A BIG TASK FOR SMALL HANDS

Two weeks ago I joined an ad-hoc committee with some other physicians on our medical staff. We are organizing efforts to visit Legislative Day in Albany on March 4, 2008 to express our concerns about the medical malpractice crisis. Click here to survey national efforts, here to join our state and local efforts, and here to read my own (too) personal account. Thanks.

Aura and Mystique

I thought I was over him. Really done. Convinced myself it was a stupid infatuation. This was the news, the real deal breaker. Getting a 24 year old Brazilian girl pregnant...how could he?

In a jealous frenzy the likes of which I only vaguely remember from high school, college, OK medical school, too, I scrambled the internet for a cool 15 minutes, investigating the rumor, looking for reliable news sources, pictures, confirmation. These jealous frenzies are much easier now that there is an internet. In the past, confirming such infidelities required hours of sleuthing, sneaking, not to mention driving. And with each mile under my wheels, each sad song on the radio, my jealous anger would dissipate, undermining the power of a woman scorned.

And now it was happening again, every news clip, every glossy picture makes my heart melt and think how could I every begrudge, bemoan, besmirch or be over him?

Then, I found it, a journal entry, in his own handwriting, on the internet. He confirms it, a baby due in six months. Says he's "stoked and wowed." But just reading the words, seeing his face again, listening to the music he loves, understanding how he's gone on with his life and I with mine...I realize I'll probably never be over him. I can only be happy for him and remember the only advice he's ever really given me, "just keep living."

POETRY AND BASEBALL

"Do you know what it’s like
To be chased by the Ghost of Failure
While staring through Victory’s door?
Of course you do, you’re a Mets fan"

FRANK MESSINA, the self-proclaimed Mets Poet.

Forget alcoholism, depression, and suicide...to be a real poet you have to be a Mets Fan!!! Just ask Frank Messina, self-proclaimed "Mets Poet," who is likening this season's Metropolitan's collapse to the fall of Troy. Just like a poet...alluding to the classics.

THE RIGHT TO REMAIN SILENT

OK, I figured out what to do. I just deleted one of my blogs that contained ALOT of my previously unpublished poetry, because I'm finding that many publishing venues will not accept work if it has been published somewhere before, AND most are including internet publishing , even blogs! I guess it makes sense. Why would they want to print something if it is readily available on the internet for free?

So, until further notice, (most of) MY POETRY WILL NOT BE AVAILABLE ON MY BLOGS. Sorry to disappoint my legion poetry fans, but you'll have to wait until it comes out in print, or is accepted by some reputable e-lit 'zine, like The Long Island Quarterly or Literary Mama.

Blogs and Patient Privacy

I worry when I hear stories of doctors blogs being attacked, or worse, used in court during malpractice litigation. Apparently, anonymous discussion of a patient's problem on an anonymous blog, with adequate disclaimers, can be traced to the author and considered an invasion of patient privacy. I worry now, about my blog, The Wounded Surgeon, posting my experiences during cancer surgery. But wait, I AM the patient whose privacy I invaded. I worry about publishing my poetry, at least as obscure as blogging, but often inspired by patients and their stories. I worry about my latest blog, Constipation Corner, which I wanted to set up FOR patients, with a link from my practice's website, and on which I planned to post some relatively reliable information regarding the disease processes I treat every day. I worry that I am now sucked into this "culture of worry," and that the same forces that have driven up the cost of healthcare (fat managed care companies, shrinking reimbursements, rising malpractice insurance rates, fear of being sued) are now seeping into and suffocating the last breaths of pure expression and pure communication between a doctor and her patients, between a surgeon and her self.

I worry what to do with such small hands.

The Trouble with Legislating Poetry

In the early 1800's Percy Bysshe Shelley argued that "Poets and philosphers are the unacknowledged legislators of the world." The "unacknowledged" part was driven home at Monday's meeting of the Nassau County Legislators where 6 of 7 county lawmakers voted against the appointment of Maxwell Corydon Wheat, Jr. as Nassau County's first poet laureate, saying some of the poets' writings were offensive to our troops.



