Monday, February 21, 2011
Sunday, February 20, 2011
Friday, February 18, 2011
"it is a tale...
Told by an Idiot,
Full of sound and fury,
Signifying nothing."
I am aware of these things happening in the week or so since I last wrote:
I ate the incredibly flavorful celebratory food of Tet, the Lunar New Year, at the home of my friend Quan. He is a street book-seller turned tour guide, whom I met last year when he offered to sell me a book by saying, instead of "YOU BUY BOOK ME, YES?", he quietly said "Hello, would you like to buy a book from me?" Because of his excellent English he was recently hired to take tour groups to the deservedly famous Halong Bay, which I visited back on my first RICE trip in 2009. The bay is an increasingly popular day trip from Hanoi, with most tourists booking tour packages which including a night spent on a majestic if rickety wooden boat.
Starting the next day I became incapacitatingly nauseated and feverish just as our reconstructive team began to trickle in from the US.
The next morning my fever broke, though it left me unable to be more than sprinting distance to a bathroom for the day, during which the team examined about 75 patients and planned a dozen operations for the following week, such as for the young teen who had most of the skin vaporized from the front of his body, including his entire penis, in a traffic accident.
On Monday we began to operate, doing things like repairing the eyelid of a patient whose post-traumatic scars had turned the lashes of his eye inward against his naked eyeball. Without this repair, he would have eventually lost sight in the eye from ulceration and scarring.
Some operations went well, or tolerably well; others not so much. One of these 'other's was the boy without a penis, which we actually succeeded in creating for him out of an incredible feat of 'skin origami', by which the excess skin, fat, and fascia of a forearm is made into a functional, sensate, penis..
Unfortunately, due a series of bizarre misadventures including an unprecedented and possibly never-before-described equipment failure, the fully formed penis had to remain attached to its native blood supply- on the forearm of our patient- where it will have to persist for one year until we are able to return to Hanoi and reattempt the microsurgical transfer. Our patient is a teenager. His family name - Dong- is relatively common in Vietnam.
-as an aside, the working hypothesis for the mysterious equipment failure was that it was caused by the use of a re-sterilized device originally designed to be single-use and disposable. This is a very common practice in Vietnam. In fact the hospitals where our team operates routinely re-sterilize and reuse the disposable things that we bring and use while operating here. Lives, limbs, livelihoods, livers etc. are saved because of this practice, as these pieces of equipment are often limiting factors in operations in even the premier medical institutions in Vietnam.
Our instruments for the trip are kindly donated by device representatives for large medical supply companies in the US.
For example take Covidien; a group that makes about ten billion U.S. dollars per year selling things like the Ligasure hemostatic dissection device intended to make traditional surgical dissection using a replaceable $1 knife blade with blood loss controlled by application of 10 cent silk strings, obsolete. This device, a disposable plastic curling-iron looking robo-pincer job that can cook and crush its way through a human abdomen in a fraction of the time of traditional, painstaking dissection with steel, costs only about $925 a pop, If you do the math the price is clearly aligned to be just under the cost of the OR time theoretically saved by using the instrument, justifying in some philistine sense the ballpark 2000% markup.
Successful innovations like this one, given enough time, actually do make obsolete their more time consuming forerunners. Given enough time, as practice shifts and training accommodates then perpetuates the change, the old techniques are abandoned, and finally the old products lost to history. New innovations utilize the new tools, sometimes become dependent upon them, with any technical alternative lost except to a few borderline-senile Emeritus professors.
These innovations are published in the literature and eventually trickle down to places like Vietnam, where a vital procedure's success might hinge on something like an $80 disposable suture (priced to gouge the bloated American market) , preventing the carrying-out of the operation despite its clinical necessity or superiority.
The profit made through ventures such as this is such that said companies can donate their products to places like Vietnam quite generously.
- end aside
Today was post-op rounding day, requiring only a few hours of hospital time in the a.m. We undid dressings, examined wounds, took photos, said our goodbyes- leaving the remainder of the day free.
As I left the hospital, I was surprised and glad when my friend Quan called and said that he was also free this afternoon- I knew he had been scheduled for a tour to Halong Bay. So we sat on a busy street corner, sipping tea while the motorcycle traffic boiled beside us.
