Man-babies, good and bad

The bathroom looked like a troop of foul-tempered chimpanzees had been in there.

Dr. David Metro (right) and a couple of our anesthesiology residents. The man-baby is NOT pictured. Picture source: Surgicorps.org.

Once a year I go to Guatemala with a bunch of physicians, nurses, therapists, and technicians who use a week of their precious vacation time to provide free surgical care to people who are so poor that even the almost-free national health system is too expensive.  One year I woke up on my first morning in-country, having let my roommate have first dibs at the shower–he was an anesthesiologist, and among their other duties, the anesthesiologists show up in the operating suite half an hour before everyone else to check their equipment.  He left, I headed into the bathroom, and stopped at the door, shocked beyond words.  Minus shit thrown on the walls, the bathroom looked like a troop of foul-tempered chimpanzees had been in there–I knew 5 minutes after meeting the guy that he was somewhere on the uncomfortable-to-be-around end of the Asperger’s spectrum, but didn’t realize until I let him shower first that apparently he’d also spent his entire life thus far with his mother walking behind him, picking up every blessed thing that he dropped on the floor.  Towels, a small pond where he’d apparently gotten out of the shower before towelling off, and–horror of horrors–his dirty underwear.  

I spent about 30 seconds deciding whether I should spend the rest of the week getting in the shower before this pig or spend the rest of the week cleaning up the bathroom before the maid showed up–it’s a shame to leave a nasty room for a maid.  The decision was easy to reach–get in the shower before him, and leave an extra-good tip for the maid.  Making it through the week without ripping the guy’s head off was easy, as I was positive about one thing: I would never see this spoiled man-baby again.  


The reason that I knew that I would never see him again: he was a resident.  In the context of health care, a resident is a physician who has finished medical school and is getting additional training in a specialty.  Every year, our group’s chief anesthesiologist, Dr. David Metro, brings two anesthesiology residents to Guatemala with him.  He typically brings one male and one female, and the male anesthesia resident is usually my roommate.  They’re usually lovely people,  happy to spend evenings explaining malignant hyperthermia to me or trying to describe how to intubate a kid for a cleft palate repair.  (I am incapable of thinking in three dimensions, and after 5 years in Guatemala, I still can’t quite wrap my head around how you ventilate a kid who’s having a cleft repair done.  To wrap one’s head around something explained in the English notes below.)

I’ve written elsewhere about what anesthesiologists contribute to a surgical procedure. (Click here for details, but be forewarned that it’s gory.)  Briefly, before the invention of anesthesia, operations could only be done very quickly, which meant that anything much more involved than an amputation wasn’t very practical.  The fact that today anesthesiologists can let someone be painless for hours–and then wake them up afterwards–means that we can now do long, complicated surgeries.  That means that you can reconstruct a kid’s hand, or repair a baby’s cleft lip, or fix a woman’s disabling uterine prolapse—all of which our group does routinely in Guatemala, and none of which is possible without anesthesia.

On any given day, about half of our operating rooms are staffed by the anesthesiology residents that Dr. Metro brings from the United States.  It is both an important educational experience for the residents, and a crucial contribution to the care that we give in Guatemala.  As Dr. Metro put it, “The residents maintain the same standards of patient safety that they provide in the United States; here they learn to do it with far fewer technological resources, and they bring those skills back to Pittsburgh with them.”


The man-baby anesthesia resident never came back to Guatemala, of course.  My roommates in subsequent years have included a delightfully Christian guy who had been on other missions elsewhere–and who spoke quite competent Spanish, which he learnt while working his way through college as a bartender; a very bald, very muscled young man who convinced me that I, too, could go full Yul Brynner with just a hand-held razor and a careful hand; the guy who enthusiastically followed me on my peripatetics to pick up my laundry on the crappy side of town, and then surprised me by ordering the very expensive room service every night, which admittedly did make more sense when I overheard his long phone calls about his investments.  Currently the only man-baby in my life is the President of the United States of America, but I don’t have to use Trump’s bathroom, so as long as he doesn’t get us into a nuclear war because someone hurt his feelings (remember how he always said that Hillary wasn’t “tough enough”?), take away 20 million poor people’s health insurance to give yet another tax break to the wealthy, or sell us off to Russia because He Just Wants To Be Loved, it’s all good.  (See here for a military person’s perspective on the Draft-Dodger In Chief…)

