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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.

Podcasts, Stanford News, Surgery

Sherry Wren, MD – a surgeon’s road home

Sherry WrenWhen I first met Stanford surgeon Sherry Wren, MD, I immediately liked her. The affinity was probably due to the fact that we’re both from the south side of Chicago. She’s a powerhouse personality. Down to earth. No pretensions. A surgeon who goes in for the toughest assignments. During her downtime she takes her expert surgical skills to the African bush for Doctors Without Borders and creates make-shift ORs in the most remote of locations. It’s clear she has a passion for her profession and also for life.

I don’t see Wren that often so I was surprised to learn earlier this spring about a serious disc injury she suffered that brought about a paralysis. Tracie White, one of our gifted writers who always gets to the essence of the people she writes about, has a feature article on Wren’s injury and recovery in the latest issue of Stanford Medicine. In it, Wren speaks candidly about losing the use of her hands and the real possibility she would never be able to return to the OR. Sherry is indefatigable so I wasn’t at all surprised in the end that she was victorious. But the road to get there wasn’t easy.

This is a survivors’ story about grit and determination. You’ll learn a lot about Sherry and her journey in Tracie’s story and in my latest 1:2:1 podcast, above.

Previously: Surgery: Up close and personal, Stanford Medicine magazine opens up the world of surgery and Stanford general surgeon discusses the importance of surgery in global health care
Photo by Max Aguilera-Hellweg

In the News, Pediatrics, Stanford News, Surgery, Transplants

Parents’ heroic effort help 12-year-old daughter receive a new heart and lungs

Parents' heroic effort help 12-year-old daughter receive a new heart and lungs

Fewer than 10 children received a heart-lung transplant in the United States last year. One of them was 12-year-old Katie Grace Groebner, who was diagnosed with pulmonary hypertension in 2008 and given a year to live.

Determined to save their daughter’s life, Katie Gracie’s parents sold their house in Minnesota and most of their belongings and moved to the Bay Area so she could be treated by Jeffrey Feinstein, MD, director of the Center for Pulmonary Vascular Disease at Lucile Packard Children’s Hospital Stanford.

As reported in the NBC Bay Area segment above, the Groebners understandably call Katie’s doctors and nurses “heroes,” but Feinstein says it’s the other way around. “You want to find a hero? Talk about the parents,” he says in the video. “If you look at the amount of work that I did, compared to amount of work Katie Grace’s parents did? There’s no comparison.”

Previously: Living long term with transplanted organs: One patient’s story, Stanford study in transplant patients could lead to better treatment, Anatomy of a pediatric heart transplant and ‘Genome transplant’ concept helps Stanford scientists predict organ rejection

Media, Podcasts, Surgery

CNN’s Sanjay Gupta, MD: journalist, surgeon, advocate

CNN's Sanjay Gupta, MD: journalist, surgeon, advocate

Gupta - smallWhen the history about medical marijuana’s path to legitimacy is written, CNN’s chief medical reporter Sanjay Gupta, MD, may be more than a footnote. Gupta famously authored a 2009 TIME magazine column decrying efforts to legalize marijuana for medicinal purposes. In a 180-degree turnabout in August 2013, he issued an apology and said he was wrong. He wrote that he didn’t look hard enough at the “remarkable research” indicating that for some illnesses marijuana provided a relief. He told me in this 1:2:1 podcast that while he’s cautious about the impact of marijuana on some brain and psychiatric disorders, he feels that the evidence is clear for certain diseases like epilepsy, neuropathic pain and muscle spasms brought on by MS that cannabis has the power to heal.

I wanted to talk to Gupta for this special issue of Stanford Medicine on surgery not only because of his controversial yea-and-nay positions about weed as medicine but because he’s also a neurosurgeon who still spends time with patients in and out of the OR  between covering health crises around the globe. And in recognition of his clinical and advocacy skills, he was also personally asked by President Obama to consider taking the position of U.S. Surgeon General. (He turned down the offer as the timing just wasn’t right for him.)

And what about this new campaign to Just Say Hello that he launched on Oprah.com? He tells me that if we were a friendlier society – neighbor greeting neighbor -  perhaps we could heal some of the loneliness out there and become a more civilized society.

I asked Gupta, since he travels internationally, whether there’s one universal truth that he finds all human beings seek. “Most everyone wants to do good by their bodies, understand health and how they can improve the health of their family members. I think that the desire for good health and desire for improved function is a universal thing,” he told me. And in his storytelling, what impact does he want to make with the viewer?  What does he want the audience to understand about the world as seen through his eyes?  He said:

If I can explain to them that as the bombs came raining down the same family that was driving their kids to school the day before, grocery shopping after that, stopping at a bank to withdraw some money, that they are now fleeing with whatever few possessions they could garner and run for the border… that they are a lot like families in your own neighborhood… That’s really important to me as a reporter.

