Today I am going to do something different. I am going to look at some surgically-oriented
medical memes, and I am going to tell you whether they are right or wrong,
and whether or not I like them. Let’s get to it.
1. Heal Me - Pill I love this meme because it is so representative of what we see in
clinical practice regularly. The placebo effective describes a patient’s response to a particular
medication or treatment that is designed to have no therapeutic value. It is known to be somewhat
effective in the treatment of a number of medical problems and disorders. This basically means that
a treatment can have no measurable medicinal effect, but that in a significant proportion of
those treated with this treatment, their belief in the treatment will allow them to respond to
the treatment, especially when the condition being treated is of a subjective nature, eg. pain. You
can tell patients all the time that they just need to do x, y, or z to treat their problem and they
won’t believe you. However, the second you tell them that you can give them a pill to treat the
issue, they are all in. There is this perception that we need this secret sauce to fix ourselves,
and we tend to discount our own ability to change and potentially heal ourselves.
This certainly doesn’t apply to everything, but it applies to way more than we think it might.
2. Military grade This is sooo ortho. But it isn’t really because we just want to
overkill everything to because we like spending a lot of money. As surgeons, our goal is to fix
fractures in the simplest way possible, with the implant that is most suited for the job,
in the safest way possible. Certain fracture or injury patterns are ideally suited to particular
implants. Those implants are especially designed for the characteristics of the fracture pattern.
We use what works for the fracture. these days, most implants are constructed from titanium
because it is a metal whose properties closely mimic those of bone. The implants are lighter,
more durable, and offer less stress shielding than does surgical stainless steel. Yes, they are more
expensive, but their improved characteristics may lead to better healing outcomes,
and potentially less complications. This may lead to lower costs in the long run. In addition,
wants to hear, “your grandma is 95 lbs, so we’re gonna use the cheap shit.”
3. Upside down cast this reminds me a lot of some of the shoulder surgeries that I perform.
After rotator cuff surgery patients can be immobilized in a sling for up to 6 weeks.
Patients hate it, and it is uncomfortable. It is particularly awkward for sleeping and
often patients cannot sleep normally in bed. They have to contort themselves in
strange positions with pillows in order to be able to get to sleep, and they are always
so pleased when they are eventually able to sleep normally again. Much of what we do in
orthopedics requires temporary immobilization after surgery to secure what we have done,
and to prevent undue stress on the surgical implants before healing is complete. Our goal
with immobilization is to protect our work, it is typically not for patient comfort. So we get it,
but we do what we gotta do to help the patient heal properly. If it means you gotta sleep on
your head, then…..you gotta sleep on your head. 4. Ha ha stitches I was trying to see whether
this was a photoshopped image or not. I am not sure. However, if it is not, this surgeon has
a sense of humor, but it also playing with fire. Most certifying colleges would frown upon this
if it came to their attention and a patient who did not appreciate this humor might have cause to
file a complaint or to take medico legal action. While these sutures are not permanent in nature,
someone could argue that they were disfigured by this stitch pattern. It is a reach,
but I could see it happening. There was a recent case where a transplant surgeon
carved his initials internally with cautery into a patient’s liver at the completion of a surgery.
This didn’t have any clinical impact on the surgery performed and the initials weren’t visible
externally. The initials were noted in the patient at a later surgery. This surgeon was charged with
assault to which he pled guilty. He subsequently resigned his position at the hospital where he
worked. This is all to say that stuff like this is shady and should be avoided at all costs.
5. Ben Carson. I am not sure whether this one is poking fun at Ben Carson specifically,
just black surgeons, neurosurgeons, or just surgeons in general. I am going to assume it
is the first case. Ben Carson is a Republican politician who was a presidential candidate in
2016 and part of Trump’s cabinet between 2017 and 2021. Prior to his career in politics,
he was a neurosurgeon at the Johns Hopkins School of Medicine.
He has written over 100 neurosurgical publications and has pioneered several groundbreaking surgeries
in pediatric neurosurgeries. He was the subject of a 2009 autobiography entitled Gifted Hands,
where he was portrayed by Cuba Gooding Jr. By most accounts, he was a gifted surgeon. Neurosurgeons
perform very delicate and precise surgery, so they generally must have very good, steady hands. So
if anyone was able to play the game of Surgery successfully without setting off the buzzer,
it would probably be this guy. 6. MagLev I love this one. I am a big
fan of tech and I have loved the idea of mag lev trains since I first learned of them as a teen. I
have always hoped to see one, or ride one myself, and it is certainly something on my bucket list
of experiences. It is quite an ingenious pic to be honest. Most people have heard of the saying,
“a doctor a day keeps the doctor away”. It was an exceptionally bright idea to use this figure
of speech in a literal sense to levitate high speed trains. Absolutely genius. There is one
drawback of course. A large amount of doctors may be required for each train to provide enough
levitation force to elevate the train. Since each doctor takes a minimum of
6 years to train at enormous expense, the cost of creating an MD-based maglev train would likely be
exorbitant. Consequently, I can imagine that the cost of riding this train would be very,
very high. I am not sure who would be able to afford tickets on this train. Not to mention,
it is not clear what the durability of the doctors used to elevate the train will be so maintenance
costs could be exceptionally high as well. While this is a really bright idea, it may turn out
to be cost prohibitive to most riders. 7. Cats watching As a community surgeon,
I don’t have the opportunity to teach medical students or residents that often. However,
I can remember my time learning as a medical student in a teaching institution.