It turns out that all the tours for today were cancelled, and for tomorrow, and likely for the foreseeable future. It turns out the Vietnamese government issued a moratorium on overnight tours of the Bay, as early in the morning one of the overburdened wooden boats sank over the sleeping heads of a dozen passengers- 11 of them international tourists. It turns out this included 2 Americans and 2 French in their 20's.
This is the deadliest tour boat accident in the history of Vietnamese tourism. The Bay has been a backpacker destination since visiting it became possible 25 years ago- 1986-, around the time of the births of most of the current wave of tourists, myself and the Halong Bay unfortunates included. This occurred when, disappointed with a decade of sluggish economic recovery following the end of the war, the VN gov. instituted a wave of significant capitalist reforms and loosened prohibitions on travel, which in turn fueled rapid economic growth, especially in areas like tourism.
The date is significant because it fell 10 years after reunification of North and South Vietnam, the Americans having been booted out the year before. The country was unified, its independence complete, on July 2nd 1976 - two hundred years to the day, since the penning of the U.S. Declaration of Independence.
to quote Kurt Vonnegut quoting Bokonon:
"Round and round and round we spin,
With feet of lead and wings of tin..."
Full of sound and fury,
Signifying nothing."
I am aware of these things happening in the week or so since I last wrote:
I ate the incredibly flavorful celebratory food of Tet, the Lunar New Year, at the home of my friend Quan. He is a street book-seller turned tour guide, whom I met last year when he offered to sell me a book by saying, instead of "YOU BUY BOOK ME, YES?", he quietly said "Hello, would you like to buy a book from me?" Because of his excellent English he was recently hired to take tour groups to the deservedly famous Halong Bay, which I visited back on my first RICE trip in 2009. The bay is an increasingly popular day trip from Hanoi, with most tourists booking tour packages which including a night spent on a majestic if rickety wooden boat.
Starting the next day I became incapacitatingly nauseated and feverish just as our reconstructive team began to trickle in from the US.
The next morning my fever broke, though it left me unable to be more than sprinting distance to a bathroom for the day, during which the team examined about 75 patients and planned a dozen operations for the following week, such as for the young teen who had most of the skin vaporized from the front of his body, including his entire penis, in a traffic accident.
On Monday we began to operate, doing things like repairing the eyelid of a patient whose post-traumatic scars had turned the lashes of his eye inward against his naked eyeball. Without this repair, he would have eventually lost sight in the eye from ulceration and scarring.
Some operations went well, or tolerably well; others not so much. One of these 'other's was the boy without a penis, which we actually succeeded in creating for him out of an incredible feat of 'skin origami', by which the excess skin, fat, and fascia of a forearm is made into a functional, sensate, penis..
Unfortunately, due a series of bizarre misadventures including an unprecedented and possibly never-before-described equipment failure, the fully formed penis had to remain attached to its native blood supply- on the forearm of our patient- where it will have to persist for one year until we are able to return to Hanoi and reattempt the microsurgical transfer. Our patient is a teenager. His family name - Dong- is relatively common in Vietnam.
-as an aside, the working hypothesis for the mysterious equipment failure was that it was caused by the use of a re-sterilized device originally designed to be single-use and disposable. This is a very common practice in Vietnam. In fact the hospitals where our team operates routinely re-sterilize and reuse the disposable things that we bring and use while operating here. Lives, limbs, livelihoods, livers etc. are saved because of this practice, as these pieces of equipment are often limiting factors in operations in even the premier medical institutions in Vietnam.
Our instruments for the trip are kindly donated by device representatives for large medical supply companies in the US.
For example take Covidien; a group that makes about ten billion U.S. dollars per year selling things like the Ligasure hemostatic dissection device intended to make traditional surgical dissection using a replaceable $1 knife blade with blood loss controlled by application of 10 cent silk strings, obsolete. This device, a disposable plastic curling-iron looking robo-pincer job that can cook and crush its way through a human abdomen in a fraction of the time of traditional, painstaking dissection with steel, costs only about $925 a pop, If you do the math the price is clearly aligned to be just under the cost of the OR time theoretically saved by using the instrument, justifying in some philistine sense the ballpark 2000% markup.