…and you know what else?  That man-baby anesthesiology resident might have been a messy, entitled, arrogant slob, but he was a messy, entitled, arrogant slob who spent a week of his life making it possible for kids to get their hands reconstructed, and for babies to get their clefts repaired, and for women to get their disabling uterine prolapse fixed.  That’s more than man-baby Donald Trump ever did–with all of his billions…

Enjoying these posts from Guatemala?  Why not make a small donation to Surgicorps International, the group with which I come here?  You wouldn’t believe how much aspirin we can hand out for the cost of a large meal at McDonalds–click here to donate.  Us volunteers pay our own way–all of your donations go to covering the cost of surgical supplies, housing for patients’ families while their loved one is in the hospital, medications, and the like.


English notes

to wrap one’s head around something: to understand something; to absorb an idea or a concept.  It’s usually used in a situation in which understanding something was or is difficult for you.  Some examples:

  • The wife of the Alexandria, Virginia, gunman says she’s shocked about the attack and had no idea what her husband was planning.  “I just don’t know what to tell you people. I had no idea this was going to happen and I don’t know what to say about it. I can’t wrap my head around it, OK?” Sue Hodgkinson said.  (CBS News)
  • I can’t wrap my head around my mother’s concept of a ‘Good Girl.’  Can you?  (Avantika Says)
  • My five-year-old (once she wrapped her head around the fact that this particular gummy bear isn’t candy) begged to go to bed at four in the afternoon because she was so eager to use the Gummylamp as a nightlight.  (Wired.com)
  • Hamill said that even hours before the ceremony, he hadn’t wrapped his head around receiving the honor (Daily Herald)

    quote-it-s-a-hard-concept-for-me-to-wrap-my-head-around-to-completely-sacrifice-any-sort-of-leonardo-dicaprio-124-56-77
    Source: azquotes.com
    trying-to-wrap-my-head-around-how-someone-managed-to-22895477
    Source: https://pics.onsizzle.com
    quote-i-write-poetry-to-figure-things-out-any-time-i-m-trying-to-wrap-my-head-around-something-sarah-kay-116-26-24
    Source: azquotes.com
    quote-i-could-never-wrap-my-head-around-why-the-world-and-the-president-that-republicans-describe-jon-stewart-102-10-25
    Source: azquotes.com
    04ea409f513771549105a29a3ccbce1e4d88b1-wm
    Source: https://cdn-webimages.wimages.net

A guide to the nymphs of France

img_2682Just in case we need it today, here’s a practical guide to keeping your nymphs straight, from the immortal Pièges et difficultés de la langue française, by Jean Girodet. This book is so indispensable that I have two copies–one for at home in France, and one for when I’m in the US. Mind you, I couldn’t find an entry in it on the subject of whether or not you use the subjunctive after the word possibilité–but, at least I have some confidence that if I need to talk about a nymph today, I’ll use the correct noun…

Go ahead, end this sentence without a preposition–if you can…

Of all of my students, this is the one on whom my work habits rubbed off. 

Déteindre sur: to rub off on. Ton pull à déteint sur ma chemise–il ne fallait pas les mettre ensemble au lavage.   (Collins French-English Dictionary)  Why ensemble and not ensembles, I have no clue…

Observed agreement, expected agreement, and chins

Imaginez qu’au lieu de bien zyeuter les crânes…

Screenshot 2017-08-29 06.26.00
Source: Yadav et al. (2017), Semantic relations in compound nouns: Perspectives from inter-annotator agreement

Question : Coucou, C’est quoi Cohen’s kappa ?

