Hungarian Rhapsody No. 2 by Franz Liszt

Last week's pneumonia has now affected 4/5ths of the family. I've recovered, but now my wife has it and both the boys have fever. Apparently we were all infected by the canaries with chlamydia psittacci. Needless to say, the foul fowls have been evicted. Person to person infection is extremely rare so, Trep, you are safe (you ol' germaphobe you!).

As a result I'm not at work. The upside of all this is the "quality" time I'm spending with our youngest child. We are watching lot's of DVD's together. And his (and my) favorites are the Bugs Bunny shorts.

My favorites are the musical cartoons and my all time favorite is "Rhapsody Rabbit" based on Franz Liszt's Hungarian Rhapsody No. 2. The funniest bit is when the phone rings inside the piano and Bugs answers, "Franz Liszt? Never hoid of 'im." I have several versions of the Hungarian Rhapsodies but this was the first one I ever heard and it still makes me laugh. So here it is:

Here are some other versions:

And for the purists:

The Gift

A month ago, a 12 year old boy needed ultrasound guided drainage of Perforated Appendicitis with Abscess. This invasive procedure often requires sedation and I was sent to the radiology suite for that purpose.

I talked to the patient and to put him at ease I asked him what movie he would like to watch during the flight. He eagerly wanted to see the latest James Bond movie (I thought 007 was retired!). I told him I'd do my best.

The procedure went well. In recovery the boy was very agitated and complained of abdominal pain. The parents were in tears. I prescribed pain medication and asked the patient to breath slowly and deeply (a great meditation and auto-hypnotic technique) and explained that he would feel less pain.

This was at the end of Thursday and I was eagerly anticipating joining the rest of the family for a long weekend at a hotel near Jerusalem. Before I left the hospital, I went back up to Radiology to see how the boy was. The father seemed more worried than ever. Despite my desire to leave, I answered all his questions to the best of my ability (the surgeon could better answer most of his concerns, however at that point in time I was most available). After about half an hour of discussion, the father seemed somewhat relieved.

When I got to the hotel, I called the hospital. The boy was back in the pediatrics ward and was no longer suffering from pain.

A few days later I again met the father at the local cafe. He was all smiles and said that his son was fine and was being discharged. He thanked me and I went to work.

This week, when I returned to work from sick leave, I was given a package. It was a letter of thanks and gifts. The package included a very portable 3 book set of the Mishna and a silver bookmark. I have never received such beautiful gifts for just doing my job. This gift means quite a lot to me. Among the changes in my life this past year, is an interest in the sacred texts of Judaism, and I have begun (albeit sporadically) to study the Talmud with my local Chabad Rabbi (who, in my humble opinion is a genius).

However, the accompanying letter is very touching. Here is a (very) rough translation:

Dear Dr. L,

On Thursday xx/xx/09, my son was brought to the ED because of abdominal pain. The diagnosis of Acute Appendicitis with Peritoneal Abscess was made in the ED and within an hour Prof. K and Dr. N performed an invasive procedure which saved my son's life. This procedure couldn't have been performed without your dedicated help. Now, having been discharged from the hospital, is the time for giving thanks:

"...you are charged day and night to remain by the side of a patient in distress at all times and all hours...you have been taught to understand the heart and soul of the patient and lift his spirits with understanding and the love of humanity...

So it is written in the Physician's Oath (the Hebrew version. Here is the original with the biblical references. -QL)

At times, in life, events occur which bring into focus the meaning of the word: humanity. So it was in this case.

Deeply stirred, frightened, unable to speak, I watched as the doctors worked calmly with determination to save my son, and again understood the sanctity of your work and especially your humanity.

Thank you from the bottom of my heart for the dedicated treatment and for literally saving the life of my son. Blessed is the man who has known you.

In the tractate Sanhedrin (from the Mishna - QL) it is written:

"He who saves one soul - saves an entire world."

On behalf of the entire family, please accept this humble gift.

I will end with the 8th blessing of the Amidah:

"Heal us Lord, and we will be healed, save us and we will be saved, bring complete healing for all our illnesses, for you are a compassionate healer."

