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Medicine and Literature, Stanford News, Surgery

A surgeon battles her own unexpected complications

A surgeon battles her own unexpected complications

I first interviewed Stanford surgeon Sherry Wren, MD, a year and a half ago for an article about a course she taught to other surgeons on global health care. Based on her personal experience from medical missions to Chad, Congo and Ivory Coast, it was obvious the course was a labor of love. Here was a surgeon who was passionate about her work, and whose goal it was to overcome any and all obstacles to save patients – from using papaya paste for wound dressing to hand drills for relieving brain bleeds. She made use of a combination of her surgical skills, her physical strength and her love for her work to accomplish her goals. “You have no idea how physically hard it is to crank a six-millimeter pin into someone’s femur with a hand drill,” she told me then. “And I’m strong.”

When Wren mentioned off-hand that she was still recovering from post-surgical paralysis after her own neck surgery, I knew there was another story waiting to be told. Almost two years later, that story about Wren’s struggle to return to surgery following the partial paralysis of one of her most important tools, her left hand, has been published in Stanford Medicine magazine. My colleague Paul Costello referenced it here earlier this month.

This is a story about a surgeon experiencing what it’s like to be on the other side of the scalpel when something goes horribly wrong. In the piece, she describes what she felt upon waking up following neck surgery:

My left hand was like a claw. I couldn’t lift my left knee. Then my surgeon came to see me, and I recognized that ‘Oh shit!’ look on his face, because I’ve had that ‘Oh shit!’ look many times.”

Wren, who injured her spine following a deep-sea diving shipwreck, also talks of her struggle to return to the demanding, 10-14 hours surgeries that she excels at despite lingering damage to her left hand and the accompanying depression that blindsided her. I wrote:

It was the correct diagnosis. The correct treatment. There was no surgical error. And yet somehow, the veteran surgeon who makes a living with her hands woke up partially paralyzed. The unexpected complications included paralysis of her left hand and her left leg, and a weakened right hand. Already she thinks, Will I still be able to operate? Already she thinks, What am I if I’m not a surgeon?

This is Wren’s very personal story, one that she tells open and honestly. The experience of being the patient has made her a better physician, she said. And it’s a story that she hopes by telling, others can learn from.

“I thought a lot about whether I wanted to share this story,” Wren said. I, for one, am appreciative that she did.

Previously: Sherry Wren, MD – a surgeon’s road home, Surgery: Up close and personal, Stanford Medicine magazine opens up the world of surgery Surgery: Up close and personal and Stanford general surgeon discusses the importance of surgery in global health care

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Medicine and Literature, Stanford News, Surgery

The operating room: long a woman’s domain

The operating room: long a woman’s domain

In my recent story for Stanford Medicine magazine on the transformational changes in surgery, I reported that “women were once personae non gratae in the operating room.” An alumna of the medical school, Judith Murphy, MD, took me to task for my choice of words, for as she points out, women have long been the backbone of the OR.

“In fact, for decades, women outnumbered men in the OR – circulating nurse, scrub nurse, overseeing nurse, etc.,” she wrote to me. “So it is not that there were no women in the OR, but there were no women surgeons. No Women Who Count, although everyone knows these nurses are essential to successful surgery.”

When she was a medical student at Stanford in the early 1970s, she says female students and faculty had to use bathrooms and lockers that were labeled “Nurses,” whereas the men’s room was labeled, “Doctors.”

“We all laughed about it, but it did reflect the unconscious assumptions that your language still perpetuates, all these years later and after so much progress,” she shared with me. “The women who came after us were a bit more empowered and did not think it was funny; they complained, and the doors were changed to Men and Women.”

Murphy, a practicing pediatrician in Palo Alto for decades, says she might not have made note of the issue were it not for a recent encounter with a male acquaintance who, on learning she was connected to Stanford Hospital, said, “I never knew you were a nurse.”

“When he said that, I thought, ‘Darn, I can’t believe this is still happening.’ I gave him my usual response: ‘I have great respect for nurses and could never have done as good a job without them, but in fact, I’m a doctor,’” said Murphy, who is now retired.

“The power of the cultural unconscious assumption remains strong, even here where we have come so far,” she wrote. “This has been happening to me occasionally for 40 years, less so lately. I had hoped it would become archaic.”

Murphy says her response may have been a bit testier than in the past. But she can be excused, for it is always good to be reminded of our unconscious biases about the role of women in health care, reflected both in our language and behavior.

Previously: Surgery: Up close and personal and Stanford Medicine magazine opens up the world of surgery

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Medicine and Literature, Stanford News

Stanford Medicine magazine in images

Stanford Medicine magazine in images

There were lots of oohs and aahs among my colleagues when we first got our hands on the latest issue of Stanford Medicine. The award-winning magazine always contains good stuff (kudos to editor Rosanne Spector), but we all agreed that the artwork in this issue was particularly strong. Above are some of the more striking images.