Réponse : Ce n’est pas moi, ce Cohen.  🙂  Cohen’s kappa est une façon de calculer l’accord entre deux personnes.  Par exemple : Diap. 11, les deux personnes sont d’accord l’une avec l’autre 4/5, donc 80% des fois.  Cohen’s kappa essaie de prendre en compte la possibilité d’être d’accord juste par hasard.  On peut dire que la probabilité d’être d’accord juste par hasard, c’est 50% en ce cas.  Imaginez qu’au lieu de bien zyeuter les crânes, chacun fait pile/face.  On a donc ces possibilités :

  • Kevin oui, Mayla oui : 0.25
  • Kevin oui, Mayla non : 0.25
  • Kevin non, Mayla oui : 0.25
  • Kevin non, Mayla non : 0.25
Voilà les deux cas où ils sont d’accord :
  • Kevin oui, Mayla oui : 0.25
  • Kevin non, Mayla non : 0.25
0.25 + 0.25, cela fait 0.50.  Donc, ils peuvent être d’accord 0.50 (50%) des fois… par hasard–rappelez-vous qu’ils ont fait pile/face.
Le calcul du kappa de Cohen, cela se fait comme ça :
  • Accord experimenté – Accord prévu par hasard = 0.80 – 0.50 = 0.3
…divisé par accord prévu par hasard, donc
  • 0.3 / 0.5 = 0.6
…donc on prévoit que le kappa de Cohen, c’est toujours moins que l’accord “cru.”  Vu que l’on ne veut pas surestimer la performance, on utilise le kappa de Cohen pour éviter cela.

Question :  C’est un genre de coefficient correcteur de réalité j’ai l’impression pour ne pas s’emballer sur des résultats in vivo qui parfois peuvent être faussés par le caractère très humains des annotateurs.  Enfin je crois comprendre ça 🙂

Réponse : Tu l’as dit mieux que moi !  🙂
Why would anyone want to label skull specimens as to whether or not they have chins?  See this post, and be sure to read MELewis‘s comment.

 


French notes

l’accord inter-annotateur : inter-annotator agreement.  See a nice set of slides on the topic, in French, here.
zyeuter : to scrutinize.  It seems like a soutenu word, but given the book where I ran across it, I would expect it to be familier.  (Comment from native speaker Phil dAnge: zyeuter is definitively not “soutenu”but completely “familier, limite argot ”)

Acquisition of edible invertebrates

As far as I know, no videos of Morning Dance Party exist.

thelenota_ananas
Thelenota ananas, a species of sea cucumber. Credit: By Leonard Low from Australia – Flickr, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=1552175
I mostly relate to places through two things: food, and language.  (Presumably it would be better to be relating to people, rather than to places, but in the absence of a shared language, relating to people is difficult.)  Both of those–food, and language–get you pretty quickly into odd and difficult-to-resolve questions of what one might call “authenticity:” people never want to teach you slang, but it’s the thing that interests the typical linguist-on-the-road the most; we’re all always looking for that “real” svíčková na smetaně in Prague, but looking for “real” anything these days gets you into either fun conversations about cultural appropriation or fun conversations about post-modernity, both of which are fairly instant buzz-killers for anyone other than, say, me and the two other people in the universe who enjoy talking about cultural appropriation from the perspective of post-modernism without having slept very much the night before.  (Obviously, I’m not a very fun date–this may be related to my shitty divorce record.)

I think I cracked the “authenticity” nut on a recent evening in Hangzhou, though, where I had the funnest experience I’ve ever had in China that didn’t involve me, my niece and nephew, and Morning Dance Party.  (As far as I know, no videos of Morning Dance Party exist, and we should all be thankful for that.)  A colleague took me out for dinner to a buffet at a place that he described as typical and reasonably priced–the kind of place that any family could afford to go to.  Indeed, it was packed with families–imagine a very loud room filled with long tables, those long tables filled with big families talking, laughing, and passing an ever-growing assortment of plates back and forth while various and sundry foods hiss over a grill built into the table.

The way that the restaurant works: you wander around and pick things from an enormous selection, then take them back to your table, where you grill them.  When I say “enormous,” bear in mind that I’m talking about China here–“enormous” in China is really big.  Then think about this: I only recognized perhaps 10% of the available foods.  Some fruits; some vegetables; duck gizzards, certainly, and I guessed the avian liver correctly, too.  But, for the most part, I hadn’t the faintest clue what I was looking at.


Zipf’s Law describes an important characteristic of language: about 50% of the words in any large sample of words almost never occur–but, they do occur.  The word that came up in the Chinese restaurant: trepang.  As a verb, Wikipedia defines it like this:

Trepanging is the act of collection or harvesting of sea cucumbers…

“Not to be confused with trepanning,” it adds.  Indeed, indeed.