With Infinite Gratitude,

The L. Family

I called the family to thank them for their generous gift. The son answered the phone. When I identified myself he said that I had done a poor job because he didn't see the James Bond movie. I apologized and assured him that it was much more important to be healthy again.

He then passed the phone to his father. I thanked him for the gift. He said it was only a small token of appreciation. I assured him that it was much more than that.

Hypochondria by Proxy

On the cel phone my wife was sobbing, "Thank God!" and she hung up. My temperature must be up again, I'm having an auditory halleucination. My wife is actually thanking God that I have pneumonia. I'm definitely hearing things. "Nurse!" I call out, "get me a psych consult...for me!"

Let me start over. Most people have one Yiddishe Mama, the biological one (Hi Ma!). I have three:

1. My actual mother.

2. My mother-in-law.

3. My wife.

Of the three, my wife is the most accomplished. To be sure, it is genetic, her whole family are master worryworts. And they have taken Hyphochondria by Proxy to completely new levels. Every cough, rash, sneeze, pain, tingle and premonition in a family member is cause to seek expert consultation.

About four months ago I was hit with the ol' one-two punch. I got the common cold and then when I recovered, I got it again. I was pretty worn out. Since then, I've had this cough. Just a dry cough and a constant tickle in my throat. It got to be so routine that I didn't even notice that I was coughing.

Eventually, my wife and mother ganged up on me. "Go to the doctor!" "But I feel fine, besides I'm too busy". Both were true, I felt fine and I was very busy.

But last week, I developed a fever. It started in the middle of a very long operation. The surgeons had the air conditioner on full Siberia mode. And I felt awful. I took a surgical drape and fashioned a balaclava out of it. So, the next day I called in sick and went to my family doctor. "Your lungs are clear, it's probably just a viral infection. No cause for worry." (I've used that line myself many times) "Good, I can finally reassure my wife the hypochondriac by proxy." He laughed.

A few days later, my cough got worse, more productive. I went back to the doctor and this time He heard crepitations in my right lung. "You've got pneumonia." OK, Emergency Dept. here I come. First I went home to drop off the mail and tell my wife. I was met with the patented hypochondriac-by-proxy-gaze. She looked more worried than ever. I tried reassuring her, "It's just to get a chest xray to confirm the diagnosis. I'm fine, really." The gaze became a black cloud.

I went to the ED in the hospital I worked in for ten years and received the royal treatment. I was actually enjoying myself seeing old friends and co-workers. The most senior internist in the ED recognized me and took my chart even though any resident could take my case. A couple hours later, after blood work and a chest xray I was the proud new owner of a right middle lobe pneumonia. See?

Well It is actually hard to see if you're not trained to see it.

Anyway, then transpired the conversation that began this post. I must be insane, my wife is relieved that I have pneumonia? When I got home I was greeted with that "I told you so" look. That too is patented. I swear, I'll have "My wife told me so." engraved on my tomb stone.

It was only today that I asked my wife what she was thinking when she thanked God that I had pneumonia. "Something worse, much much worse."

"You mean cancer?"

"Don't say that word in this house! Besides, your mother must think I'm a loony toon."

"Oh, Oh. Why?"

"Because, when you were in the ED I phoned your mother. She said it was probably pneumonia, and I said "I hope so.""

Just for the record, had I gone to the doctor a month ago, he wouldn't have found anything. I was assymptomatic (except for the cough), my lungs would have been clear on auscultation and the chest film would have been normal.

But "I told you so" just can't be lived down.

The Cherry Festival

David and family invited the Sandpeople to his neck of the desert to partake of the Cherry Festival. Those still interested can still go this Friday and next and pick cherries. This festival puts me to shame since I will never rise above the calumny of the infamous (and pathetic) Great Potato Festival Fiasco.

Here for your viewing pleasure are pictures of the pickers:

Me (selfportrait).

One of my pickers.

David caught in the act.

David's main picker.

Mini picker.

The pickees.