Previously: Stanford Medicine magazine opens up the world of surgery
First two images in first row by Max Aguilera-Hellweg; illustration by Gérard Dubois
Illustrations in second row by, from left to right, Jon Han, Tina Berning and Harry Campbell
Images in third row by, from left to right, Jon Han, Max Aguilera-Hellweg and Gérard Dubois

Anesthesiology, Medicine and Literature, Neuroscience

Exploring the conscious (and unconscious) brain in every day life

Exploring the conscious (and unconscious) brain in every day life

line of peopleThe first time I fainted, I was seven. I passed out while racing my fellow second-graders across the playground. One minute, I was leading the pack in the race; the next thing I knew, I was lying in the nurse’s office with adult faces hovering all around me. My parents explained to me that I’d lost consciousness – it was like falling asleep for a minute, they told me.

It frustrated me to no end- even as a seven year old – that I didn’t know where that time had gone. Why couldn’t I remember those moments where I collapsed onto the grass and got scooped up by a petrified teacher? I ended up fainting a handful of times over the next few years (luckily doctors chalked it up to nothing more than dehydration and a genetic propensity to faint), and each time I was reminded of that frustration of not being able to grasp what was going on in my brain during those lost minutes.

As a seven-year-old, I didn’t have the chance to call up scientists and ask them to explain the brain to me, so when I started working on a feature article on consciousness for the latest issue of Stanford Medicine magazine, I was thrilled that maybe I’d get that chance to finally answer those questions that had been lingering in my head for decades. What makes the brain go from awake and aware to such a blank state, and then back again?

But it’s not that simple, I learned: There’s no single switch that flips the brain from conscious to unconscious. In fact, consciousness isn’t an on-off switch at all; it’s a whole spectrum of states. Anesthesiologist Bruce MacIver, PhD, pointed me toward this handy chart that shows different levels of consciousness. Each state of consciousness has its own unique place on two scales: physical arousal and mental awareness. As I looked at it, I realized that my experience with altered consciousness wasn’t just limited to my childhood fainting episodes – we all go in and out of multiple states of consciousness on a daily basis, and not only when we fall asleep and wake up.

“If you’re an elite athlete and you get in that so-called ‘zone,’ that’s an altered state of consciousness,” anesthesiologist Divya Chander, MD, PhD, explained to me. I’m no elite athlete, but after talking to Chander, I suddenly started paying attention to those not infrequent times when I “zone out” while driving or exercising. And when I woke up to a noise in my house on a recent night, I immediately noticed my heightened senses – that alertness is an altered state of consciousness too.

“What I’m always hoping is that hearing about this kind of work makes people ask more questions about what it means when they themselves enter different states,” Chander said to me when we talked. Her message was not lost on me; I’ve become an active observer of my shifts in attention and awareness.

My Stanford Medicine story delves much deeper than these observations of daily life, to look at how and why anesthesiologists are probing what it means to be conscious – and how their research could lead to better anesthetic drugs. But I hope that in addition to conveying the science, it also helps readers realize that subtle changes in consciousness happen in your brain all the time.

As for the questions I had as a seven-year-old, they’re not fully answered, but I’ve only gotten more intrigued to know how the brain mediates consciousness, and more excited to follow where this research goes in the future.

Sarah C.P. Williams is an award-winning science writer based in Hawaii, covering biology, chemistry, translational research, medicine, ecology, technology and anything else that catches her eye.

Previously: Stanford Medicine magazine opens up the world of surgery, Your secret mind: A Stanford psychiatrist discusses tapping the motivational unconscious and Researchers gain new insights into state of anesthesia
lllustration by Jon Han

Medicine and Literature, Patient Care, Stanford News, Surgery

Surgery: Up close and personal

Surgery: Up close and personal

gholami - smallTens of millions of patients undergo surgery every year in the United States, yet very few have the opportunity to be on the other side and observe a surgical procedure in action.

I had that rare privilege recently in the course of writing a story for Stanford Medicine magazine about surgery and how far the field has come in recent decades. The operating room, I discovered, is a world unto itself. It’s governed by a strict set of rules to help safeguard patients, but within those strictures, there is an elaborate kind of dance and much artistry in the way clinicians work together and finesse the tools to help heal their patients.

Sepideh Gholami, MD, a six-year surgery resident at Stanford who is featured in the story, said it was in part this sense of artistry – the movement, rhythm and pacing – that attracted her to the profession. And like many surgeons, she found it gratifying to be able to use her hands to fix a problem to quickly restore a patient’s well-being. She describes one of her early experiences, assisting in a procedure to remove a life-threatening tumor from a young man’s colon.