Zipf’s Law takes you into some pretty out-of-the-way corners of the lexicon.  As Wikipedia points out, to trepang is a member of a larger group of English verbs.  A trepang is a sea cucumber–a marine invertebrate animal related to starfish and crinoids.  To trepang is to harvest sea cucumbers, and in having that relation between the noun and the verb meaning to harvest things that are labelled by that noun, it resembles a number of more-familiar verbs.  From Wikipedia again:

Trepanging is comparable to clammingcrabbinglobsteringmusselingshrimping and other forms of “fishing” whose goal is acquisition of edible invertebrates rather than finfish.

Other than the pure joy of having a verb that means “to collect or harvest sea cucumbers,” what’s interesting about this?  In science, “interesting” usually means “different from what you would expect based on what you already know.”  The interesting thing here, then, is that there are other verbs that come from a noun that refers to an animal–but, they don’t mean “acquisition of.”  Consider, for example, the verb to flea.  Don’t look for it in Merriam-Webster—it’s not there.  What it means is to remove fleas from.  It’s a transitive verb–here’s an example from a forum on pets:

https://www.petforums.co.uk/threads/can-i-flea-my-cat-a-week-after-shes-had-kittens.431344/
Source: http://www.petforums.co.uk
The poster has a cat, the cat has fleas, and the poster would like to cause the cat to no longer have fleas, but is concerned about the fact that the cat has recently had kittens.  Thus: Can I flea my cat a week after she’s had kittens?

To foal is another verb that comes from a noun that refers to an animal.  A foal is a young horse, and to foal is to give birth to a foal.  It can be transitive or intransitive:

  • I would say she will foal in less than a week. (Intransitive.  Source: enTenTen corpus, from Sketch Engine.)
  • Animal science students have been involved with the entire process of preparing the horses to foal and bringing them to campus.  (Intransitive.  Source: enTenTen corpus, from Sketch Engine.)
  • Ada had just been up four hours helping to foal a horse and wasn’t prepared for the intrusion of the outside world.  (Transitive.  Source: enTenTen corpus, from Sketch Engine.)

To lamb is a similar verb–Merriam-Webster gives the example The ewes will lamb soon.

Getting into conversations like this over dinner is probably why I get divorced a lot, so I’ll point you to this YouTube video, One way to flea a cat, and get on with my day–I need to run a bunch of experiments on how to split up words in sentences in biomedical journal articles…

On being stared at

At some point in their life, everyone should spend some time in a place where they’ll be stared at

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Picture source: me.

It’s 1981, and my ship has pulled into Istanbul for a week.  Being a stupid young sailor, I’m wandering around alone.  I pass some old men sitting on a stoop drinking tea (a common pastime for old men in Turkey).  One of the old men gets up, walks over to me, spits on a finger, and tries to rub one of my many tattoos off.  When he can’t, he shakes his head in disgust and sits down again.


It’s 1981, and my ship has pulled into Istanbul for a week.  Being a stupid young sailor, I’m wandering around alone.  Going down a busy street, I suddenly find myself surrounded by a crowd of young men.  One of the guys emerges from the crowd, and in broken English starts translating for the rest of the crowd, telling me everything that they have to say about how much they love my tattoos.


It’s 2016.  I’m waiting in line at an art show in China.  A guy walks up to me: excuse me, I can take picture of you with my children?  Sure, why not?  Smiles all around as pictures are snapped, and we all go back to waiting in line.


My job and my pastimes take me far and wide, and in some of the places that they take me, I look unlike anyone else.  Japan, Guatemala, China, Mexico, Turkey–in all of them, I am a “white guy,” a light-skinned, blue-eyed guy in a country where everyone else is brown-skinned, with black hair and brown eyes.  In some of those countries, I go places where I may be the only “white guy” that I see all day, and in those countries, I get stared at–a lot.  It’s not just me–it’s the experience of any Westerner in those places.

What I’ve learnt in those countries: how good it can feel to be smiled at.  This morning I took a walk along the riverfront in Hangzhou, China.  Men (and a couple women) did tai chi alone.  Women (and a couple men) did synchronized dancing to music.  Grandmothers pushed strollers, and grandfathers jogged–often in business casual–occasionally omitting a loud yell or two.  (I have no clue what the purpose of the yells is–native speakers, do you have any insight into this?)  For 45 minutes, I was the only “white guy” that I saw.