Successful innovations like this one, given enough time, actually do make obsolete their more time consuming forerunners. Given enough time, as practice shifts and training accommodates then perpetuates the change, the old techniques are abandoned, and finally the old products lost to history. New innovations utilize the new tools, sometimes become dependent upon them, with any technical alternative lost except to a few borderline-senile Emeritus professors.
These innovations are published in the literature and eventually trickle down to places like Vietnam, where a vital procedure's success might hinge on something like an $80 disposable suture (priced to gouge the bloated American market) , preventing the carrying-out of the operation despite its clinical necessity or superiority.
The profit made through ventures such as this is such that said companies can donate their products to places like Vietnam quite generously.
- end aside
Today was post-op rounding day, requiring only a few hours of hospital time in the a.m. We undid dressings, examined wounds, took photos, said our goodbyes- leaving the remainder of the day free.
As I left the hospital, I was surprised and glad when my friend Quan called and said that he was also free this afternoon- I knew he had been scheduled for a tour to Halong Bay. So we sat on a busy street corner, sipping tea while the motorcycle traffic boiled beside us.
It turns out that all the tours for today were cancelled, and for tomorrow, and likely for the foreseeable future. It turns out the Vietnamese government issued a moratorium on overnight tours of the Bay, as early in the morning one of the overburdened wooden boats sank over the sleeping heads of a dozen passengers- 11 of them international tourists. It turns out this included 2 Americans and 2 French in their 20's.
This is the deadliest tour boat accident in the history of Vietnamese tourism. The Bay has been a backpacker destination since visiting it became possible 25 years ago- 1986-, around the time of the births of most of the current wave of tourists, myself and the Halong Bay unfortunates included. This occurred when, disappointed with a decade of sluggish economic recovery following the end of the war, the VN gov. instituted a wave of significant capitalist reforms and loosened prohibitions on travel, which in turn fueled rapid economic growth, especially in areas like tourism.
The date is significant because it fell 10 years after reunification of North and South Vietnam, the Americans having been booted out the year before. The country was unified, its independence complete, on July 2nd 1976 - two hundred years to the day, since the penning of the U.S. Declaration of Independence.
to quote Kurt Vonnegut quoting Bokonon:
"Round and round and round we spin,
With feet of lead and wings of tin..."
Tuesday, February 15, 2011
Thursday, February 10, 2011
Wednesday, February 9, 2011
Life's Dram is but a Quarter dry
Sitting here in the Boston Logan Airport, literally in the shadow of a 6-foot-tall "sculpture" of a Dunkin Donuts "coffee." I don't put scare quotes on DD's saccharine-sprinkled, malarial-swamp version of the sacred skittish water because I'm snobbish about coffee- in fact Harrison recently revealed unto me the dark magic of Folger's Black Silk Coffee, which retails for about $4 a pound. Its spot in front of the International Departures ticketing counters is really fitting, as it's hard to imagine a better 6 foot symbolic spur to encourage people to get far far away from this country. Unless, the Daughters of the American Revolution paid this guy to hand out greasy Apocalyptic pentacostal pamphlets while topless.
Anyway, I received a really special birthday present in the form of a dispelled long-held belief regarding brains. Stemming from a psychology class I had back in high school, I had always thought that by the age of 25 the brain had substantially reduced the overall number of neurons (peaking in adolescence) in order to optimize efficiency at the expense of interconnectivity and plasticity. Apparently that is false, which is good news because I still can't speak a foreign language or play a musical instrument- though I'm working on both (I swear!).
Lastly, I just now thought up the idea of the Whiskey Vital (play on Uisge-beatha ['water of life' in gaelic]- meaning a bottle of scotch distilled in the year I was born from which I will take a hundred-part (7.5mL) each year a progressively more delicious and dire reminder of:
"Whether at Naishapur or Babylon,
Whether the Cup with sweet or bitter run,
The Wine of Life keeps oozing drop by drop,
The Leaves of Life keep falling one by one. "
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