eventually. When a patient has unexpected severe ...

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I am an anesthesiologist who practices in Omaha, Nebraska at a large university. Our institution is preparing around the clock to care for our community in the midst of the COVID-19 virus. We are all coming together – doctors, scientists, nurses, technicians, administrators, therapists, and staff to develop plans. Leaders are not sleeping; they are working. We are all preparing. Reading. Staying up to date. Trying to learn from our ...

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Recently, I realized that something needed to change in my family life. With three busy daughters at three different schools who participate in multiple activities along with my full-time job as an anesthesiologist, my life depended on accurate and concise communication. However, this was the third time in a week that a ball had been dropped between my husband and me. This time it resulted in my middle daughter, Laini, being ...

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Once, when I was a senior resident covering a busy trauma service at a county hospital, I was on call for nine days in a row while my co-chief had an uncovered vacation. It was July, and we were all -- interns, junior residents, and me -- new and uncertain in our roles. I left the hospital only twice in those nine days. When I finally signed over my pager for ...

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I live and work in Los Angeles, one of the plastic surgery capitals of the world. Quite a few of my patients have “had a little work done” — the blandly euphemistic term you’ll hear for plastic surgery makeovers of all kinds. That’s fine. Plastic surgeons have children to feed too. The problem is this: many of my patients want to convince everyone that their “look” is entirely natural. They don’t ...

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An excerpt from The Invention of Surgery: A History of Modern Medicine: From the Renaissance to the Implant Revolution. Johns Hopkins University was unlike anything ever built. Armed with an enormous endowment from a wealthy industrialist, the hospital (and its associated medical school) would be patterned after ...

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Last week, Lais and Yuri, our five-year-old twins, were volunteers at the school of medicine, for students to learn how to examine children. Full disclosure: Volunteers do get a gift card. Therefore, I asked them if they wanted to "work and get some money," and I also told them what they would have to do during that afternoon. They both said yes, and they were truly excited about the opportunity. When I saw ...

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I feel like I’m in prison. Vacation was a small taste of freedom. A fresh breeze on my face at 9:00 a.m.—the feeling of my mom’s breakfast casserole in my stomach—the small things that remind me I’m still human. I don’t know what I stand for anymore. I just yelled at the intern for not feeling comfortable consenting our kidney transplant patient. “Aren’t you a physician?!” I asked. How did I get ...

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A surgery resident from halfway around the world emailed me the other day looking for advice as she was nearing graduation.  She confessed, "I am beginning to question myself if I am good enough ... what is 'good enough' anyway?" I had absolutely no idea how to answer the question – what is "good enough" for a surgeon? First, I tried Google. "Am ... I ... Good ... Enough"? 2.5 billion hits and some ...

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