In disbelief I read the article in Newsday. Then I watched the video at Newsday.com/LI. Then I checked some email from my poetry friends...we had been tracking this event since the Nassau County Legislature had voted last year to create this position, a ceremonial post, to be held by an artist residing in Nassau County who would commit to promoting poetry in the region. He would be required to give two public readings each year, visit schools and libraries, and foster appreciation for the art of poetry, and receive no stipend. I even found an invitation to the event -- poor, unknowing poets thinking it was a done deal. Little did they realize that there were no laurels for a crowning that day. I think I hear some of them in the background of Wheat's video cackling their disappontment, what to do with the banner.

Hold on to it, girls. In an excellent essay in The Guardian last fall, Adrienne Rich spoke of the importance of poetry as a different way of seeing, as a reinvention of vision, as a freedom to express our existence in this world. Poets are the defenders of this freedom, this democracy. Poets protect our freedoms in ways that legislators never will. And they'll do it without a stipend, if you'll let them.

Sleepless in Setauket

As the Democrats bevy up for the '08 Campaign, (did anyone see the hysterical parody of the DNC meeting on MadTV last night?), I am throwing my hat into another ring, with THREE NEW POEMS on my poetry site, BardParker Poets' Society. Speaking of society, I am considering entering the world of Internet Poetry and joining an online poetry forum, after spending some time on the IBPC website yesterday, and realizing in the past year how little time I have to attend actual bricks and mortar poetry readings or workshops. We'll see...

The New BLOGGER!!!

To celebrate the new format and features now available on Blogger, I've posted a few new poems on my poetry blog. Hoping that I might be able to flesh out my blogs with the new mobile blogging features, as well. And for those of you who have decided to be more organized in the new year...never mind, say "Yes to the Mess."

Warm Milk

In a time that seems long ago, I was in college. My best friend/study-buddy/soul mate and I were taking a break, maybe even doing laundry. It was, of course, two-thirty in the morning, and for us, "miles to go before I sleep." Not even sure I would even ever sleep again, I asked my bud what she did when she couldn't sleep. She told me about warm milk. She took out a saucepan and brewed up what was left of the quart in the fridge. I still remember the steam rising off the creamy white magical substance she poured into mugs she and her roommates had lifted from the cafeteria. I can still feel the sweet warmth filling my throat, blanketing my heart, filling my stomach.

Twenty-some years later, I am tossing in bed. It is, of course, two-thirty in the morning, but now the miles to go are the happy result of late nights studying Cyto/Hist and Mammalian Phys. Now it's miles of colonoscopies, reams of patient charts, cold, sterile rooms, warm, squirming guts. Tears and hugs, wounds and bandages. I really should get some rest. Time for some warm milk.

COMING SOON ! ! !

My latest contribution to the Blogosphere, Constipation Corner, will feature articles of interest to my patients, and anyone with problems related to the colon, rectum, and anus. Look there for the latest info on constipation, incontinence, rectal prolapse, laparoscopic colon surgery, fissures, hemorrhoids, abscess, fistula, and warts! The list goes on when I try to index the myriad causes of a pain in the ass. See you at "The Corner."

FDA APPROVES CERVICAL CANCER VACCINE

The Food and Drug Administration announced today approval for the use of Gardasil, a vaccine developed to protect against human papillomavirus (HPV), strains of which are the cause of 70% of all cervical cancers and 90% of genital warts. Currently the vaccine is approved for use in girls and women between the ages of 9 and 26, but has been shown in studies to be most effective in girls and women who have not been exposed to the virus, itself the most common sexually transmitted disease. See The Wounded Surgeon, for my recent posts on this issue, and click here for the New York Times article on the subject.

Patient Perspectives on Colorectal Cancer

In 2005, a group of clinical investigators in Houston, headed by Neil Love, MD, began a project to gather information about patients being treated for colorectal cancer, and to disseminate this information to physicians who regularly treat and recommend treatments for colorectal cancer with the hopes of facilitating the complicated process of introducing, sorting through, understanding, and utilizing the myriad options available to patients. They called this project the Research to Practice Colorectal Cancer Patient Education Initiative.

One hundred fifty patients with colorectal cancer were surveyed and answered questions ranging from their initial diagnosis, their participation in clinical trials, recovery from chemotherapy, even patient grading of physicians and patient education needs. The results have been published as a monograph, distributed to physicians, and are being used to further develop educational aids for patients. The goal is to produce an audio/text patient education program designed to provide information and perspectives on critical aspects of chemotherapy for colorectal cancer.

