Author: heenastat

Acute Care Surgeon who blogs about joy in the profession.

Memories (In a pile of old receipts)

Originally posted in heelskicksscalpel.com

In college, soon after I got my first bank account and a credit card with a $300 credit limit, I started keeping every receipt for every purchase I ever made. At the end of every calendar year, I would box up an annual pile of receipts. This continued until a few years ago when my husband decided he could no longer tolerate me forcing us as a family to save every receipt filed away into individual envelopes for necessities, frivolities, groceries, gifts, etc. He was right, outside of certain big ticket items and shoes from Nordstrom, there really was not any reason to “hoard” receipts (his words, not mine).

It’s been a tough habit to break. Now, when I empty out my wallet after a few days I scan the receipt for what I purchased and then cringe as a toss it. Every. Single. Time. Not sure if it’s just me still trying to break the habit or some weird paranoia that I will truly someday miss having proof of purchase for that t-shirt from target or that gallon of milk.

In any case, during some spring cleaning yesterday I came across all of my receipts from those college years. It was a fascinating lens into my past habits and routines. He’s what I remembered/learned about myself all these years later.

  1. I bought a lot of feminine hygiene products. A lot.
  2. I spent a lot of money on photocopies and laser printing.
  3. I ate out. Often. And, surprisingly I can remember who I ate with for each of those meals away from our usual two or three go-to restaurants. Making the effort to go somewhere more expensive or (gasp) leave the general vicinity of campus = a special occasion and I found myself imagining everyone who I thought was special to me all those years ago.
  4. I didn’t, however, indulge in snacks at convenience stores or similar. This is notable only because I am married to someone who definitely did.
  5. I always love to shop, it seems.
  6. I never paid more than $19.99 for any of my shoes or clothes back then. Typically, my stuff came in well under ten bucks.
  7. I owe a special thank you to the Wexner family of Columbus, OH. Were it not for their Limited/Express stores back in the day I might have had to go through college naked.
  8. I even once purchased something at an Abercrombie & Fitch store. This must have been before I developed migraines in response to strong perfumes or colognes. I won’t allow my daughter to shop there (at least when I am with her) because it’s some sort of moral stand I decided to take for reasons related to the forced inhalation of strong smells as I walk by their stores in the modern American mall.   I have always denied ever shopping there; evidently, I am a big liar.
  9. I never bought anything that would be considered athletic. Nope. Not a thing in which one could workout. This is regrettable, not only for the fact that it is evidence of my complete lack of physical self-care back then but also because it likely led to the backlash known as my current Athleta problem.
  10. I got just a bit nostalgic that Caldor, Lechmere, and Filene’s no longer exist.
  11. I evidently was also the kiss of death for any bank I decided to do my saving with. None of the three banks I used during those years exist today.
  12. I used to listen to a lot more music than I do now. Today I could stream constantly if I wanted to but honesty I don’t ever listen to music outside of my car or on workouts. Back then between mail order and the local Tower Records, I bought a lot of CDs.
  13. I enjoyed live music far more often than the concert every couple of years I enjoy today. But, there was no genre in particular that called my name as was evident from my ticket stubs for House of Pain, Duran Duran, James Taylor, and They Might Be Giants. And, as with those special dinners, I remember exactly who I saw each of those shows with.
  14. If there wasn’t live music to be enjoyed, I went to the movies. I saw some great films and some mediocre ones. I often sought out art house cinemas for limit release films. I didn’t just seek out the big screen for films whose effects would warrant the time, effort, and cost of going to the movies [read: the only movies I have seen in the theatre in the last 3 years are the 2 Star Wars movies.] I simply enjoyed going to the movies back then unfettered by the logistics of sitters and evening little league games or by the gravitational pull of my pajamas at 7:30pm.
  15. Occasionally, I went to a play but I was not so much a theater person. Rather I was an ardent supporter of my friends who ran the set, played in the pit, or were making their acting debut on their way to become ophthalmologists, lawyers, and Drosophila experts.
  16. I clearly went out a lot. But when I was in, I spent a lot of time on the phone at substantial cost. If I had invested the money I spent on hours of late night calls with my best friend from home, she and I would be enjoying some really tricked out girls’ weekends now. Calling friends came at a premium back then. Now, we have unlimited minutes to talk yet we rarely do; and, if we do it’s for minutes, not hours.
  17. I was proud of the fact that I worked to finance all of these “frivolities” that lightened my college years. I made $65/week at my work study and always deposited $40, spending about $25 on the typical weekend (Thursday night through Sunday brunch back in those days — never paying for a brunch until years later because, well, dining waffled were just that good) and putting away the rest for my phone bill and summer adventures.
  18. I didn’t really have any real adventures, though. I visited my sister and my best friend in New York a lot. I had a great trip to visit my roommate on the west coast our first summer after college. And, yes I saved every boarding pass and bus ticket. Greyhound and Peter Pan still exist but wow my TWA ticket for the *non-smoking* section was a real blast from the past. As was that boarding pass for my first every Southwest flight in 1993 — an experience that kept me from using this airline for the ensuing nearly a quarter of a century until driven by desperation about 2 years ago.
  19. I wonder what has happened to the carbon paper industry. I miss the satisfying mechanical sound of the credit card impression maker thingy. The screeching feedback that it’s time to remove my chip is not the same.
  20. I also miss my original signature with first, middle, and last name fully legible. receipts

