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Non-Medical Musings of a Surgeon I have no special talents. I am only passionately curious. -Albert Einstein Item Title Read More Item Title Read More Item Title Read More

Medical Editorials Why Don't They Believe Us? [Editorial inspired by @kari_jerge] Read More Kelly Snap Mosquito Give me that thing that does the thing… Read More Austere Damage Control Surgery Caring for soldiers in the deployed environment Read More Don't Call me Anesthesia A response to the Tweet about being offended by being referred to as anesthesia Read More Consults How to play nice in the sand box...and why it matters Read More I could never do your job The emotional stress and challenges of ACS Read More Are you sure? The Challenges of Being A Female (Acute Care) Surgeon Read More It's a Small World And You Really Should be Nice to People Read More Comfortably Numb Maintaining our humanity in the clinical environment Read More Goals of Care The person you know her as isn’t there anymore Read More Heartless with a God Complex Stereotype of a Surgeon Read More Code Blue: Who's in Charge? Advanced Practice Nurses to begin coming to Code Blues and supervising residents Read More Peer Support Learning how to live with an ostomy Read More Radiologic Dyslexia 1st day in radiology: your right is your left, your left is your right Read More Accessing the Right Information Confessions of an ICU Physician with a terrible memory Read More Tackling the expertise bias Overcoming barriers while teaching and being humble as a consultant Read More Blood Shortage Life and Death Decisions in a Resource-Constrained Environment Read More Giving Bad News 6 Tips to Be More Comfortable with Uncomfortable Conversations Read More How Do I Do It? Practical Tips on Having a Difficult Discussion Read More Who's my doctor? Resolving Patient Concerns Read More End of Life Issues Brain Death and Organ Donation Read More Speaking Greek What language are we speaking? Read More Giving Bad News, #2 Difficult Discussions Read More

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Patient Education Anorectal Disease Hemorrhoids GERD Gallbladder Disease Appendicitis Before Surgery ICU Anal Fissure Pruritis Ani Stomach Ulcers Pancreatitis Colorectal Disease Wound Care Disclaimer This website is provided for educational and informational purposes only and although every effort has been made to present accurate information, this is not a substitute for professional advice. Always seek guidance from a qualified healthcare provider or physician for inquiries regarding medical conditions, treatments, or before embarking on any new healthcare regimen. Never disregard professional medical advice or delay in seeking it due to information found here. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. No physician-patient relationship is created by use of this website. This website is based on my interpretation of medical literature and best clinical practices. It is my attempt to compile the information I share with my patients. This information does not replace the clinical expertise of a physician. Every effort has been made to ensure the accuracy and validity of the information, yet there remains a possibility of inaccuracies or unintended errors in this information presented here. The practice of medicine relies on using the best available evidence, but clinical scenarios often lack clear-cut answers. Every clinical situation is unique, and no single solution applies universally. Clinical guidelines attempt to provide recommendations that apply in most situations, but that are not one-size-fits-all solutions and they do not replace clinical judgment. The infinite variety of patient, disease, and environmental factors influencing clinical decision-making cannot be fully accounted for in medical literature. Therefore, any variance in the approach of physicians from what is presented here does not necessarily signify an error on their part.

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The emotional stress and challenges of ACS I could never do your job < Back The emotional stress and challenges of ACS René Leriche, “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures.” Acute Care Surgery is not an easy profession. My time as a surgical critical care fellow challenged me in ways I never predicted. The challenges of this field are numerous, although not all are unique to acute care surgery. Historically, trauma surgeons worked long hours (with the associated sleep disruptions), unpredictable workloads managing a mixture of high acuity critically-ill and injured patients, high patient mortality rates, and frequent exposure to horrifically injured patients.(1) Despite my intense desire to pursue this, I didn't truly grasp the depth of the emotional toll I would face. I am incredibly grateful to the mentors who guided me during my fellowship. I have told plenty of family members about the death of their loved one. There is a palpable difference between the interaction with a family of a patient you never knew- someone who came in unresponsive or someone who died shortly after arrival. It’s tragic, without a doubt, and it’s never easy to tell a family about this unexpected loss. But managing patients in the ICU, you have the opportunity to talk to them, to learn about them as real people, to meet their family. There are a few specific patients and family conversations I will never forget. After a busy week during the winter holidays, I was already emotionally drained. Friday morning, I sat in a large room full of family members and had to break the news that their loved one had become significantly sicker overnight. Unfortunately, he continued to deteriorate, and the following day, I had to tell them there was nothing else we could do. From my viewpoint, all human life is valuable. Sometimes it seems incredibly hopeless, which leaves us feeling helpless. It took me a while to gather myself for the second conversation with that same large family. I confided in my attending that I didn't think I could get through the conversation without tears. Thankfully, she gave me the gift of acceptance- she told me that I had established rapport with the family, and it was okay to cry. She also reminded me that I wouldn't have to give a long speech because they would already know that it wasn't good news. I am grateful for the opportunities I had to witness intense conversations between senior trauma surgeons and various critical care physicians and patients and families. I learned lots of critical care and patient management, the principles of managing multiple critically ill patients, and advanced operative techniques of trauma and emergency general surgery. But I am most grateful for the "art of medicine" that I learned from my mentors, which can't be taught in a textbook. Learning how to deliver bad news and help families navigate the difficult decision-making process are vital skills in this profession. This is a challenging specialty. It demands expertise in multiple clinical disciplines, the skill to manage multiple critically ill patients and the ability to balance contradictory needs of competing organ dysfunctions in one patient. Thankfully, with a good team of senior surgeons, you can navigate the nuances while training to practice this honorable profession. 1. The Committee to Develop the Reorganized Specialty of Trauma, Surgical Critical Care, and Emergency Surgery. Acute Care Surgery: Trauma, Critical Care, and Emergency Surgery. J Trauma. 2005;58:614 –616. Previous Next