I received the monograph in the mail this week. As I read it I will post comments here.

Give Them Some Credit

You know I'm a sucker for "National (fill in your favorite cause or hobby) Month." But this is a good one. Apparently, somebody named May National Museum Month! As you may also know, I love museums. In fact, on my sister blog, The Wounded Surgeon, I talk about how I turned an appointment for pre-surgical testing into a day at the Museum of Modern Art.

I heard on the radio that Bank of America is celebrating National Museum Month, too. They are granting free admission to selected museums in nine northeastern states to anyone bearing a Bank of America or MBNA ATM or Credit card.

So visit a museum in May. I'll see you there!

Synchronicity

Once you change the curtains, you have to paint the walls. I have a PALM IIIxe, which is a primitive version of the handheld PDA that now exists as a smartphone, mp3 player, and a digital camera. I changed my computer at work last month and suddenly realized that I had lost the software for the Palm operating system. A quick visit to Palm.com allowed me to witness all that I've been missing, but not having the money, or the need for anything more sophisticated, I decided to download some updated software for the operating system. Three hours later...I was wading through all the incredible sites that are available for the PDA. Avant go is a fabulous site, with hundreds of PDA friendly channels that can be updated each time you "hot sync." Here are some other great sites geared toward PDA users in the medical field:

• pdaMD -- great information about handheld resources for healthcare personnel
• epocrates -- handheld drug information database, including formulary and pricing info
• merck medicus mobile -- good resource for latest medical news with capacity to launch searches from your PDA

Of course, with all these great applications, I may have to upgrade my palm to a Treo 700 or Life Drive mobile manager. Some pretty expensive taste for such small hands!

Who needs poetry?

I do.

See what other poets think in this Newsweek article, "Poets Debate National Poetry Month."

The Cruelest Month

If you are anything like me, you spent most of Colorectal Cancer Awareness month on my new blog, The Wounded Surgeon, and now find yourself well into April, which we all know is National Poetry Month. One of the best Poetry Blogs I've run across is out of the Harper Collins Publishing House, and is called The Cruelest Month. Check it out...if you dare.

My other nascent blog, Bard Parker Poets' Society, will be more devoted to poetry and literature, and I've furnished it with some links that I use to stay in touch with contemporary poetry, but I haven't had much time to work on it, and I'm not sure quite yet where it's going. Getting late. Need rest. Yankees won their home opener 9-7 this afternoon. Ahhh.

Hooray for Hollywood

Recovering from my own recent surgery by starting a new blog, The Wounded Surgeon. Wanted to keep the such small hands fans up to date on the latest events and attempts to increase Colorectal Cancer Awareness countrywide.

• Hollywood meets Motown event in NYC
• The Super Colon Tour 2006 -- hits Washington, DC this month. Soon in a city near you?

Approximately 140,000 new cases of colorectal cancer are diagnosed every year and another 56,000 people die annually of this disease. But colorectal cancer is a disease that can be prevented and cured if detected and treated early.

Prevention techniques include regular screenings, a healthy diet and regular exercise. If detected, colorectal cancer requires surgery in nearly all cases for complete cure, sometimes in conjunction with radiation and chemotherapy. Between 80 and 90 percent of patients are restored to normal health if the cancer is detected and treated in the earliest stages. However, the cure rate drops to 50 percent or less when diagnosed in the later stages.

Studies have shown that patients treated by colorectal surgeons -- experts in the surgical and nonsurgical treatment of colon and rectal problems -- are more likely to survive colorectal cancer and experience fewer complications. This is attributed to colorectal surgeons' advanced training and the high volume of colon and rectal disease surgeries they perform.

To learn even more about Colorectal Cancer, visit the American Society of Colon and Rectal Surgeons website.

Colorectal Cancer Awareness Month

Falling a little behind in my attempts to promote Colorectal Cancer Awareness Month. Please visit the American Society of Colon and Rectal Surgeons website for important information and links to many helpful resources.

LIKE CHURCH

When
When do you
When do you find
When do you find time
When do you find time
To write?

Early in the morning.
Wife at church.
Kids asleep.
Computer on.
Another chapter, paper, poem.
Early.
On Sundays.
Like Church.