 

A Belated Thank You

It was late. I had just finished a straight-forward appendectomy. I explained the findings and expectations for recovery to the family gathered in the waiting area. There were a lot more people there than in the emergency room just a few hours earlier.

“Yes, he will most likely be going home tomorrow morning,” I answered in response to a final question from a family member. I shook the mother’s hand and turned to walk away. Everyone’s expression was one of relief. It’s an every day diagnosis and procedure for us; for them, it’s quite possibly the scariest thing to have happen to a love one.

Except it wasn’t.

“I think I know you,” I heard when my back was already turned. “Do you take care of people in car crashes?” It was a timid inquiry.

“Yes, I am an acute care surgeon. I do trauma and emergency general surgery.”

“You think you took care of my daughter. Years ago. She died in a car crash. She…”

I cannot imagine how difficult it must have been for that mother to be back in that hospital, back in a bland waiting room with fluorescent lights illuminating my face again. I simply can’t. But, I had a crystal clear memory of that morning. Nothing was left to the imagination that day. Nothing needed to be discerned by the powers of radiation vectors.

It was a long time ago. Still, the image of that poor girl, a life I could not save, a body badly mangled by someone going the wrong way at highway speeds, was seared in my brain. It was truly horrific. The bodily damage was unlike I had ever seen before. My boss with more than 30 years more experience was there too. Neither had he.

“…Thank you for everything you did. You were so kind to us. You told us she didn’t suffer. You let us wail and you held us. We never said thank you.”

“Yes, I remember,” I gulped. I felt a lump in my throat, a tear in my eye.

CPR was in progress upon arrival. There was nothing to do but be kind. Words of gratitude were neither needed nor expected. It’s what we do. However, the reminder that families are grateful when we tell them we removed a vestigial organ without incident or when we deliver the soul-crushing news that their child is dead was deeply appreciated. For the lives we cannot save, with kindness and empathy we can at least spare those left behind from just a little bit of suffering in the midst of so much agony.

A Leading Woman Surgeon Speaks the Truth about Women in the Profession 

Originally published on heelskicksscalpel.com

Any one who follows this blog on the nuanced life and career of a woman surgeon  should watch this. In its entirety.

http://academicsurgicalcongress.org/aas-2017-president-address-caprice-greenberg-md-mph/

It is the Presidential address delivered recently by Dr Caprice Greenberg to end her term as President of the Association of Academic Surgery. She speaks with clarity and conviction on a topic of importance to both men and women across generations of surgeons. She provides data, vivid examples, and eye opening analyses about how and why women are professionally held back, not just in surgery but across specialties and other professional roles.

