Author: heenastat

Acute Care Surgeon who blogs about joy in the profession.

Here’s to all the Lead Parents, the co-Parents, and the Village it takes to Raise a Child

Originally posted at heelskicksscalpel.com

I get the working mom dilemma. I am a mother and I work the hourly equivalent of 3 full time jobs. I get it. It’s hard to do it all. And sometimes the tasks involved in either or both are just not that much fun. Though I have never been a stay at home mom I suppose this is why many call this the hardest “job” of them all.  It’s not all coos and snuggles. Parenting can be onerous.

But every time I hear a working mom anthem or a stay-at-home mom  anthem I feel sad for everyone who is left out, or worse, by implication, accused of not being able to or interested in parenting. As far as I can tell, other than gestating and breastfeeding, men can do every bit of parenting – the good and the bad, the fun and the tasking, the easy and the hard – that women can. And, just ask any adoptive mom or mom through surrogacy or step-mom and she’ll  probably tell you that those to bio/physiological processes aren’t requisite either.

To be sure,  I too am guilty of getting caught up in the mob mentality of the “moms have the hardest job in world” even though my husband does the vast majority of parenting in our household.

But, it’s 2016.

We do nothing but reinforce old stereotypes about gender roles with tales of the plights of moms. These are plights shared by all parents. Single parents. Gay parents. Heterosexual parents. Widowed parents. Each person’s role in the day to day tasks of parenting will vary. Sure there are deadbeat dads (and moms!) out there and, without congratulating them on their parenting failures, let’s just agree that the definition of an involved parent will vary based on a number of complex, overlapping factors ranging from natural affinity for children to income potential.

I understand that statistically the bulk of childrearing in our society is provided by women. Social norms, cultural discourse, and possibly some biology are at play in determining this statistic. But, as a woman whose children have been well-reared by a devoted lead parent (who happens to be my male heterosexual partner), four healthy-able bodied grandparents, and a neighborhood of friends who I trust to nurture and admonish my children, it just makes me cringe when a mixed audience of dedicated parents is subjected to a “The Hardest Job is Being a Mom” mantra.

Parenting is hard no matter who does the parenting. It’s also filled with incomparable joys. So hats of to to all the lead parents, to the co-parents, to the moms and the dads, and to the various villages who are doing their best amidst the ups and downs to raise a child in our modern world.

Here is my village.

We don’t need data, we need to ban semi-automatic assault rifles

Originally posted at heelskicksscalpel.com

I am on call today. It’s been an average day for this trauma surgeon. 1250 miles away, it has been a day of extraordinary carnage at a trauma center in Orlando, and that was for the 53 people who survived the incident. Another 50 were left dead at the scene, all shot by a single person.

Yes, a single gunman.

This tragedy brought up a lot of issues that torment and divide us Americans today.

Anti-gay bigotry.

Islamophobia.

Gun control.

No doubt the perpetrator was a horrible, soul-less person. While whether he was driven by hatred for gays or misappropriation of Islam or an obsession with ISIL are issues worth considering, the fact of the matter is that, regardless of what drove him to do this, his impact would have been far less severe if he had not been in possession of an AR-15 semi-automatic rifle.

In the hours since news of the horrific event emerged, several friends shared a clip of President Obama on the PBS Newshour responding to a query on gun control where he discusses how the reduction of automobile-related mortality was data driven and how we are hamstrung by the NRA and those who are backed by the NRA when it comes to finding data-driven solutions to the gun problem. The President assured his audience that no one is going to take away guns from “lawful, responsible gun owners [who use them] for sporting, hunting, protecting yourself.” In fact, it appears that Moms Demand Action (an organization that emerged after the Sandy Hook tragedy) used data to change its focus from a ban on assault weapons to a focus on background checks and common sense use of firearms. Evidently, the data showed that the 1994 assault weapon ban, which existed for a decade before it was allowed to expire in 2004, did not save that many lives, and the organization wants its efforts to save as many lives as possible.

But let me ask you this:

Did the lives of the 50 people killed and 52 wounded in the Pulse night club not matter?

Did the lives of the 26 people killed and the 2 wounded in Sandyhook Elementary School not matter?

Did the lives of the 12 people killed and 70 wounded inside the Century 16 Theater not matter?

In his PBS town hall, the President also commented on restrictions on background checks which some believe may have prevented this man in Orlando from becoming a gunman. Many people posted the list of the 45 senators who blocked legislation that would have kept someone on a terror watch list, a person of concern to the FBI, from getting any gun legally. However, when there is not a legal way, someone truly intent on killing will find an illegal way. An so this single person who killed so many instantly in such rapid succession would have found a way.

