Thursday March 10

     We again joined the residents and faculty for "chart rounds" at 8:30am, where they review admissions, consultations, deaths, and overnight operations. Each case is presented by one of the residents who was on call, and they are subject to questioning by the faculty. Being embarrassed in front of your colleagues because you don't know the answer to a question, or didn't elect an important fact from the patient, is a well established technique in surgery ( and medicine generally) which decreases the chances that it will ever happen again. While humiliation is uncomfortable, and needs to be tempered by a degree of understanding, it is a powerful educational weapon.
      After 30 minutes of this, Santiago and I went off to the OT to start the day's work while the faculty had a curriculum meeting. We ended up doing 6 of the 9 cases we had scheduled, which was a pretty good days work. Santiago and Dr. Cassel started with a woman who had a small bowel obstruction in an incisional hernia who had come in last night; she turned out to have a perforation,miso Dr. Gbozee was smart in scheduling her for the OT. While they were doing that, I was in the Orthopedic room doing recurrent bilateral inguinal hernias and then a new unilateral inguinal hernia. For reasons that are unclear, there was no resident to help me; I thought that was unfortunate since I am here to teach, and I really don't need more experience doing hernia repairs ! On the other hand, doing a hernia repair with inadequate lighting, instruments consisting of a meat cleaver and a samurai sword ( okay a bit of an exaggeration, but not nearly as much as you might think!), and a scrub nurse to assist who isn't sure why he signed up for this gig in the first place...now that makes it an interesting challenge.
        One of the cancelled cases is a women whom I operated on 2 years ago for advanced breast cancer. She now has an exophytic raw mass over her right chest wall which smells and she wants to be rid of. She likely doesn't have long to live; I hope we can make whatever time she has left the best possible. But she had no blood available for the operation, and the anesthetists quite reasonably felt it was unsafe to proceed without blood. So after some time my patient finally got her son to agree to come in tomorrow morning with money so she can pay for 2 units of blood.