Brain surgeon- Another Day in the Frontal Lobe 1

[Guest guest]

In preparing for my interviews with neurosurgeons, I read a book by a female neurosurgeon named Katrina Firlik, MD, (Kat Firlik? Say it isn’t so!) entitled “Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside”.

She describes several years of residency and some of the harrowing experiences in surgery. It is an interesting book and gives tremendous insight into the world of postgraduate medicine. She is very clear that some of the time in a six-year residency is spent wondering what you are doing there.

Dr. Firlik has a very interesting take on pharmaceutical medication. So interesting that I xeroxed a few pages, scanned them into my trusty Scansnap scanner and translated them into text for you. It is printed below with OCR errors ignored (sorry).

Stay tuned for more interesting tales from the cranium and the rare breed of wizards who would dare to enter in and try to positively affect God’s handiwork.

--

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

Don’t forward this outside the group as it is copy written.

Buy the book here: http://www.amazon.com/Another-Day-Frontal-Lobe-Surgeon/dp/0812973402/ref=sr_1_1?s=books & ie=UTF8 & qid=1328852940 & sr=1-1

From: ANOTHER DAY IN THE FRONTAL LOBE

I saw a patient recently who had had spine surgery performed a few years earlier by another surgeon. As can often be the case, the origi­nal reason for the surgery—advanced arthritis, or garden-variety " wear and tear " changes that can occur with age—continued to progress and she was now faced with requiring treatment, and maybe even a second operation, for a neighboring level of her spine. I knew the surgeon who performed the first operation, a highly reputable colleague, and I voiced some question as to why she wasn't in his of­fice instead.

" Well, he gave me a wound infection, so you can be sure I won't be going back to him.” This sort of statement, and the vehement emotion that goes with it, worries me and raises a red flag. It might be easy for me to fall into the trap of flattery, at first (the patient specifically chose me over the other surgeon), but the realistic re­sponse should be one of caution. This is the type of patient who be­lieves that the concepts of risk and complication are neatly and inextricably linked to another concept: blame. If something bad hap­pens, it's someone's fault. There is no such thing as bad luck.

Based on the alarmist tone of her voice, I imagined that in her mind, the surgeon willfully smeared bacteria into the surgical site, aiming to set up an evil chain reaction leading to fever, pus, and a red, swollen incision. The trirth is that infection remains (and will al­ways remain) a risk of any surgical procedure. Although all measures are taken to bring the rate as close to zero as possible, it still hovers around 1 percent or so (or slightly higher or lower, depending on the surgical site, the circumstances, and how healthy the patient is to begin with). Surgeons feel terrible when a patient of theirs develops an infection, but they normally don't feel guilty. While it's true that in very Tare cases, careless breaches in sterile technique are to blame, and certain individuals can be held liable, that is the very rare ex­ception.

So, if you are the unlucky individual who happens to fall into that 1 percent because natural bacteria on your skin (the usual source) in­fected your wound, should you blame your surgeon? Should you call your lawyer? Should you expect someone to pay up? One reason physicians are unhappy these days is that the definition of malprac­tice has changed. Malpractice is no longer defined as truly negligent or improper behavior. Now, a poor outcome alone triggers claims of " malpractice. " The quality of the care may be irrelevant.

I have never been sued but I expect to be. The entire new gener­ation of surgeons expects to be sued. Our elders tell us it's coming; it's just a matter of time. It doesn't matter how good you are or how care­fully you practice. For that reason, I'm always trying to figure out which of my patients might be most likely to sue me. If it's really ob­vious (they gloat about the lawsuit they won against Dr. So-and-So when surgery wasn't everything they had dreamed it would be), then I'm likely to steer clear of them and recommend definitive treatment elsewhere. Most of the time, though, it's not so obvious, and you have to go with your gut. Unfair? Maybe. Paranoid? Not at all.

On the subject of risk, I have to include my two cents about medication. You might think that, because I am a surgeon and accustomed to " cutting people open " (as a few of my more eloquent patients have referred to it), the thought of simply prescribing a medication, or popping a pill myself, would give me no pause at all. Not so. I am a firm believer in the pithy statement: " Anything strong enough to help you is strong enough to hurt you. " No treatment, at least no worthwhile treatment, comes without risk. Even natural supple­ments, if you take unnaturally large amounts, can have untoward ef­fects, which is finally starting to dawn on the public. For that matter, placebo pills have been shown to have a whole host of vague " side ef fects " (headaches, dizziness, stomach upset), triggered either by the mere belief that the placebo is a real drug, or purely as a coincidence.

I've been lucky to be relatively healthy. I've never taken a pain medication stronger than Tylenol or Advil, never taken an antibiotic for anything, and have never been on any prescription medications. Aside from a garden variety multivitamin and extra calcium, I don't take anything. I'm wary of taking natural things in unnatural doses. I am amused by the burgeoning pseudo-medical chain stores that hawk supplements. My idea of maintaining a healthy diet is to make sure I sample from multiple different types of ethnic cuisine. The jury is still out on which culture has produced the best regimen for longevity, so I hedge my bets and include them all.

Surgery is visual and tangible. The risks are pretty concrete. Med­ications are a little more mysterious. There are plenty of medications that work wonders without us having a clear idea as to how or why they work. To me, that means that there are probably other things those drugs are doing that we may not expect. It would be unlikely for a drug to have one and only one effect on the body. That's not how the body works. One physiological mechanism can mediate numer­ous different functions. One natural chemical, blocked or enhanced by a certain drug, may have dozens of different targets. Those targets are probably not all figured out yet.

For that reason, I'm not surprised when scientists discover that a seemingly innocent medication, taken for years by thousands or mil­lions of people, is found to be associated with a slightly higher risk of something scary and unexpected: blood clots, stroke, heart attack, ex­cessive bleeding, sudden death, weight gain. This doesn't mean that I will shun all medication out of fear of adverse effects. I'll take a med­ication when I need it, when the time comes, if the benefits clearly outweigh the risks. But I won't expect to get something for nothing.

The thorniest medication questions arise with pregnant patients. What can you do for a pregnant woman with bad headaches or bad back pain? Is there any pain medication she can take or does she have to suffer? What if she has a seizure disorder? What antiepileptic med­ication is safe? What about if she gets an infection? Are antibiotics okay? The standard teaching pounded into my head was that all medications should be considered potentially risky, at least to the fetus. That seems a bit drastic, but not if you think about it for a sec­ond.

How would you go about doing a careful study to determine whether a medication is " safe " ? You would have to recruit, say, one thousand pregnant women, early in their pregnancies, to participate in a medication trial. You'd want to pick relatively healthy nonsmok­ing, nondrinking women. Allow half of them to take a certain med­ication, and forbid the other half from touching it. Follow them through their entire pregnancies. See how their kids turn out. If 4 percent of the women on the medication have babies with birth de­fects, compared to only 2 percent in the other group, you'd have a nice study to publish in the medical literature and newspapers. ( " Twice the risk of birth defects! " would be a great headline.) More meaningful warning labels could be put on medication bottles. This all sounds good—it sounds scientific—but who would volunteer to participate in such a study? No one. Now you can see why doctors don't have all the answers, and probably never will.