Previously: Stanford Medicine magazine opens up the world of surgery and The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe
Illustration by Tina Berning

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

Stanford News, Stem Cells, Surgery, Videos

Stanford reconstructive surgeon Jill Helms reminds us that “beauty isn’t defined by our faces alone”

Stanford reconstructive surgeon Jill Helms reminds us that "beauty isn't defined by our faces alone"

Jill Helms, PhD, a professor of plastic and reconstructive surgery at Stanford, leads a team of scientists that are working on methods to activate a patient’s own stem cells at the site of an injury to speed up tissue healing. In this TEDxStanford video, Helms discusses how surgical scars can sometimes impede growth of a patient’s body, such as the repair of a child’s cleft palate, and the potential of using stem cells to enhance the body’s natural healing process.

As previously mentioned here, Helms delivered a talk on the topic of beauty reconsidered, and she reminds us at the end of the video that “beauty isn’t defined by our faces alone.” She says, “Beauty is compassion, kindness and warmth, and that’s internal beauty. That’s the most important beauty.”

Previously: A spotlight on TEDxStanford’s “awe-inspiring” and “deeply moving” talks and Stanford study shows protein bath may rev up sluggish bone-forming cells

Neuroscience, Stanford News, Stroke, Surgery, Videos

Raising awareness of moyamoya disease

Raising awareness of moyamoya disease

Today isn’t just May 6, it’s also World Moyamoya Day. Well, not officially – but one patient is trying to change that.

Moyamoya, a rare cerebrovascular disease is often overlooked by neurologists, and its symptoms confused with those of chronic migraines. Tara MacInnes spent most of her childhood suffering from excruciatingly painful headaches and bouts of numbness and tingling in her hands, face and legs. Like many others with moyamoya disease, these episodes were overlooked by her pediatric neurologists. By age 16, when an especially bad episode led to an MRI and eventually a correct diagnosis, both sides of her brain had already suffered damage from strokes.

But MacInnes was lucky: She happened to live close to Stanford, where Gary Steinberg, MD, PhD, one of the world’s leading experts on moyamoya treatment, practiced. And like many patients, what MacInnes needed was more than just surgery – she needed a sense of belonging and the ability to interact with others who had gone through a similar experience.

Shortly after her surgery here MacInnes began volunteering at the Stanford Moyamoya Center, talking with patients and their families. The more she met with people, the quicker she realized it wasn’t just the general public that didn’t know much about the disease, but that many medical professionals had never heard of it. Now, 10 years after her successful surgery, MacInnes has become a devoted advocate and is determined to raise awareness about the disease; you can sign her petition to help spread the word and make World Moyamoya Day official.

Previously: How patients use social media to foster support systems, connect with physicians

Cardiovascular Medicine, In the News, Stanford News, Surgery

Looking at aortic valve replacement without open-heart surgery

SM heart imageSome patients with aortic stenosis undergo open-heart surgery to replace a constricted heart valve in an attempt to stave off heart failure. But others, such as elderly adults, aren’t candidates for this type of surgery. In 2011, the FDA approved a non-surgical alternative procedure called TAVR, or transcatheter aortic valve replacement, but the new method, as discussed in the New York Times earlier this month, also carries certain risks.

In the current issue of Stanford Medicine magazine, my colleague Tracie White digs into the surgery-or-TAVR debate and follows the story of one aortic stenosis patient who was treated by the newer method. Maryann Casey, at 62, is younger and healthier than the average TAVR candidate, but she had faced an increased risk for complications during open-heart surgery because of radiation treatment for breast cancer decades ago.

From the magazine piece:

Casey was lucky. Her Stanford oncologist, Frank Stockdale, MD, PhD, the Maureen Lyles D’Amrogio Professor of Medicine Emeritus, was well-informed about treatment options for aortic stenosis, a calcification of the heart valve. This new nonsurgical approach to valve replacement involves placing an artificial heart valve, made of cow tissue supported by a stainless steel mesh frame, inside the damaged valve. Referred to as “transcatheter aortic valve replacement” or TAVR, the procedure is designed for patients with severe, symptomatic aortic stenosis who have health conditions that make the preferred treatment, open-heart surgery, very high risk.

On Oct. 16, 2012, Casey became one of the more than 120 patients that year at Stanford to undergo the TAVR procedure. The first catheter-based aortic valve transplant was in 2002 in France. It has been approved for use for the past six years in 40 other countries including most of Europe, with a total of 45,000 procedures conducted worldwide.

In the United States, institutions such as Stanford, the Cleveland Clinic, Columbia University and the University of Pennsylvania have been leaders in introducing the new procedure and determining its effectiveness through the clinical trials.

Careful patient selection is key to the successful use of the procedure, says [D. Craig Miller, MD, the Doelger Professor of Cardiovascular Surgery], and that sometimes means not recommending TAVR for a patient who is too old or too sick with other illnesses to benefit from the device.

“That’s a very sobering point,” says surgeon Miller. For patients who are too old or ill, undergoing the procedure may not increase their quality of life or life expectancy; Miller says that the boundary line between TAVR “utility and futility” is still being defined.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questionsAsk Stanford Med: Answers to your questions about heart health and cardiovascular research and Major advancement for once inoperable ailing heart valves
Art, which originally appeared in Stanford Medicine, by Pixologicstudio

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