Atul Gawande

Atul Gawande

A weeklong electronic journal.
June 6 1997 3:30 AM

Atul Gawande

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       Wednesdays begin early like any other day, but operations are put back two hours for teaching conferences. The residents gather for a couple of hours of discussion on exciting topics like when and how to remove a segment of the liver and how to evaluate trauma victims for multiple injuries (our topics today). I gnawed on a bagel to stay awake.
       I was up late last night putting together a presentation I did at this afternoon's cancer conference (and writing yesterday's diary entry). I was assigned to talk about a patient with testicular cancer. Here are a few things I learned:
--It's the most common cancer for males age 15 to 35.
--For unknown reasons, the testicular cancer rate for whites has doubled in the last 20 years while holding steady for blacks.
--As with girls and breast self-exams, high-school-age boys are supposed to begin examining their testicles monthly. How-to brochures for boys abound (gosh, thanks, Doc!).
--After orchiectomy (excision of a testicle), patients used to have the option of having a prosthetic ball put in place, usually made of silicone. With all the lawsuits against silicone breast-implant manufacturers, however, they've been pulled off the market.
       This reminded me that one year, while I was in high school, my pediatrician mother performed the football team's physical exams. Half the kids spent the next week avoiding me. The other half would stop me and say things like, "Hey, Gawande! Your mom felt my balls, man."

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       My father is a urologist. His patients always used to surprise me with the same kind of unabashedness. When I was about 10, a grateful patient took me and my dad out shooting (I grew up in rural Ohio). We had barely hopped out of his truck and gotten the rifles down from the rack before he mentioned he had a new problem.
       "Well, let's take a look," my dad said. Our host happily dropped his pants. He started to urinate and out came a little whoosh of air.
       "I keep pissing air, Doc." My Dad stood watching, his interest piqued. He said he'd need to do some tests that week. Up went the pants. The patient fired off a few shots. And that was that.

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       In my big case today, the attending and I excised a cancer from a patient's upper arm. It looked like a shark bit him when we were done. The plastic surgeons had to come in and use skin and muscle from his back to fill in the space.
       My splenectomy patient turned the corner today. Pushing him to get out of bed and walk, walk, walk, worked. His fevers persist, but his oxygen level is up, he's thinking clearly again, and his pneumonia is in retreat. Despite all our badgering, he was surprisingly grateful today.

Atul Gawande is a surgical resident in Boston who will be starting a regular column for SLATEcalled "Medical Examiner" in July.