Thursday, January 20, 2005

Surgical Deep Thoughts, part 1

The femoral head is the round bit at the top of your thigh bone, your femur. It's the ball in the ball-and-socket joint of your hip.

In a total hip arthroplasty (a hip replacement, in other words), a titanium rod gets inserted a little ways down the center of the femur*. That part is meticulously measured and the rod is planted solidly. After the rod fits and the artificial socket up on the cup-shaped hip bone fits (that's the acetabulum, by the way), then the last bit in is secured to the top of the rod; this is the artificial dealio, made of titanium or ceramic or some other space-age material, that will become the de facto femoral head.

The femoral head is (on most adult people) slightly larger than a golf ball, smaller than a cue ball. Sitting there in a little metal tray, it can look awfully bewildered. Even, dare I say it, a little sad. A minute ago, it was an important body part, and now it's been replaced by some fancy-schmancy bionic thing. It's suddenly become medical waste. Hard to preserve your dignity in that situation, but the femoral head is nothing if not practical. It does retain some of its natural poise and beauty, despite being totally irrelevant at this point in the operation.

I thought it was sort of like the way a pitcher looks, when the manager walks out to the mound in the bottom of the fifth, with only one out and two of their guys on base, and says "nice work today, kid, but we need more juice out here right now. Hit the showers, willya?"

Except with more awe and respect. Not enough awe to make my brain seize up, though. Too much musing on the thin gossamer thread of every human's mortality, or the sacred yet profane work of we the blessed healers, can get in the way of people doing their jobs. And people doing their jobs is worthy of respect and awe, right there.

So, uh... yeah. I've had the chance to do some shadowing. Surgery is very, very cool. It's interesting to be aware of myself as someone barely scratching the surface. I know the names of most of the parts, and I understand much of what's going on. Yet outsider-style ideas and observations still bubble up. I'm hoping that I can hang on to some of that, along with all the actual knowledge and skill I'll be needing, when I'm standing in one of those other spots.

Total hip info (complete with gory photos) can be found here:

* Some marrow gets sucked out to make this work properly, and for some reason that part wigs me out more than all the rest of it -- including the part where the surgical team gets to be standing there in the first place, looking down into an open wound at the bones of a live person, like a bunch of guys eyeballing the half-disassembled transmission from a 1993 Ford Escort. And also, shaping the bones so they'll fit snugly with the implant. Shaping them with a saw. And a hammer and chisel. Ortho is cool as hell, and that's partly for the way it is not at all glamorous. It's clearly science and art, and one of the specialties that can make a person perspire from the physical effort of practicing it. As an Emergency kid, this is something I can respect.

Saturday, January 08, 2005

Welcome to the Backwater

I recently commented at SpaceWaitress' place about blogs, and how they provide a skewed prism of a person (a persona, really). There's a discussion there about people "in real life" who get ahold of one's writing, or stumble across it subsequent to the ending of the actual acquaintance, and use it to build a mental bridge that allows them to think they know the writer. Not unlike fans who have "connections" with famous people.

Sometimes readers actually do know the writer, so friends and family who read a blog can participate in one more way in that person's life. This is undeniably cool. We've learned that Spacey's mom is even cooler in her head (and via her keyboard) than she's always seemed at those brief times when we've talked in person. We've seen evidence of why people are such good friends to one another, and it's always heartwarming (or, since it's kind of an intellectual thing, maybe it's "brainwarming") to see an affirmation of people who get one another so well. I had been impressed by Spacey's group of friends, and their loose-knit ability to stay connected and in synch, but now I have another view of that quality, and I have a sort of observer's affection and respect for it.

My contribution to the thread over there was the awareness that as I plod through the process of various applications -- to postbac (done!), med schools (the plan is for the 2007 app cycle) and eventually, residency programs (2011, god willing and the crick don't rise), I'm going to be asked to write and talk about a lot of stuff... which in many ways, I am thinking and writing about now.

Part of being a good tech is anticipating the need, and having the whoosit ready by the time it's asked for. The ambulance is due to arrive in five minutes; we're all gowned up standing around the cart and saying hello as though it's the first time (which it sometimes is). We're looking at each other's name tags. The ultrasound is right behind you, doc, and it's booting up now. The nurse's documentation sheet has the Hollister sticker and my signature on it, and it's in the bin ready for other paperwork to join it. Empty blood tubes are arranged like a multicolored pan-pipe by the phone, and my gloved finger will jab any speed dial you need. We're all set.

So, okay. Is this mental processing here at the humble little pseudo-blog going to be useful later on? Or will it just be one more thing I can be evaluated on later? And, if it makes me look like a clueless tool with delusions of competence, wouldn't that evaluation actually be more like what in the liberal arts we like to call "judging?" Ay, there's the rub.

But you know what? This is public, but it's primarily for me right now. Convenient, that, since almost no one else comes here. Still, that may change with time. The work so far is not on my own C: drive because I do want some elements of a conversation. I don't want to talk only to myself. And in the long run, even though it might bring some of the complications that Spacey notes now, giving over the ability for people to jump in to this place from various points in the future or past, I think it's worth it. There could be value in helping other non-traditional students get on the road. It might be amusing or interesting. There could be some worthy insight. And best of all, there's the chance that it might help establish a pattern that corroborates something positive a decisionmaker thinks they see in me at some point.

And really, everybody else has a blog. Maybe in the 2007 application cycle, it will be weird not to have one. And you gotta believe that a person's true colors show over time. Whether this is a footnote or the Lake Itasca of one segment of my eventual doctorhood, welcome to it. It might provide clues about letters to the editor I'll write in 2024, or things I'll argue about at national conferences, or how I'd give feedback as chief resident.

At the very least, yeah, it proves I am actually like this, and not just at interviews.