It was unusual for people not to stare at me.  Sometimes out of the corner of their eyes, and sometimes quite openly, but almost everyone stared.  Some of them, though–some of them smiled at me, too.  你好, they might say.  你好, I would answer.  I waved at little kids, and their grandmothers smiled–and made them wave back at me if they were too shy to do it on their own.  Not big-deal interactions–but, it always felt so good.  What it cost them: nothing.  What it gave me: a lot, actually.


I maintain that at some point in their life, everyone should spend some time in a place where they’ll be stared at.  It’ll teach you the value of a smile for someone who doesn’t seem to fit.  Lots of people get stared at in today’s America–Muslim women in hijab.  Black men in nice hotels/white neighborhoods/academic conferences.  Any woman at all in a computer science department.  A smile at someone else costs nothing–and can give a lot.


English notes

on being stared at: I include this one in the English notes because of the commonly-taught, commonly-believed old bullshit that there’s something wrong with ending a sentence with a preposition.  Is on being stared at English?  Absolutely.  Is there any other way to say it?  Not that I know of.

their life: This is a good example of the use of a third-person plural pronoun to refer to a singular person.  Since there is no reason to assume any particular gender here, some dialects of English use their gender-neutral pronoun, which looks like the plural pronoun, but in this context is not.  You can read more about this phenomenon here.

stoop-project-philly-1200x800-2
Picture source: http://media.philly.com

stoop: Besides being a verb with a number of different meanings, stoop can also be a noun.  Merriam-Webster defines it as  a porch, platform, entrance stairway, or small veranda at a house door.  How I used it in the post: I pass some old men sitting on a stoop drinking tea (a common pastime for old men in Turkey). 

Rackling against the breast bone

When I was a kid, I liked to do drugs as much as the next trailer trash, but I never, never understood how someone could stick a needle in their arm–until I had my wisdom teeth out. (Trailer trash explained in the English notes below.) The oral surgeon pushed the plunger on the syringe, I watched the medication travel down the IV line, and before I slipped off into unconsciousness, I heard the sound of the wind blowing in my ears and thought Ohhhhhhhh–THIS is why they do it.


I was lucky–before anesthesia was invented in the mid-19th century, that would’ve been a horrible procedure. Here’s a woman’s description of her mastectomy in 1811. Her name is Fanny Burney, and her record of the operation has survived until today because she was both a popular novelist and a part of the court of George III. This extract from a letter to her big sister Esther is quite unusual, in that it is a rare record of pre-anesthesia surgery from the patient’s point of view, rather than from the surgeon’s point of view, which is much better documented. Just in case you don’t feel up to reading the whole dreadful thing, I’ve shortened it, and then I’ve bolded the most horrific sentence—the sentence that people cite the most.  You’ll find the whole thing at the bottom of the post, after the English notes.

…when the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves… I began a scream that lasted unintermittingly during the whole time of the incision—and I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, and the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards, that were tearing the edges of the wound—but when again I felt the instrument—describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired… The instrument this second time withdrawn, I concluded the operation over—Oh no! —Dr Larry rested but his own hand, and—Oh Heaven!—I then felt the Knife rackling against the breast bone—scraping it!—This performed, while I yet remained in utterly speechless torture…

Once a year I spend a week in Guatemala with a group of physicians, nurses, operating room techs, and therapists who do free surgeries for people for whom the almost-free national health care system is still too expensive.  When people think about groups like ours, they mostly think about the surgeons, and the stories that people want to hear are mostly about the surgeries that those surgeons do—the children who will be able to get married some day because a plastic surgeon repaired their cleft lip; the child who will be able to learn to write because the hand surgeon gave him functioning fingers; the woman who will be able to go to the market and sell corn again—thereby getting cash to pay for her kids’ school supplies—because the gynecological surgeons repaired her prolapsed uterus and urinary incontinence. There’s someone who usually gets left out of these stories, though–the anesthesiologists and nurse anesthetists who made it possible for those surgeries to happen.