What I Really Care About During A Trump Presidency

Originally posted on heelskicksscalpel.com

The internet is ablaze with images and commentary about our new president. They focus on a baby blue dress with an interesting collar or lack of chivalry or delusional views of a crowd or pithy signs about that which cannot be combed over, but let me tell you what I do and don’t care about when it comes to our new president.

I don’t care what his wife wears; but, I do care about how his trade policies will impact the price of everyone else’s clothes since most Americans cannot afford 4-figure price tag garments made in America.

I don’t care how he treats his wife or the two wives that preceded her; but, I do care about what he is doing to dismantle women’s healthcare and reproductive choice.

I don’t care what size of his crowds were compared to my crowds; but, I do care that  he has no qualms about every person in either of those crowds or in any other public space carrying a loaded weapon.

I don’t care how bad his spray tan is or how awkward his combover looks when the wind gusts; but, I do care that he is going to decimate our environment and exacerbate global warming.

I don’t care about his son’s personality or medical history; but, I do care that he is going to dismantle a public school system and higher education financing mechanism that educates the rest of our children.

I don’t care that he hasn’t released his tax returns; but, I do care that he intends to give the top 1% tax cuts while everyone else pays more and loses necessary services.

I don’t care that he is not as amazingly healthy as his hyperbolic doctor purported him to be; but, I do care that he is going to significantly reduce access to health care for millions of our most vulnerable citizens.

I don’t care that he was obsessed with promulgating the “alternative fact” that our 44th President was not born in the US; but, I do care about him oppressing those among us who were not born here especially if we do not bear a white European ethnicity or do not practice Christianity.

When our new president cares only about stroking his own ego and pandering to those who simply cannot tolerate a progressively diverse society and increasingly global economy, we must have a laser like focus on the values and policies we really care about.

Self-Inflicted

“Not again,” we all silently sigh when the page comes through. He arrives under lock and key and stays that way no matter what our plan.  Every trauma surgeon and nearly every resident has previously participated in his care over the years.

He has a life sentence.

The abdomen is socked in. There is no more retrieving the foreign bodies piercing his abdominal cavity. We have been there and done that. If something is visible on the outside we can pull it out. Now we just have to hope whatever was injured causes a process that walls itself off and does not cause too much physiologic compromise.

But what about the psychologic compromise? He does not wish to end his life; that much is clear. But he is looking for escape. The lure of the secondary gain is strong. He has admitted to us:

The food here is better.

The nurses are cute.

I don’t want to be near the pedophiles.

With our incarcerated patients, it is not our place to address these cries for help. We can’t imagine the fortitude it must take to clandestinely acquire a sharp object and then meticulously drive it through the abdominal wall into whatever organs lie beneath; but, we must stay focused on the anatomic issues and potential complications.

He is screaming at us now. The guards tell him to calm down. Now it is his words that pierce our ears:

You have to cut me open.

Please put me to sleep.

I am not a bad person.

As trauma surgeons we view all patients as equal. They all deserve the same compassion and high standard of care no matter what the circumstances of the injury, no matter what the personal status of the patient. We never, not ever, inquire as to the circumstances of the crime(s) for which the patient is serving his sentence or how long the sentence is. None of that matters. He is our patient and we provide him the best care possible.

Today the best care possible is to provide minor bedside care with local anesthetic to remove a foreign body. To calm him down I take his hand while the residents work. I lock his eyes so he will stop trying to see their sterile field. I ask him about himself. I am not sure why but it seemed like the natural thing to do.

He tells us where he grew up. He describes his childhood. He takes a sentence to describe his crime and then speaks more in detail about how the next 37 years of his life sentence led to today. He says:

I wasn’t always like this.

I used to be normal.

Now, this is the only way I know how to cope.

The self-inflicted stab wound will be fine. No hospital food needed. No bedside care from nurses needed. But before he goes back to his bunk with the pedophile, I tell him that we are sorry things turned out this way for him. We wish him luck trying to cope better but we fear he won’t be that lucky.