Tuesday, August 23, 2016

Ear tubes, Undescended Testicles, and Jonbenet Articles in PEOPLE Magazine

This week I'm [very remotely] involved with thoracic surgeries, Since I've had only one day of it, I'll share more about it when I've been through a few more procedures.

Last week I worked in pediatric outpatient surgeries. I inserted a lot of IV's -- I'm good at getting the IV's into place on the first try even with tiny children; the nursing staff was impressed, and I've been told that they're not easily impressed -- and dealt with scared and cranky  [hungry] children in the preoperative stations. I did some post-operative work as well, but there wasn't usually much to do other than to monitor. I did remove the packing from a little guy's nose following an eye surgery that involved nasal passages as well.

Other than just a few sutures and a little work in placing ear tubes, I mostly looked on in horror as the others did their work. I scrubbed in for one circumcision.  There are valid reasons to have one's baby boy undergo the procedure, and there are valid reasons to avoid it. We all have our own opinions about the costs versus the benefits of the circumcision procedure, and nothing I can say here will change anything a reader already thinks about the procedure. (Nothing anyone says in the comments section will change my opinion, either.)  I cried more than the baby did during the procedure, though not as loudly.  The only other thing I will say about it is that I hope to have only baby girls.

The majority of the surgeries for which I scrubbed in this week were myringotomy tube placements, which are tubes placed in the ears to remove and to prevent recurrence of fluid in the ears. This was extremely common  in the 1980's, but later many doctors began to take a wait- and-see approach to frequent otitis media with fluid build-up; often a child will outgrow the tendency toward the condition by eighteen-to-twenty-one months. If the fluid is remaining in place for three months or longer, however, it's probably time to proceed with the tubes. Otherwise, hearing loss occurs, which is temporary but still impedes language development.  Myringotomy tube placements are currently the second most common pediatric procedure in the U.S., preceded by tonsillectomies.

Tonsillectomies (often accompanied by adenoidectomies) are far less common than they were as late as the 1950's through early 1970's, but are still considered the most common pediatric surgical procedure in the U.S. Tonsillectomies have made a bit of a come-back since the late eighties to the turn of the century. ENTs are once again concluding that the procedure is necessary in many instances, though it's not nearly so automatically done as it was in the 50's and 60's. I'm told it's almost 50/50  at best in terms of adults who grew up in that era who still have tonsils. I'm editing this to add that one tonsillectomy patient was admitted following what is routinely an outpatient surgery. She lost a bit more blood than was considered normal, though not quite enough for the necessity of a transfusion. Blood of the correct type was collected from family members in the event that a transfusion was required. She was monitored for three days, then discharged with no further complications, although I know from personal experience that complications from a tonsillectomy can occur later.

We had several optical procedures, most of which were to deal with the effects of strabismus, which is a misalignment of the eyes,  by cutting and reattaching eye muscles. I've heard from my mom, who underwent multiple eye muscle surgeries as an adult to correct the effects of Graves' Disease on her eye muscles, that it's an incredibly uncomfortable procedure, but the children were  troupers and complained only minimally.

We had inguinal and umbilical hernia corrections. We had several percutaneous pinnings, which involve insertions of pins to aid in the healing of fractures of small bones.  We had one orchiopexy, which is a procedure to lower a testicle not yet descended into the scrotum. The child was seven years old, which is an unusually late age for the procedure to be performed. The mom was convinced that the testicle would drop on its own based on a supposed similar happening with the child's uncle, but a boy can reach a point at which it is both cruel to him and dangerous to his reproductive health to wait any longer. The pediatrician had to play hardball to get the mother to agree to the surgery. Fortunately, the little boy came through with flying colors.

An eight-year-old girl confided to me prior to her scheduled tonsillectomy that her mother had given her a single piece of toast and a small glass of milk prior to bringing her to the hospital. I immediately paged the anesthesiologist and texted the information. The surgery was postponed. The father was unhappy with the mother, and the parents were upset with the little girl, with me, and with the anesthesiologist, but an empty stomach is needed to safely undertake any surgical procedure requiring general anesthesia and many that don't required general anesthesia. There are times when emergency surgeries must be performed without regard to when a patient's last meal was, but a tonsillectomy is not one of those emergencies. Chances are that everything would have been OK even had the surgeon gone ahead with the tonsillectomy, but it would have been an unnecessary risk to have taken. I hope the parents were not unduly hard on the child once they left, as it certainly was not her fault, and she was looking out for her own best interests in telling me about her morning meal. (In all honesty, I believe the little girl told me of the meal because she was scared of undergoing the surgery and thought having eaten might be her ticket out of surgery for the day, but that is beside the point. I told her that if I possibly could, I would arrange to be there on the day for which her surgery was rescheduled. I don't know how easy it will be to arrange it, but I'll try. I'm also not all that sure how much difference my presence will make to the child in the long run, as kids forget quickly, but I keep my promises; in this case, my promise was to do my best to be there.)

During a brief hiatus, I was standing near the nurses' station in the preoperative area when I noticed a copy of People magazine on the desk. On the cover was a glamour photo of Jonbenet Ramsey. This presented for me a quandary. I've been obsessed by the Jonbenet case since I first learned of it when I was a very young child, and have followed all of the developments as they were revealed by the media. On the other hand, People magazine is not a highly regarded publication in the medical profession. I'm surprised that even a nurse was brave enough to bring the magazine into the hospital. I really wanted to know what People magazine had to say about any new developments in the Jonbenet case, but I didn't want to be caught openly thumbing through People magazine.

When I thought no one was paying any attention, I quickly grabbed the rag, checked the table of contents, and flipped to the Jonbenet article. I tried to appear to be looking at the data on someone's monitor as I quickly scanned the article. I must not have been subtle enough. An ENT announced loudly for everyone to hear (in an area where almost no one speaks much above a whisper), "Alexis' IQ just dropped 80 points! She's reading People magazine."

For the rest of the day I had to endure obnoxious questions about Johnny Depp's divorce, about the Kardashians, Jenners, and Wests, about the apparently nasty divorce of two people I've never heard of named Johnny and Amber, about two equally unfamiliar people named Jojo and Jordan, about Gwyneth Paltrow's love life, and a host of other nonsense. I smiled through it all, as what else could I do? I had been caught reading People magazine.  I'm now getting all sorts of tabloids shoved through the vents of my locker. Why are all these people wasting their hard-earned money just to poke fun at me? I carefully check the front of each scandal sheet to ensure that it doesn't have a subscription label. If any doctor, nurse, or med student is ever stupid enough to taunt me with a tabloid to which he or she actually subscribes, the person will rue the day he or she ever passed along his or her rag mag to me.

Justice for JonBenét? A New Look at the Evidence and the Suspects| Crime & Courts, Murder, True Crime, JonBenet Ramsey


  1. I used to love reading People, but it really has gone downhill.

    It sounds like you were great in your pediatric surgical rotation. I am one of those people who finds medical stories fascinating, as long as they don't involve me.

    1. I enjoyed the pediatric rotation except for the gruesomeness of a couple of procedures. I supposedly get at least another two weeks of it next year.

  2. Alexis, have you heard of Grace Vanderwaal? She is 12 & sings & writes songs & plays the ukulele. Howie says she is the best performer on America's Got Talent ever. Simon says she is the next Taylor Swift. What do you think?