Tuesday, October 30, 2007

Surgeon speak

Ok, going to try to go a bit lighter in topic today. Last post was just a touch on the heavy side.

I always knew that 97% of surgeons had personality disorders, but I wasn't aware that most of them communicated as well as 5 year old autistic children. Our fun for the last couple of weeks:

Exhibit A:
Dr. Smak: How long until he wakes from the surgery?

Neurosurgeon: He'll be up as quickly as he was from his sedated MRI.

Translation: His Glascow coma score will be 15 out of 15 within a few hours. However, he'll lie in bed and moan for 2-3 days.

Exhibit B:
Neurosurgeon: We got it all out.

Translation: The tumor was successfully resected. Of course, there remains portions that had spread to your son's spine and we know that there is microscopic spread across much of his brain, however, the main tumor is gone.

Exhibit C:
Dr. Smak: Why does he have a lateral rectus palsy since the procedure?

Neurosurgeon: It'll go away. I wasn't anywhere near that.

Translation: Lateral rectus palsies are not uncommon when operating near the brainstem due to stretching of nerve fibers. They generally resolve without intervention.

Exhibit D:
Pediatric surgeon after Hickman catheter placement: There was an abnormality on your son's chest xray....grand pause....He has a small pneumothorax....grand pause...He won't need a chest tube.

This one didn't really need a translation, but come on! Don't use the word abnormality to someone whose kid has cancer. That means metastasis.

Maybe they need mandatory play therapy to work on the concept of empathy.
Ok, so it wasn't puppies-and-bubbles-and-balloons light, but it wasn't lead-anvil heavy either. I'm working on it.

Sunday, October 28, 2007

Your worst nightmare

I loved pediatrics during my training. I briefly considered choosing it as a speciality, but opted for family medicine for 2 reasons:

1. Sports physicals. There is such as a thing as too many.

2. Sick kids. That's Sick with a capital S.

I hated setting foot in the PICU during training. Every story was worse than the one before. It troubled me deep down in my being to see kids on vents, kid's broken bodies after trauma, kids whose lives were forever altered before they had a chance to grow up.

During my floor months, I had an uncommonly high number for heme-onc kids, just by chance. They were all great kids, and dealt with their lot in amazing ways.

But their parents. To see them just killed me. There is a pain in the eyes of a parent who has faced the spectre of their own child's death that eats at you just to see.

And now I'm one of them.

My dear friends keep telling me if I need anything, just to talk, to call at all hours of the night. Some of them I've taken up on that. But I've become every parent's worst nightmare, and I can hear the pain and fear in their voices even as they try to comfort me. This road is so painful to walk that it hurts people to even think about someone else walking it.

Thursday, October 25, 2007


I find it easy to be bitter about what my son Henry and my family is going through.

Time to count my blessings.

1. He's too young to be scared about the future, but old enough to be verbal enough to tell us what's going on.

2. His older sisters. They keep our spirits up with their bouncing and laughing and general full-of-life-ness.

3. We live close enough to a major academic hospital that Henry is going to get top notch care.

4. We have had an outpouring of support from friends, family, coworkers, etc. It's been truly humbling.

5. My employer has been supportive, gracious, and flexible with me. What a luxury.

I'll add to the list as I remember more. My blessings have indeed been on my mind.

Sunday, October 21, 2007

Life is Fragile

My lesson for the week: Life is fragile.

My three year old son was diagnosed with an aggressive brain tumor on October 13th.

My family is coping as well as we can. The future is uncertain, and scary.

This blog was never intended to catalog my personal life. That said, if I can find a way to make it therapeutic for me, I may write about this journey that we are going to make.

I wanted my friends and acquaintances in the blogosphere to know where I am.

Life is fragile.

Love is not.

Friday, October 12, 2007

And the nobel goes to...

I'd say he wins biggest image comeback of the decade to boot.

Thursday, October 11, 2007

Vix vaporub, anyone?

Many large pharmaceutical companies voluntarily pulled infant cough and cold medicines from the market today. This is on the tale of increasing evidence, and increasing noise from several medical organizations, that the use of these medications in infants is ineffective at best, lethal at worst.

I have long been telling my patients of infants not to use these until after the age of 2. A good portion of patients did anyway. And since the dosing on all of these infant medicines says "Ask a doctor" I can tell you that most parents just make it up. I have been asked maybe twice yearly how to dose these meds, so the rest are getting Mom The Pharmacist to dose.

My fear: parents will now want the elusive antibiotic even more, just so they are doing something. It is hard to watch your kid suffering.

The solution: Vix vaporub! Kid gets a massage, mom feels like she's helping, might even open up the nose a little bit. No, don't eat it (tho some of my patients swear by that - eeych!). Of course, I recommend the nasal saline/bulb suction thing too, but really, if you've actually had kids, sometimes that one is better in theory than in practice.

Don't forget, moms and dads, everyone gets colds, and they will eventually go away. By loving and caring for your child, you are doing plenty!

Monday, October 8, 2007

More later

Apologies to my readers.

Chez Smak is currently infested with a particularly virulent gastroenteritis.

More later, once things have....errrrr, slowed down around here.