He might have built as bomb as we saw in Oklahoma City and at the Boston Marathon. But, fertilizer, diesel fuel, pressure cookers, and ball bearings have other purposes.

He might have flown a plane into the building as was done in a calculated, multi-person, multi-year scheme set up by a worldwide terror group on 9/11/2001. But planes are intended for transport.

I could go on and on. And I often hear these myriad ways that others can kill cited when people state “Guns don’t kill; People kill.” Heck, I see them daily in my job: beer bottles, baseball bats, ice picks, kitchen knives, pipes, motorized vehicles…These all can be used to commit murder but are nowhere near as efficient as a semi-automatic rifle.

And for these reasons, yes it is worth discussing what motivated this man to commit mass murder. It’s worth trying to understand how he became this venomous monster. It’s worth examining our processes of surveillance by law enforcement of those whom we suspect might become venomous monsters. But come on, do we really need to amass any quantity of data on semi-automatic rifles? A single magazine can hold 20 to 100 rounds of military grade bullets and fire up to 60 times a minute. Do we need really need study if this kind of weapon is necessary for decent law-abiding folks to shoot tin cans in their back yards, or take down deer for sport, or protect themselves from home intruders?

Don’t get me wrong. I am both a surgeon and a health services researcher. I thrive on studying vexing issues through data collection and robust statistical analysis. I believe evidence-based approaches. Like many trauma surgeons and injury prevention researchers, I too want to know if biometric locks would reduce accidental deaths due to handguns. I wonder what psychometric tools might be used to optimize background checks if we ever could effectively implement them. I just don’t think we need data on this particular kind of weapon.

In case you missed it before, the kind of weapon that was used to kill 50 people nearly instantly and injure 52 more in Orlando overnight, was also used to killed 12 and wound 70 in Aurora, CO and was used to kill 20 children and 6 adults while injuring 2 more in Newtown, CT.

I was recently attended a talk by Dr. Lenworth Jacobs, a renowned surgeon at Hartford Hospital. He spoke of what steps they took on the day of the Sandy Hook massacre to ready their trauma center. Alas, no one was transported there because the vast majority were dead at the scene. Dr. Jacobs had the difficult task of reviewing every single autopsy while preparing a consensus statement on how to handle active shooter events. The air went cold as he described to a room full of surgeons what the military grade ammunition did to those poor kids’ bodies. They never had a chance.

The Hartford Consensus statements that would emerge from this review of Sandy Hook and other mass shooting focused on how to prepare civilians, first responders, and trauma centers to save as many lives as possible in the face of such horrific events. Nothing was said about the weapons themselves. When asked about this, the Dr. Jacobs responded that it’s too politically charged; and since active shooter events will presumably continue to happen, our role [as surgeons] was to identify a problem that is addressable (people dying of possibly preventable hemorrhage) and address it (education on hemorrhage control within the context of active shooter events). The logical person in me who understands that the right to bear arms in part of the fabric of US society admired the pragmatism and ingenuity regarding active shooter events described in Dr. Jacob’s talk.

Less than 3 weeks later there was the deadliest ever active shooter event in Orlando. To be sure, some of the 53 who lived must have benefited from the data reviewed for the Hartford statements. But please don’t tell me that you need data or that data is the reason why you won’t stand up and say “no, not ever” to a type of gun that can rip holes in the aorta, pierce through the brain, pummel through the heart, and break strong bones into bits and pieces in an instant up to 60 fucking shots a minute. There is no need for civilians to ever have this kind of a weapon. Not ever.

And while it’s true that people will continue to die because those intent on killing will do so with criminally acquired firearms or by weaponizing everyday objects, because law-abiding gun owners will continue to be careless with their hunting rifles and handguns, and because those suffering from depression will commit suicide by firearm, we simply cannot stand behind this veil of data in not calling for a ban on semi-automatic assault rifles.

The overall number of people killed by the AR-15 and similar military grade firearms might pale in comparison to the aggregate numbers of lives lost through other forms of gun violence but lets not devalue the lives of those killed and injured with these heinously destructive weapons by pretending we need data to ban them.

We don’t need data. We need to stand up and do the right thing. We need to put an end to the ‘single shooter able to kill multiple victims in just a few minutes’ phenomenon made possible by the deadly combination of soul-less perpetrators and powerful semi-automatic assault rifles.