Reasonable people could debate about what the most important inventions in the history of humankind have been. The wheel makes most lists; penicillin gets on a lot of them; stupid ones have “The Internet.” Here’s my hypothesis, in no particular order:

  1. The toothbrush
  2. Vaccines
  3. Corrective lenses
  4. Anesthesia

After that, the importance levels drop off pretty quickly–vaccines have killed some diseases forever (and may kill more if bad hombres with political motivations don’t prevent it–Boko Haram, Trump administration Cabinet member Ben Carson, and occasional presidential candidate Jill Stein come to mind here). Penicillin, on the other hand, is a once-great idea whose time will soon be past, leaving us with no good answers for XDR (extensively drug-resistant) tuberculosis or for people like my former Navy shipmate whose penchant for returning from port visits with gonococcal pharyngitis was legendary throughout the 6th Fleet. Few things will ever be as near and dear to our hearts as our toothbrushes, but the Internet will die as soon as the zombie apocalypse starts, leaving us poorer in idiotic Twitter feeds (see death of Internet) but immeasurably richer in our appreciation for the value of our ties to our fellow humans (see zombie apocalypse).

Anesthesia, though: let’s think about some things that would not have ever happened without anesthesia. Bear in mind that before anesthesia as we know it today was invented in the 1840s or so, surgery was something to be avoided at all costs and, in the case of non-emergencies like cancer, until the last possible minute; if unavoidable, it was to be done as quickly as possible. (The main criterion for the quality of an amputation, other than the patient surviving it, was how quickly it was done; as far as I know, amputation was the main surgical intervention of the American Civil War.) With anesthesia, though–with anesthesia, surgeons could be careful. They could do things that took time; they could do things that were complicated. As Dr. David Metro, our chief anesthesiologist, put it to me: “anesthesia is what has made every surgical advance since the mid-19th century possible. Organ transplantation–it saved over 33,000 lives last year–cochlear implants, cataract surgery, hip replacements, coronary artery bypass surgery–all of that is only possible because we can put patients to sleep, keep them there painlessly for as long as necessary, and then wake them up again afterwards.”


That’s what anesthesia has done for us–but, on some level, anesthesia is just a bunch of chemicals. You could give them to yourself, like folks once used ether for fun. (See John Irving’s novel The cider house rules for where playing with ether can lead–it’s nowhere good.)  But, anesthesiologists–they’re another thing altogether. I’m not talking here about their technical skills–about the nurse anesthetist who worked the night shift in a hospital where I worked in the late 1980s, and who saved the life of pretty much every single patient whose life got saved in our emergency room, or about the anesthesiology resident who picked up on a case of tuberculosis a couple years ago here in Guatemala. I’m talking about a display of honesty and intellectual rigor that has had effects not just in the surgical world, but in the engineering world in general and in flight safety in particular.

In the 1970s, four anesthesiologists at Massachusetts General Hospital undertook a study of errors by members of their profession. 47 of their colleagues discussed with them–on tape–the errors that they had made in their careers. They talked about 359 incidents in total, of which 82% were caused by human error. As one commentator on that paper put it, Anesthesiology is the one domain in which patient safety was identified as a problem long before the Institute of Medicine’s 1999 wake up call to the healthcare community. Not only was the problem identified in the late 1970s, but anesthesiologists faced the issues, taking actions to effect changes that would reduce errors, adverse outcomes, and injuries. While it is often difficult to trace the historical path of change, there is reason to believe that the anesthesia critical incident studies planted seeds of ideas for others, either directly or subliminally.

Along with later work on equipment problems in anesthesia that proceeded on the same methodology, this body of research set the standard for a broad field of research in engineering on how to understand problems with systems, and how to use your understanding of those problems to make those systems safer. Table 3 in that paper gives nice insight into how that works. It shows the distribution of frequent types of equipment-related errors; one thing that you notice there is how many of the frequent categories of problems are related to misconnections or disconnections of the various and sundry tubing systems involved. One of the responses to this finding was to make it mandatory to have connectors on medical gas systems that cannot be plugged into the wrong gas supply–today, it is mechanically impossible to plug your oxygen line into a “room air” supply, or your room air supply into a vacuum. Today’s anesthesia machines are one of the best-designed kinds of systems for supporting a human life on this planet, and the anesthesiologist’s approach to thinking about what he or she does is ubiquitous in fields as diverse as flight safety—and surgery. As Atul Gawande put it in his book The checklist manifesto, describing the ways that checklists are used to help a pilot and co-pilot work together to recover from a potentially fatal emergency: as integral to a successful flight as anesthesiologists are to a successful operation.  Step back for a second and think about where these advances came from: anesthesiologists admitting to other people what they did wrong, on the record.  I wish that I had that kind of courage.

