I hope everyone had a wonderful mothers day and I hear it is raining a lot at home. Hard on the baseball teams and the track teams to enjoy this time of year. I always think this time of year is the best in Nebraska. It generally isn't hot and there is some pretty nice days with temperatures in the 70's and such. The thunderboomers can be a little scary and by the news that I can watch Oklahoma and Kansas has been hit pretty hard. We have been lucky b/c we haven't had a storm like those ever really hit our town. Please stay safe and watch the weather channel every 10 on the hour so that you know what is happening. Looking for a little kickback there.

Its been interesting here the last few days. You may think I had my appendix taken out but I did not. A little background. When you become an orthopaedic surgeon. Spelled the orthopaedic with a goofy ae in the middle instead of orthopedic. I really don't care but it bugs the crap out of Dr. Chingren when you spell it with just an e in the middle. When you go through medical school you obviously do everything. You become a doctor. You learn about every basic speciality. You spend to with internal medicine, family practice, Ob/Gyn, pediatrics, and general surgery. You learn to take care of every problem in your four years. After medical school you chose your residency and spend 5 years doing orthopaedic work. Well the first year of the 5 is spent a lot of time doing general surgery rotations. Transplant surgery, cardiothoracic surgery, plastic, and basic general surgery. You don't do huge technical things but you learn how to operate. You become comfortable in that setting and you hold retractors for the guys doing the surgery. You see a lot of things. I had the pleasure of spending about 4-5 months of my first year doing transplant and cardiothoracic surgery. Pretty cool stuff but also very taxing. People are really sick and that makes it challenging. I don't like to see people die. I always wanted to be an orthopaedic surgeon. Not like when I was 12 but about 19 years of age. Even before college at Hastings College started I went to Colorado and took a 1 week course in how to be an athletic trainer. So right away at Hastings College I was taking care of people. I have always enjoyed that part of my life and wanted to do that. At some point in time you realize though there is some aspects of medicine that you cannot handle. I don't people dying. To be a heart or transplant surgeon you are surrounded with that all the time. I think that after you do that job and even my job you desensitize yourself to those things. You become hardened by that stuff and I think that is why you see doctors lose their caring ability. I think all of us start out the same in our theory of why we wanted to become a doctor. It is to help another human. I love my job because my hope is I can return people to the life they know before they got injured. As my career has gone on I realize that some injuries don't allow you to do that even though you feel like you have done everything possible. My point though is I could never be those other kind of surgeons b/c it would tear me apart. I did like the basic general surgery stuff especially with the laproscopic stuff. Laproscopic basically means putting a camera in your belly and blowing it up so you can work. Taking out gallbladders and appendix are the most common. Arthroscopic means to put the camera in a joint to do work. Well Maj Bro decided to take out an appendix and I got to help.

The first picture shows the Maj and myself with the 2 scrub technician doing the operation.



That gives you an overview of what it usually looks like when we operate on your abdomen. All those people who watch tv understand this picture and have a pretty good feel of what it looks like. The shows ER and Gray's Anatomy is so realistic that it is unbelievable. I am being sarcastic.

Lets walk you through the process that it takes to get to the case. Everybody gets you reading in the holding area. Tells you what you need to hear and makes sure everybody understands. You then come back to the surgery suite. Sometimes you remember and sometimes not. Depends if the CRNA gives you some medicine to help with that or not. As that is happening we the doctors are getting ready. We put the appropriate covering devices and wash our hands and then put on our gowns. The picture you see here demonstrates that it is just hot here and its time to wear the shorts and t-shirt to the OR.



I think it looks funny but it is much more comfortable like that then the other picture I took with the army scrubs on the other day. There are a few interesting things about this picture. The first is the boots. Most people who see me in the hospital on days in which I am operating are used to seeing me in the boots. Not the boots with the shorts. That would cause two effects. #1 you would blinded by the pasty white skin of my legs. #2 you would be either horrified by the skinny ugly legs or hungry for chicken. Chicken legs, get it. I always wear boots. The surgeon was giving me some grief b/c he is good at that and b/c I was wearing boots for this surgery. I told him I always wear boots. But why? This is why. The first reason is that I don't want to get anything on my shoes that I may wear home, office, or wherever outside of this area. Its gross and they are usually the good pair of shoes that are keeping these chicken legs working. The second reason I learned a long time ago. No matter how big or small the case looks or may be. That there is some nurse out there with betadine ointment, cleaning liquids, irrigation for the surgery that have a tendency to spill it on your feet. In residency is where I learned that. Just when I thought I could not wear the boots, b/c they get hot, a nurse would spill something on your shoes. So the boots go on and stay on almost all the time. The people at home working in the operating rooms with me are saying something different. When you do orthopaedics there is water everywhere. If we are not washing something out after we operate on it we are using water to insuflate your joint to do the arthroscopic evaluation. You should hear the complaining about the water on the floor. A constant drone of mumbling obscenities at me b/c of the mess I am making. I have learned to be above that and continue to do my work. Wow, that sentence will create some more obscenities.

The steps are we get dressed for the play (surgery) and the preparation for the surgery in the or begins. The picture shows Maj Gas Passer getting his medicine together to put the guy to sleep.



Dean is good at passing gas. The work of the CRNA is a combination of medications by IV and then using the ventilator to pass a certain kind of gas to make you sleep during the surgery.

We then prepare the patient. This is Maj Anderson (AND 1) holding on to the intubation tube helping Dean with putting the patient to sleep.



We prep the patients belly with an cleansing and sterilizing liquid mixture and begin the case as seen in the first picture. We are doing this appendectomy open b/c we do not have the capabilities to use the camera and do this laproscopic. This is about as complex a non-emergency case as we are going to do. The patient is sick b/c of the infection in his appendix and needs to be done. It is though not a huge emergency. Hernia repairs and things like that we will not do here b/c the environment is not clean enough. In hospital settings we have special air handling units that keep the air very clean. Here we have air conditioning units in the sides of these metal boxes. Trauma and acute things only here.

The next picture is me operating with the general surgeon



I hope my kids see this b/c I don't know if they realize really what I do. You just come and go and sometimes it just a title or description. They tested my skills with this case. Some orthopaedic surgeons don't know how to tie sutures with their hands. They may sound funny or even scary but it isn't. Orthopaedic surgeons tend to tie with their instruments and after a while you lose some of those special little skills you do with your hands. Most general surgeons tie just with their hand or both. The cases they are doing sometimes needs that special touch that suturing with their hands needs to happen. The general surgeon wanted to see if I could do it and I showed him that I could. I have always done some repairs, especially of rotator cuffs and other things, with my hands and not just instruments.

The other excitement that we had over the past few days is a soldier got really sick. Go figure. This was a medical emergency and not a surgical one. As we know we have a set of general practioners here that is there purpose to stabilize. We do not have an intensive care unit. We barely have a unit to recover patients. Its a tent remember. The FST group though is the emergency room group that helps with the medical emergencies also. Led by Cpt America we stablized a severely hypertensive (high blood pressure) person and brought in the helicopter to transport him to the big hospital in Kuwait to manage him. This is the picture of the medivac helicopter.



I know the picture is a little far away but there is a strategic barrier that they don't want you to go past. There is so much dust and small debris that you could hurt your eyes without special eye gear. That helicopter is a navy medivac helicopter. Even though there is no water around different branches of the service provide coverage in specific areas that they are good at. Capt. America and the navy guys took the patient to Kuwait for treatment.

This is as exciting as it gets. Still have a clinic everyday and we will show you that in the weeks to come. Have a great day.

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