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Since this post was first shared a number of people have posted petitions regarding a ban on assault rifles. I don’t know what if any impact any of these will have but I am sharing them below.

https://petitions.whitehouse.gov/petition/ban-ar-15-civilian-ownership

Renew the Ban On Assault Weapons

http://petitions.moveon.org/sign/ban-assault-weapons?source=s.fb&r_by=15891390

https://www.change.org/p/tell-congress-the-president-reinstate-the-assault-weapons-ban

What Brock Turner, his a$$ho#e dad, and a biased judge make me want to scream at my daughter (and my son)!

Originally posted at heelskicksscalpel.com

Warning: Expletives to follow

The internet has been consumed this week with outrage regarding the trial of Brock Turner a varsity swimmer at Stanford University who was convicted of 3 counts felony sexual assault and only sentenced to 6 months in the county jail for a crime punishable by upwards of a decade in the state penitentiary.

Evidently the trial was a classic blame the victim set up by the well compensated attorney hired by Turner’s family who was painted to be an all-American good guy. The jury didn’t fall for it and he was convicted. The judge, however, himself a former Stanford varsity athlete with seemingly similar racial and socioeconomic background, worried about the impact of a longer sentence on the convicted rapist. And so, the extraordinarily light sentence followed was in sharp contrast to what a young man of a different racial and socioeconomic background might expect from our judicial system.

Now twice victimized, first when she was raped and second when her behavior on the night she was raped and her character were drawn into question in a court, the young woman who was assaulted by Turner wrote a powerful letter that galvanized social media followers who were soon calling for the judge’s recall. The convicted rapist’s father countered the letter noting how just ‘20 minutes‘ of his son’s life had resulted in such a detriment to his well-being. He went on to suggest that his upstanding progeny take up motivational speaking on the the topic of alcohol and promiscuity on college campuses rather than taking up space in a jail cell. Not surprisingly, this sent the twitterati into an uproar.

‘Rape Culture’ and ‘White Privilege’ have been hashtagged repeatedly these last few days and I too am enraged. But, I am not here to talk to you about my rage. There are plenty of others who have expressed my thoughts on this brave victim, the entitled brat who victimized her, his piece of shit father, and a judge (no matter how neutral his prior rulings might be) who clearly was woefully imperceptive of his own unconscious bias in favor of affluent white males in rendering a sentence in this case.

I am here to express my grave concern about what to say to my children in response to this.

I don’t want my daughter to have to go through what this young woman went through. I don’t ever want to see her spirit wiped away by the most gruesome of personal violations and to have her reputation destroyed in the process of seeking justice. I want to provide her with wise counsel to protect herself from ever being raped. And by this I don’t mean the scary bogeyman rapist who lurks in the bushes preying on unknown victims; for that she will have a black belt in Krav Maga.  Since the vast majority of rapes are perpetrated by known assailants upon known victims, be they long-term intimate partners or recent encounters on a dance floor, my daughter needs solid advice on how to avoid the Brock Turner types now and in the future.

Wharton Professor and author Adam Grant’s post on Facebook (pictured below) sums up the causes of rape exceptionally well.

 And if these are it, then what can I say to my daughter to not play into the blame the victim stance that is so common in our society? I want to scream at her:

“Don’t ever, not ever, drink a single drop of alcohol, ever no matter what! I don’t care how safe the social scene appears to you. I don’t care how solid a crew your girlfriends promise to be. I don’t care if you are the legal age. You have no idea if and when you judgment will be compromised; and, since the Brock Turners of this world can’t be relied upon to exercise any judgment even when you are sloppy drunk to the point of unconsciousness just don’t let yourself to be vulnerable to the likes of him due to intoxication so JUST. DON’T. DRINK!”

“Ditto for drugs. Don’t expect anyone around you to exercise good judgment on your behalf. They won’t, especially if they are Brock Turner. Got it? NO DRUGS!”

“Don’t dress provocatively. No cleavage. No short skirts. Nothing that accentuates your femininity, NOT EVER! You can read about how rape is about violence, aggression and power rather than about sexual arousal, pleasure, and sex in the text books but in real life I beg you not to do anything that could possibly make you more attractive to the Brock Turners of this world. They are incapable of exercising control over their sexual urges and they will lash out violently and aggressively to satisfy these urges with bodies that are simply more powerful than yours so NOTHING SEXY on that body!”

“Ditto for flirty behavior. I wish a coy remark here or a sideways glance there could be just a fun, arm’s length interaction but to someone like Brock Turner it is like an invitation for sex even if it takes violent aggression to get it. So please DO NOT ACT LIKE YOU ARE ASKING FOR IT!”