Connectors for the hoses for four different kinds of gases.  It’s not physically possible to plug these hoses into the wrong source–a product of those studies by anesthesiologists.

I woke up when my surgery ended, poorer by four molars but with an increased appreciation for what anesthesia and anesthesiologists bring to the world.  When our patients wake up here in Guatemala, it’s usually with their lives changed–Monday’s reconstruction of a hand for a teenager who I’ve seen every one of the five years that I’ve been coming here, as it’s a complicated surgery that has to be done in stages; yesterday’s removal of a mass on the right wrist of a woman whose job involves writing with a pen all day, and who therefore was losing the ability to support herself in a country in which there is no such thing as unemployment insurance, or disability support for people who can’t work; Tuesday’s repair of a cleft lip for a kid who otherwise would have been unlikely to find a spouse, in a country in which your only social support net is your family…

Enjoying these posts from Guatemala?  Why not make a small donation to Surgicorps International, the group with which I come here?  You wouldn’t believe how much aspirin we can hand out for the cost of a large meal at McDonalds–click here to donate.  Us volunteers pay our own way–all of your donations go to covering the cost of surgical supplies, housing for patients’ families while their loved one is in the hospital, medications, and the like.


English notes

Trailer trash: Here’s Wikipedia’s definition of this very American term: Trailer trash (or trailer park trash) is a derogatory North American English term for poor people living in a trailer or a mobile home.[1][2] It is particularly used to denigrate white people living in such circumstances[3] and can be considered to fall within the category of racial slurs.[4] The term has increasingly replaced “white trash” in public and television usage.

How I used it in the post: When I was a kid, I liked to do drugs as much as the next trailer trash, but I never, never understood how someone could stick a needle in their arm–until I had my wisdom teeth out.


The full description of Fanny Burney’s surgery

Here are the two paragraphs of Fanny Burney’s letter to her sister describing her surgery.  There’s more to the letter, which also describes the whole process of the development and diagnosis of her breast cancer–there’s a link to it at the end of the post.

My dearest Esther,—and all my dears to whom she communicates this doleful ditty, will rejoice to hear that this resolution once taken, was firmly adhered to, in defiance of a terror that surpasses all description, and the most torturing pain. Yet—when the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision—and I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, and the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards, that were tearing the edges of the wound—but when again I felt the instrument—describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired.

I attempted no more to open my Eyes,—they felt as if hermetically shut, and so firmly closed, that the Eyelids seemed indented into the Cheeks. The instrument this second time withdrawn, I concluded the operation over—Oh no! presently the terrible cutting was renewed—and worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it adhered—Again all description would be baffled—yet again all was not over,—Dr Larry rested but his own hand, and—Oh Heaven!—I then felt the Knife rackling against the breast bone—scraping it!—This performed, while I yet remained in utterly speechless torture, I heard the Voice of Mr Larry,—(all others guarded a dead silence) in a tone nearly tragic, desire everyone present to pronounce if anything more remained to be done; The general voice was Yes,—but the finger of Mr Dubois—which I literally felt elevated over the wound, though I saw nothing, and though he touched nothing, so indescribably sensitive was the spot—pointed to some further requisition—and again began the scraping!—and, after this, Dr Moreau thought he discerned a peccant attom (fragments of diseased [peccant] breast tissue)—and still, and still, M. Dubois demanded attom after attom.

Web site with Fanny Burney’s letter http://newjacksonianblog.blogspot.com/2010/12/breast-cancer-in-1811-fanny-burneys.html

Blog about pre-anesthesia surgery https://thechirurgeonsapprentice.com/2014/07/16/the-horrors-of-pre-anaesthetic-surgery/

https://en.wikipedia.org/wiki/Frances_Burney