“I remember going to the family afterward, saying that we were able to get it all out, and seeing the glow in their faces,” she told me. She said it was reminiscent of the experience of her own mother, who had a tumor extracted from her breast: “This is how it happened for my mom, who is now disease-free,” she said.

In the story, Gholami talks about her rather unusual path from an early childhood in revolutionary Iran to becoming a surgeon in the United States, as well as the changes in the profession that have opened the way  to young women like her. The story also explores the remarkable innovations in technology that have made the patient experience today far less invasive and less painful. Those innovations, as well as new workplace rules that limit trainees’ hours, have dramatically changed the way young surgeons like Gholami are being trained to become the independent, skilled practitioners of the future.

Previously: Stanford Medicine magazine opens up the world of surgery
Photo of Gholami by Max Aguilera-Hellweg

Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine opens up the world of surgery

Stanford Medicine magazine opens up the world of surgery

surgeon hands - 560

It used to be “big hole, big surgeon” — but no more, according to Stanford’s chair of surgery, Tom Krummel, MD, who’s one of the surgeons featured in Stanford Medicine magazine’s report on surgery and life in the operating room, “Inside job: Surgeons at work.”

During his career of more than 30 years, Krummel has seen a massive shift from open surgeries to minimally invasive procedures — major surgeries conducted with tools that work through small openings.

“We do the same big operation. We just don’t make a big hole,” he said in the article leading off the report.

In the same issue, CNN’s chief medical correspondent, neurosurgeon Sanjay Gupta, MD, talks about why he’s “doubling down” on his support for medical marijuana.

As the editor, I’m biased — but I think it’s worth a read, along with the rest of the issue, which includes:

The issue also includes a report on research on Alzheimer’s disease, and an excerpt from Surgeon General’s Warning, a new book by Associated Press medical reporter Mike Stobbe on the fall from power of the U.S. surgeon general. The digital edition offers audio interviews with Gupta, Stobbe, Stanford surgeon and humanitarian-aid volunteer Sherry Wren, MD, and photographer Max Aguilera-Hellweg, MD.

Previously: The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, From womb to world: Stanford Medicine Magazine explores new work on having a baby and Factoring in the environment: A report from Stanford Medicine magazine
Photo by Max Aguilera-Hellweg

Behavioral Science, Medicine and Literature, Stanford News

Does the sight of blood make you queasy? You’re not alone

Does the sight of blood make you queasy? You're not alone

drop of blood2

After writing about my blood phobia — and what I did to tame it — in the spring 2013 issue of Stanford Medicine, I was surprised to get a lot of e-mail from readers suffering from the same condition or similar ones, or both. (In the world of mental health, blood phobia is categorized together with injection phobia and injury phobia, and known collectively as BII phobia.) Their responses gave me a welcome sense of solidarity.

Some sought guidance. A reader in the Philadelphia area wrote:

I now realize I have this phobia. And I had no idea there was a treatment for it.

I pass out with needles, blood and sometimes when someone just talks about blood! Your article actually made me queasy reading it. It took me a while to get through it. But I’m glad I did.

So you know of any treatment centers in Philadelphia who specialize in this?

A reader in the Boston area explained:

From a very young age, I have experienced BII anxiety and vasovagal responses to various medical stimuli.  I used to not be able to talk about injections without feeling uncomfortable or faint, and now I am able to get them without being anxious or needing any medical aides (I used to take Valium).

I am getting closer to my clinical rotations in PA [physician assistant] school and am worried about my irrational fears of blood, surgery, etc.

I was wondering if you had any further suggestions for the student going into health care with these types of BII vasovagal responses.  I am certain I want to be a physician assistant, I am just so concerned that I will not be physically able to carry out my surgical rotations!

Others, like this Bay Area reader,  just wanted to share their experiences:

I first fainted when I was 12 watching a vet surgery! I had no idea what happened or the reaction I had, but I knew it didn’t feel good. I’ve had a few episodes thereafter, usually at doctor’s offices drawing blood. In fact, last year I almost fainted getting my finger pricked at an office health thing! I think the fasting didn’t help… I am so excited to read something like this. To know I’m not the only one, but that there is something you can do, a real exercise to practice that helps!

Thank you for writing this. I truly enjoyed it and feel better already.

Previously: Longreads pick: Blood, sweat and fears
Photo by Alden Chadwick

Global Health, Medicine and Literature, Stanford News

Exploring global health through historical literature

Exploring global health through historical literature

deskPhysician-authors, including Abraham Verghese, MD, and efforts such as Stanford’s Arts, Humanities and Medicine Program draw the general public’s attention to issues important to the medical field. They may also elicit reader empathy by discussing real-world problems, even in fictional contexts, while situating literature and the arts in an influential position.

