Hurricane Jill

Sold!

Yeah, so you can call me a freak. I am actually enjoying trauma surgery. In fact, we finished rounds & associated scut by 10am this morning, and I went to check on a a patient of mine who’d been taken down to surgery for I&D of his stump. Now to most of us in medicine, I&D means Incision & Drainage, as in an abscess. Not so for the plastics service. Apparently to them, I&D means irrigation & debridement (i.e. exfoliation of skin and wallet, the latter preferably that of your insurance company). They were done already, so I looked on the schedule for an interesting neurosurgery case, and sure enough there was a craniotomy for tumor resection with cortical mapping. A cool case.

So I went in there and asked permission to watch, which was fine. The only thing is, I hate not being scrubbed in. When I’m scrubbed and doing something, I can stand there for hours and not notice, but standing there watching from the sideline is just painful. Anyway, the neurosurgeon initially thought the tumor would turn out to be a Grade III anaplastic glioma, but the frozen sections came back as just a Grade II. So the guy was lucky. Lucky also that the hand part of his motor cortex and motor association area were spared by both the tumor and the resection. It was a fascinating case to watch.

The surgery was over at 3pm, and it gave me plenty of time to mull over the surgery vs medicine issue, which has been plaguing me since I got my medicine shelf score back. It’s hard to turn your back on something you do well, in favor of something you love but might not be as good at. I could be really good at medicine, and my overall credentials would probably enable me to match pretty well in that field, uncompetitive as it is. And a top residency can open lots of doors. I’m not sure I can say the same about my competitiveness for a surgery residency. Ideally, I’d like to be a surgeon who’s good at the medicine side of things too. But surgery has to be part of the equation for me, because frankly, drugs piss me off. They never work as well as you want them to, and they always have inconvenient side effects. They’re getting increasingly more expensive, and it’s an ongoing cost to the patient with no endpoint in sight. And I like having that extra weapon against disease that surgery gives me.

So now the dilemma is, what kind of surgery?

thanksgiving

Well, it’s starting. Whenever there’s a news report of a stabbing, shooting, robbery or murder, invariably the newscasters lead off with “another violent crime committed in our city tonight by New Orleans evacuees…” Yesterday in trauma clinic a teenage boy came in to have some stitches removed. He had gotten in the middle of a knife fight between some “New Orleans people,” according to his mom. She said he was trying to break it up. Of course, she had no way of knowing I was from New Orleans, and I didn’t say anything to enlighten her. Although perhaps it would have served to balance out the negative image.

Not that it wasn’t entirely foreseeable, given that New Orleans was rightfully infamous for its crime, and that most of the people responsible for it were evacuated to Houston, and can’t afford to return. But Texas is not a state where you want to continue that sort of lifestyle. Here, if you don’t get shot by the person against whom you were committing the crime, the state itself will do the honors.

And as you might expect, New Orleans itself is now pretty safe.

Last summer, in the short vacation between taking Step 1 and starting clerkships, I read a book called Freakonomics. I forget who wrote it, but he was obviously a very smart guy. He drew an interesting connection between the legalization of abortion in the 70’s and the decline in crime rates in the 90’s. His theory, which he supported very convincingly with data, was that the decline in crime had nothing to do with improved policing, and everything to do with the fact that the children most likely to become criminals were not being born in the first place.

But New Orleans is a very Catholic city, and I wonder if the Catholic Church’s opposition to abortion, and its sway over a large portion of the city’s population, contributed in any way to the intractable crime problem that existed prior to Katrina. Certainly it wasn’t the only factor, because New Orleans’ lack of an industrial or economic base is probably a bigger reason. But if the reason women have abortions is because they know they lack the economic capacity to raise a child, and if New Orleans was so lacking in that capacity, a permissive view on abortion might have achieved a better balance between economic demand for workers, and able-bodied, adequately educated adults. It’s an interesting thought.

Earlier today, there was a moment or two of self-pity, in which I wondered what exactly I have to be thankful for. But it was only a moment, and then I remembered how much there really is:
1) Everyone I knew in New Orleans is safe and well. Some are here, some are there, some have lost things, and some have lost pets. None that I know have lost loved ones, and that’s something to be thankful for.
2) Even though my school was flooded, we had a place to go, and talented administrators to make it happen in short order.
3) It’s been a privilege to do rotations with both UT Houston and Baylor students. They are, on average, very sharp. But one thing it’s taught me is that Tulane med’s well-respected national reputation, despite crappy USN&WR rankings, is not an empty reflection of old glory, as I had previously thought. We’ve actually gotten a pretty high-quality education, and we have a great atmosphere among the students and between the students and faculty.