In this setting, there was very limited real estate around the surgical table.
For every surgery, you have the surgeon, the scrub nurse, and the assistant. At teaching hospitals,
you also have a resident or fellow, and sometimes both. That is 5-6 people standing shoulder to
shoulder looking down at a surgical field that often is only 10 cm or less in length. It becomes
very difficult for everyone to get close enough to the surgical field to see what is going on.
Everyone wants to learn but it is hard for everyone to see. Medical students are the
lowest rung on the ladder so they are the ones who are furthest away from the surgical field. So yes,
it is literally actually like this when students are watching in the OR.
Of course, we always have to make sure that they don’t contaminate the surgical field,
or that they don’t limit us from performing the surgery effectively. So although they are
crowding the surgical field trying to get to see, we are often pushing them back so that we
have room to work. Ahh, the struggles of medical education. It is a lot like trying to herd cats.
8. Pistol Any surgeon can relate to this one. Surgery is an inherently risky business. We are
cutting people open, which increases the risk of infection, and we are performing procedures
inside of their bodies, which can result in serious complications. It is indeed a high
stakes game. As surgeons, we prepare for each surgery by going over the patient’s medical chart,
reviewing the surgical technique, and formulating an operative plan. We also make sure that
we also have a contingency plan, in case things go sideways. During the surgery, we do everything
that we can to make sure that everything unfolds the way that we have planned before surgery.
However, this is not always the case. Sometimes things just don’t go the way that we want. A
bone breaks where we didn’t want it to, a surgical instrument breaks or is dropped on the floor.
Perhaps a surgical tool doesn’t work the way it was supposed to. All of these things happen and
we have to deal with it. In addition, Surgeons are human, we are not robots. Sometimes humans
make mistakes, for any number of reasons. Anyone who tells you different is lying. If you operate
enough, you will make an error. Usually, these errors are small and readily correctable. However,
sometimes an error can be serious and have grave consequences. You never want that, and should an
error like that occur, it is hard not to feel like you want to crawl under a rock to die.
9. Chainsaw I like this one a lot because it speaks to the dual nature of orthopedic surgery.
On the one hand, we are highly trained medical professionals that expect that patients will
entrust us with their medical care at a time when they are most vulnerable. We
wear all the trappings of cogent, erudite specialists in the clinical setting. But,
on the other hand, in the operating room, we are like the surgical gorillas wielding power tools.
I often say to people when they ask what I do, that I am a glorified carpenter that gets to work
inside the body. I use the same tools, and much of the same techniques that carpenters do day to
day. Much of the work that I do is quite physical in nature as well. So, although there is a lot of
precision work with mere millimeter tolerances, there is also a lot of physical labor on a gross
scale; sawing, hammering, chiseling, drilling, etc. And in some case, there is even wrestling,
when we are trying to reduce a fracture or dislocation back into position. But don’t worry
about it, I stayed at a holiday inn express last night [b-roll from holiday in express commercial
with guy pretending to be a surgeon] 10. When you wake
up. This one had me cracking up. This is sooo true of our anaesthetic colleagues.
Generally speaking, most cases are relatively routine in terms of the anaesthetic process.
The anesthetist will put the patient to sleep (although this is becoming less and less common
these days as a result of regional anaesthesia) at the beginning of the case, maintain the patient in
an anaesthetic state during the case, and then wake them up at the completion of the case.
Much like flying a plane. Take off, fly, and then land. Like a plane, during the flight, the patient
is on auto-pilot, with the anaesthetist doing nothing other than watching the instruments.
If the case is long, like a long flight, the anaesthesia might take this time to do other
things, like exercise, read journal articles, listen to lectures, etc,
while the machine runs the anaesthesia. Sometimes anaesthetists may catch a few
winks during this time. Generally, this is not a problem. In a plane on autopilot,
should turbulence occur, the pilot needs to be ready to take control of the plane at a moments
notice to prevent an accident from occurring. The same is true of the anaesthetist in the OR
when intra-operative problems occur, as long as they are awake that is. When things go sideways,
the anaesthetist needs to be awake and ready to take control of the flight to prevent sudden
catastrophe. No gas passer wants to wake up from a nap to bells and excitement in the OR because
that would mean that there is a serious problem at hand.
11. Relax David. I enjoyed this one a lot and think that this is a great one to end on.
As I mentioned before, surgery is a high stakes game with a lot of stress. Every time we perform
surgery, we have to be on our A game. We have to be alert and focused on the task at hand.
We have to be confident in our knowledge and skills to perform the planned surgery,
and to lead the operating room staff through the plan that we have prepared. For routine cases,
this is not a problem. However, for big, complex, challenging cases, this can be difficult at times.
None of us wants to make a mistake, or forget something that is an integral part of the surgical
plan, so we have to remain diligent in all that we do. Sometimes self doubt or nervousness can creep
in and draw our attention away from what we are doing. Positive self talk is a part of the process
of creating a favourable mental environment that facilitates our focus on the successful completion
of the surgical plan. When things are particularly stressful, we are having a running dialogue with
ourselves in our head to walk ourselves back from the edge of the cliff, so that we can get
back to the surgical plan. Yeah surgery. It can be hella stressful, but I still love it.
If you agree or disagree with anything I have said,
let me know in the comments. What has your experience in medicine been like? If you have
a meme that you like that you want me to explain or react to, let me know in the comments, or send
me a link on my socials. As always, that’s been a word from dr chris, not your everyday ortho.