This relationship between medicine and literature is longstanding and complex. A Stanford News article discusses some examples of public health and humanism in historical literature and profiles the work of Alvan Ikoku, MD, PhD, an Andrew W. Mellon Fellow in the Humanities at Stanford.

From the piece:

As a scholar of 19th- and 20-century movements in international literature and health, [Ikoku] studies the place of long narrative forms, especially novels, in the development of tropical medicine and global health.

In his current book project, Forms of Global Health, Ikoku reads not Dickens or Gaskell, but writers such as Joseph Conrad and Andre Gide, who added to a “library of metaphors about the tropics and colonial spaces,” one that was referenced by “the fathers of tropical medicine” – returnees from colonial medical services, particularly malariologists, who wrote and lectured publicly about the need to establish a new medical specialty for the colonies.

Ikoku points out that literature provided an opportunity for readers to not simply feel an emotion, but to also actively help define a medical field and its knowledge base.

The article notes that Ikoku taught a course for Stanford students from many disciplines this spring called “The Literature of Global Health,” examining “how literary and medical writers have used narrative to explore the ethics of care in the developing world.”

Previously: Thoughts on the arts and humanities in shaping a medical careerMedical students and author Khaled Hosseini share their muse with Stanford community and Intersection of arts and medicine a benefit to both, report finds
Photo by Ben Sutherland

Events, Medicine and Literature, Medicine and Society, Stanford News

Inside Abraham Verghese’s bag, a collection of stories

Inside Abraham Verghese's bag, a collection of stories

What’s inside Abraham Verghese’s medical bag? Visit the Smithsonian Institution’s National Museum of Natural History to see. Verghese, MD, vice chair for the theory and practice of medicine and a physician at Stanford, is one of the notable Indian Americans featured in the exhibition “Beyond Bollywood: Indian Americans Shape the Nation,” which runs through August 2015 in D.C. and then will tour the U.S.

An article in The Caravan dives into the diversity and complexity of experiences lived by Indian Americans in the United States and opens this way:

IN JOHNSON CITY, Tennessee, in 1982, an Ethiopia-born, India-trained medical resident named Abraham Verghese coveted Dr Steven Berk’s doctor bag. He saved enough money to purchase one for himself, then rubbed it with neatsfoot oil to approximate the well-worn, talismanic quality of his mentor’s bag. Verghese then filled it with his kit—eye drops, calipers, prescription pads—and his hopes of assimilating into the American medical establishment.

Verghese’s bag, one of the exhibition’s hundreds of objects on display, is coupled with the physician-author’s memories from earlier in his career: “I had to ask someone how to tie my tie with a thinner knot so I could fit in,” the article notes. “And the only way I could eat the bland hospital food was to put Tabasco sauce on everything.”

The piece continues:

Verghese’s words capture the familiar dual imperative of immigrant life: on the one hand, fitting in, with a tie knot of appropriate girth; on the other, maintaining one’s tastes, through the strategic application of chilli-approximating Tabasco. His story reminds us that even blue- and white-collar immigrants have to negotiate resistance to the perceived “Third World invasion” of the United States, whether through neutralising accents or by softening the stiffness of difference with neatsfoot oil.

Previously: Abraham Verghese shares what’s in his lab coatStanford’s Abraham Verghese honored as both author and healer,  Stanford’s Abraham Verghese = “today’s most creative person” and Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller

Events, Medicine and Literature, Medicine and Society

Intersection of arts and medicine a benefit to both, report finds

Intersection of arts and medicine a benefit to both, report finds

An article today on Cleveland.com notes that, at least in Northeast Ohio, collaboration between medicine and the arts benefits both camps as well as the region’s economic health. A preliminary report from the non-profit Community Partnership for Arts and Culture looks at ways art and medicine enrich one another in Cleveland and provides recommendations for enhancing those partnerships. From the news piece:

The report identifies four principal ways in which the art and medicine intersect productively:

• The use of arts and culture in medical settings;

• Participatory programs that involve patients and communities in activities and therapies that promote positive medical outcomes and general wellness;

• The potential shown by arts and culture to serve as a rallying point from which public health and social equity can be addressed; and

• The enrichment of medical training.

Meanwhile, at Stanford, art and science lovers prepare for this evening’s Medicine and the Muse symposium, featuring author Khaled Hosseini, MD. Stay tuned for a recap on Scope next week.

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”, Literature and medicine at life’s end and Thoughts on the arts and humanities in shaping a medical career

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