Yesterday I ask a friend to drive me to pick up my son, on his way home from college for spring break, an hour to a nearby pick up point and back. I can't without limping horribly: apparently the recent stress in clinic has made my muscles mad.
F. drives. He has just finished reading Reinventing Collapse: The Soviet Experience and American Prospects, by Dmitri Orlov. Mr. Orlov says that I, as a physician, should start moonlighting as a midwife for barter to have a back up plan for when the economy collapses.
I laugh. "Not very helpful where the median age is 55."
"Not to mention people want to use their pathetic health insurance."
Home and I go to sleep. Dream: I am at F.'s house. There are two other men, one of whom needs abdominal surgery. We argue for a long time but he has no money and finally I agree to do surgery with F. assisting. The other man is to help hold the young man down. We do not, of course, have anesthesia. I go over what I am going to do, force them to pay attention, discuss sterile technique, boil everything. Not ideal....
We don't have a cautery or suction either. But there is almost no bleeding and the two things that need to be removed come out easily, I am very very gentle, so I don't cause other things to bleed. Never mess with the spleen.
Now I need to close the abdomen and I don't have absorbable sutures. I am going to do a figure 8 from the surface, in skin, out the abdominal fat, across into the fat, down through the fascia, crossing very delicately up into the fascia on the other side, out the fat, in the fat on the other side and out the skin. Then slowly pull it tight, tight, and tie it off. It's thick nylon. Nonabsorbable. Usually you would take the nylon out in 7-10 days but I am wondering how long I would need it for the fascia....I thought that would take 6 weeks to heal. I am worrying.
But now F. and the other man are not holding my patient, they are backing off and congratulating each other. My patient gets up off the table. "Lie back down!" I say, "Your guts could fall out the opening! We haven't closed! F!" Surprisingly his guts are not falling out, but it's because I have done such a beautiful low abdominal incision, bikini style. "Get back on the table or I will make you go to the hospital to have it closed!"
He reluctantly gets back on the table. F. and the other guy are still being morons but are calming down....
....I wake up.
soundtrack: What does the spleen do?