In 1994 I did a rotation at MD Anderson Cancer Center in Houston. I thought, at the time, that I wanted to be a surgical oncologist. It was my first exposure to “REAL” surgeons. Not the gentleman farmers who did surgery as a hobby. Not the rich mamma’s boys who became doctors to please their parents. Not the frustrated jocks who took hammer and drill to broken old hips and arthritic knees. Not the dinosaurs who spent 4-5 months in Florida each year.

Real surgeons – who thought about surgery, read about surgery, dreamed and wrote about surgery. The thought leaders who operated and healed, who learned and taught, who read and knew. Dare I say…academic surgeons.

There I met D.E., head of GI surgical oncology, who mentored me through that rotation. He was a clean-cut Stephen Colbert look alike. He copied an article for me, insisting on doing it himself, turning the spine on the platen glass perfectly – no wasted space, no wasted time.

He closed out of a chapter he was writing on his computer to show me some data he was collecting on Medullary Carcinoma of the Thyroid. I asked him when he found the time to write. He told me Sunday mornings. Every Sunday morning – like church.

I woke up this morning and wrote propped on a pillow in bed. Even when I try, I usually can’t sleep in on Sunday mornings, too used to waking up early most other days of the week. So I wrote, in my journal, this poem, and another two verses of a poem I last looked at months ago. I wrote of a patient who haunts me, a dream I had, and I pondered adding yet another resolution to my lengthy list. Finally, I had answered a twelve year old question for myself. Sunday mornings – like church. Inevitably, this led to the birth of another related question…how do I fill the time that I am NOT writing?

Allergic

I chuckled as my patient explained that a highly respected, but recently retired local dermatologist once told him he was allergic to his own sweat. He has suffered for many years from many different skin disorders, including psoriasis, eczema, seborrheic keratosis. He even required excision and a skin graft for a squamous cell carcinoma of his groin. Now he was complaining of dry, itchy skin in both of his groins and around his anus. I recommended some ointment with zinc oxide in it.

I went to the hospital to make rounds. The patient I was seeing had a severe exacerbation of ulcerative colitis. This chronic inflammatory condition of the colon had been well controlled for two years with anti-inflammatory suppositories. When my patient fell ill with a virus that she caught from her daughter, she grew severely dehydrated from vomiting and the symptoms of her colitis flared. She had days and days of uncontrollable bloody diarrhea. Being a firm believer in alternative medicine, and convinced that her symptoms had been allayed for two years by herbal remedies and acupuncture, she drank Gatorade, swallowed vitamin supplements and refused to go to the hospital.

When she grew so weak she could not get out of bed, her husband called an ambulance and brought her to the Emergency Room. She was admitted to the medical service, resuscitated with IV fluids and started on high dose intravenous steroids. Her severe electrolyte imbalance was slowly corrected, but her diarrhea continued. Even after a week of steroids the inflamed lining of her colon forced out bloody, watery, mucoid stools seven to ten times a day. She grew weaker, afraid to eat. Her blood count dropped. Her legs swelled as her nutritional stores were depleted. She was incontinent, unable to get to her bedside commode to meet her explosive stools. She asked me to pray for her.

My partner tried to insert a central venous catheter into her subclavian vein so we could pour high protein, high calorie liquid nutrition into her system to try to make up for all the food she could not eat and all the fluids she was continually losing. His bedside attempt was unsuccessful. We relied on the interventional radiologists who were able to thread a catheter into place using fluoroscopy.

Now it was time to start talking about surgery. Because of the drastic nature of the surgery to correct this disorder, it is usually reserved for the most severe, life threatening cases. It would involve removing the entire colon and rectum, leaving her with either a permanent ileostomy, where the small intestine is brought to skin level and waste exits the body into a bag on the abdominal wall or a connection between her small intestine and her anus. Neither of these options would make her completely normal. Her stools would always be frequent and loose. Any lesser surgery would leave her at risk for persistent inflammation and cancer.

My patient was in better spirits as I entered the room. Not quite as weak, tolerating some soft, bland foods, perhaps seeing the prospect of surgery as a light at the end of the tunnel. She wondered out loud why this was happening to her, how all the herbal supplements, the vitamins, the acupuncture and her family’s prayers could have failed her.

I sat on the edge of her bed and began to explain, “It’s almost like you are allergic to your own stool…”