Lord Stanley

The possession of Lord Stanley's Cup will be decided in a 7th game.

Little known fact about me: One of my favorite sports is ice hockey. I grew up in the Philadelphia area during the magical era of the Broad Street Bullies in the mid '70's. Hence my love of that exciting sport.

Some might remember the bumper stickers that read:
"Only the Lord saves more than Bernie Parent."
Referring, of course, to that fabled goalie's almost divine ability to deny entrance of supersonic pucks into his goal.

Though the mind may be boggled, there actually is an Israel Ice Hockey Federation.

Like an Angel

Sometimes, one happens to be the right person, at the right place, at the right time. I was sitting in the nerve center of the department.  There is a large screen there that displays the monitors in all the OR's.  In addition, there are visual alarms that alert the viewer to a problem in a particular room.  The only person who is there all the time is the secretary who has no medical training whatsoever.  It is not clear, therefore, for whom the screen was installed.

I was ruminating when I noticed a decrease in oxygen saturation in room number 4.  A few seconds later the oxygenation rose up to a normal level.  This in itself is not extraordinary.  Often, during induction of anesthesia, despite preoxygenation, there is a drop and then a rise after the endotracheal tube is inserted and the patient ventilated.  However, a few seconds later, the oxygen again dropped.  Since I was not busy, I decided to go to room 4 to see if they needed help.

I was right. It was a difficult intubation.  There was a young resident and an attending, who happened to be the same attending (aka the teacher's pet) from the infamous incident. We successfully intubated however the patient was very spastic, I deepened the anesthesia, added a bronchodilator and some steroids and the situation improved.

Once everything was under control, the teacher's pet turned to me and said, "You decended upon us like an angel.  How did you know we were in trouble?"

I smiled and said, "I know everything that occurs in the OR, and I sensed that you needed help."

Her jaw dropped in astonishment.  I quickly added that I had seen the drop in oxygenation on the screen and decided to see if I could be of assistance.  

She smiled and thanked me.

Rule #9

Assuming that I'm a blogger, it stands to reason that you, don't turn around, I'm writing to you, yes, yes you...are a bloggee. Linguistics aside, some bloggees might remember The Rules. Recently I discovered Rule #9: "It is strongly advised that hemoglobin be maintained within the blood vessels."

The case was a 70 year old patient undergoing a lung lobectomy with the VATS technique. This is minimaly invasive surgery with the major benefits being less post operative pain and quicker recovery. Things did not go well from the start. The anatomy was less than optimal and the surgeon had difficulty visualizing the relevent structures. When the stapler was applied to the blood vessels supplying the lobe to be resected, all hell broke loose. The pulmonary artery was lacerated. The pulmonary artery though not the aorta, is not a vessel to be lightly dismissed. If it weren't so deadly, I'd describe the scene as breathtaking. The velocity at which one's entire blood volume pours into the chest cavity literally takes one breath away.

No doctor, no matter how talented is immune from complications. What is unforgivable is unprofessional behavior. The surgeon screamed at the top of his lungs at the nurse who did not provide the rib spreader fast enough. I understand who stressful such a situation is. No one likes killing a patient, but that is no excuse for venting one's frustration on an innocent team member, especially one who is desperately needed to continue functioning. I have previously stressed how important it is to keep a cool head in an emergency. Even I, with my experience, was frozen in place during the surgeon's cathartic rage. (The surgeon may have felt very good about himself afterwards, but the rest of us felt like crap.) Despite the delay, the rescucitation went relatively well and the patient made it alive, albeit post pulmonectomy, to the ICU.

I personally have no desire to ever work with that surgeon again.

In the Chapters of the Fathers (פירקי אבות), chapter 4 verse 1 it is written:

איזהו גיבור, הכובש את יצרו שנאמר טוב ארך אפיים מגיבור ומשל ברוחו מלכד עיר

In translation:
Who is strong? He who subdues his passions. For it is said: "He who is slow to anger is better than a hero, and he who has control over his will is better than he who conquers a city."

We still have much to learn from our forefathers (and mothers).