“Don’t walk alone. You never know when a stranger is going to assault you. Wait you have Krav Maga for that. What I really mean to scream is DON’T GO ANYWHERE ALONE WITH SOMEONE LIKE BROCK TURNER! Especially if you have not obeyed my prior four rants about drinking, drugs, dressing, and flirting. If you do, you better hope that the non-Brock Turners are randomly riding by on their bikes or their skate boards to save you.”

And here I am seriously teetering on the edge of an unprovoked screaming fit at my daughter because my first reaction is not to scream at my son:

“DON’T BE LIKE FUCKING BROCK TURNER!!!!!!!!!!!”

“Nope. Not ever. I don’t care how she dressed or behaved, or how compromised her judgment may have been for whatever reason, or whatever fantasies have been imprinted in your brain from the media, or how our society tends to treat men and women differently when it comes to matters of power and sex and everything in between. You are better than that. You treat women-all humans for that matter-with respect. You protect those who might be vulnerable, be they male or female, young or old, drunk or sober, black or white, whatever their potential vulnerability may be. You stand up for what’s right and you squash all that is morally reprehensible. You be the guys on the bikes or the boards. You help. And unlike Brock Turner, his asshole dad, and this biased Judge you be the one who sets a good example for all the little boys that follow.”

The trouble with discourse that drives us apart in response to a death in the line of duty

My heart sank when I heard the news that a local police officer had been killed in the line of duty. I was not on call that day but I knew exactly what the words “he was taken to a local hospital where he was later pronounced dead” meant. As trauma surgeons we provide care for those injured in senseless, often preventable ways daily. But when an officer is stricken it hurts so deeply because we share a position with them at the forefront of the worst that happens in our society.

So when I heard the news I mourned for the officer, for his family, for his colleagues, for all of law enforcement, and for the people who tried so valiantly to save his life and would forever be asking themselves “was there something else we could have done?”

Let me assure you, there was not.

As with all trauma centers, we have a comprehensive morning report where we discuss all of our new patients: what was the mechanism, how did they present, what was done for the work-up and subsequent treatment? So it was clear that the trauma team did everything they scientifically or physiologically could in this case. In morbidity and mortality* terms, this would be a ‘non-preventable’ death.

Here’s the thing though, of course it was preventable. And we are all (as members of the community, as his brothers and sisters in law enforcement, as representatives of both sides of the criminal justice system, as providers in the healthcare system) asking this same question “why, why did a good man—a good cop, a good husband, a good father, a good son, a good citizen—die this way?”

In a statement to the press less soon after losing her son, the officer’s grief-stricken mother was quoted as saying there is “no respect for police anymore” suggesting perhaps that a pervasive devaluing of law enforcement by society might be at the root of her son’s preventable death. She was no doubt alluding to the national discourse evolving in recent years due to some high profile episodes where the actions of responding officers have been questioned. Some actions have been proven to be criminal by our justice system, as in the case of an Oklahoma City Police Officer who serially raped women he had pulled over, in other cases, however, the facts in support of criminal behavior beyond a reasonable doubt are less clear (e.g., Officer Parker of Madison, AL and Mr. Sureshbhai Patel; or Officer Wilson of Ferguson, MO and Mr. Michael Brown; or Officer Pantaleo of New York, NY and Mr. Eric Garner).

Clarity notwithstanding, there has seemingly been a shift in public rhetoric questioning of infallibility of those on the front lines of law enforcement. Sadly, in some cases the rhetoric has escalated to vitriol, rioting, and even directed acts of violence against law enforcement.  It truly is maddening that a man, fueled by the overarching discourse questioning police intentions and behavior, would then seek an opportunity to kill the police as in the case of Mr. Ismaaiyl Brinsley who gunned down Officers Wenjian Liu and Rafael Ramos of the NYPD, not during the act of apprehension or while committing another crime, but just because.

However, no matter what the headlines are, the overwhelming majority of our men and women in blue are good men and women who take on their duties with the best of intentions and model professional behavior. And so, when this good man’s mother cites this volatile discourse as a possible cause of his death—as much as my heart breaks for her—it hurts our community by suggesting a local conflict where there was none.

By all accounts, the cop killer in this case was a sociopath lacking any respect for human life or the laws of our society in general as evident by a lengthy record replete with charges ranging from cocaine trafficking, to assault & battery, to weapons possession. Those of us who are not career criminals might get tachycardic or diaphoretic during traffic stops but our natural instinct is to reach for our license & registration, not for our gun. A man with no moral compass felt cornered and so he fired; but, this was no more because he was cornered by an officer than if I had made some gesture to this armed and dangerous criminal during my nightly dog walk.

So, while a family, a profession, and a community mourn, I urge each of us to contemplate how the criminal justice system might have functioned differently to prevent this senseless tragedy but to avoid stoking fired up rhetoric that pits people against the police and police against the people. Discourse that drives us apart stands in the way of viable solutions to combat the socioeconomic and psychological factors that may drive one to a lifetime of crime in the first place and to take those who cannot be rehabilitated off the streets before another preventable death, be it of an ordinary citizen or a man/woman in blue.

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*Morbidity & Mortality, or M&M as it is called is a weekly conference held by surgical teams to review all deaths and complications in an effort to learn more about the systems-based and disease-based processes that led to the adverse outcome.

An Explanation: The #1 tool in your physician’s toolkit

It was almost a formality, me rounding on that patient that day.

The obstruction had resolved. The nasogastric tube was out.   If the diet advanced as expected he could be discharged to continue his chemotherapy. He was not even my primary patient. He was on the heme-onc service so I wasn’t even responsible for the paperwork.

Yes, he was dying of cancer. That was not news to him. Nor was the nausea and vomiting that he had come to expect in the wake of periodic infusions of poison. That which was intended to kill the cancer cells also killed a little bit of his insides with every dose. But the distention and obstipation was new. He had not felt right 4 days ago and he had rightfully come to the ER.

His diagnosis was small bowel obstruction. However, one could not tell from the CT scan if it was due to adhesions from his cancer surgery some years ago or due to new tumors scattered in his pelvis which had in recent months made him the unfortunate bearer of the “stage 4 cancer” moniker. As if the side effects of chemo for his cancer recurrence were not enough, now he had to suffer through this. But he was better by the time I met him as the new attending on a consulting service.

My exam confirmed the residents’ optimism that the obstruction had resolved. It was likely adhesions given the swift improvement and I noted how the nasogastric tube works to relieve such obstructions to the patient and his wife. But I explained that we were not sure, based on the original CT scan, if the cancer was playing a role in impeding the flow of GI contents. Either way, as long as he was able to tolerate oral feeds he could resume his cancer treatment with the hopes that the same symptoms would not recur. He did not need an operation in the immediate future. The patient and his wife were relieved.

As I concluded my visit, I asked (as I always do) if there were any other questions.

“No,” replied the patient’s wife. “But thank you so much. In all our time here, no one has explained what was really happening. Thanks for making it so clear. We really appreciate it.”

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I know I have written about this before-about the power of clarity in the medical encounter.

But seriously, I was at least the 4th attending physician to meet the patient not to mention the countless 1st through 6th post-graduate year trainees who had cared for the patient before I met him. Yet no one had taken the few minutes it would take to explain why the patient felt so miserable and how an uncomfortable tube down his nose might help.

Understanding the disease process is pathophysiology 101. Explaining it to the patient is doctoring 101. Sure, doctoring 201 is the art of explaining it in a way that caters to a patient’s educational and verbal capacity without instilling fear; but that no one had even tried just made me sad as a physician and as an educator. Once again, I took solace in the fact that there was a resident with me to both observe the explanation and to witness the words of gratitude. Hopefully, that’s my way of paying it forward just a little bit.

So at the risk of sounding too preachy let me leave you with this: If you take care of patients, remember they and those who love them are humans in a state of crisis. Amidst the pain, the fear, and the uncertainty of what’s to come, taking a moment to offer an explanation for the suffering can go so much further than any medication or procedure. Consider it the #1 tool in your physician’s toolkit.

surgeoninheels's avatarHot Heels, Cool Kicks, & a Scalpel

It was almost a formality, me rounding on that patient that day.

The obstruction had resolved. The nasogastric tube was out.   If the diet advanced as expected he could be discharged to continue his chemotherapy. He was not even my primary patient. He was on the heme-onc service so I wasn’t even responsible for the paperwork.

Yes, he was dying of cancer. That was not news to him. Nor was the nausea and vomiting that he had come to expect in the wake of periodic infusions of poison. That which was intended to kill the cancer cells also killed a little bit of his insides with every dose. But the distention and obstipation was new. He had not felt right 4 days ago and he had rightfully come to the ER.

His diagnosis was small bowel obstruction. However, one could not tell from the CT scan if it was due to…

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