Pediatric Surgery Quotes

Crest, that was his name, was meanwhile droning on, while Kate seemed to be only half listening. I could not hear him clearly, but I could guess at the gist of it. “Blah blah blah, I am handsome, I make a lot of money, this suit is expensive, and my shoes are made of the finest Corinthian leather hand-stitched by virgins under the moonlight. Of course, I could have gone into pediatrics, but for one of my amazing skill, really, plastic surgery was the only option. Beauty is so important, don’t you think? Oh, Kate, you are nearly as attractive as I. Why then should we not be beautiful together?”

If the operation is difficult, you are not doing it properly.

Surgery is the most masculine of medical disciplines, taking knives and penetrating the body to find disease and destroy it. It is a war game in which cold and shiny stainless steel is pitted against the unseen, sinister but discoverable and conquerable enemy. Pediatrics is in many ways the most feminine of medical disciplines, with its focus on small children, preventive care, nurturing. In terms of gender, neonatology seems to be somewhere in between.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine.

Societally, we will need to see shifts in how we—including the medical community—approach wellness. Instead of hospitals being repositories for the sick, they will need to become wellness centers after recovery or treatment reverses major issues. That is, they will need to focus on prevention, on health optimization, on opportunities to reboot our bodies. Many more people will recover from illness at home, as hospitals will bring those facilities and services to you, and less expensively. Note: With a decrease in fertility we expect more stabilization of pediatric and delivery centers, and with an increase in longevity we will see growth of plastic surgery and cosmetic procedures.

Now, even as her family grieved, she was giving birth again.

Then in March 1993, everything changed. My one-year-old son, Charlie, had his first seizure. There’s absolutely nothing funny about being the parent of a child with uncontrolled epilepsy. Nothing. After a year of daily seizures, drugs, and a brain surgery, I learned that the cure for Charlie’s epilepsy, the ketogenic diet—a high fat, no sugar, limited protein diet—had been hiding in plain sight for, by then, over seventy years. And despite the diet’s being well documented in medical texts, none of the half-dozen pediatric neurologists we had taken Charlie to see had mentioned a word about it. I found out on my own at a medical library. It was life altering—not just for Charlie and my family, but for tens of thousands like us. Turns out there are powerful forces at work within our health care system that don’t necessarily prioritize good health. For decades, physicians have barely been taught diet therapy or even nutrition in medical school. The pharmaceutical, medical device, and sugar industries make hundreds of billions every year on anti-epileptic drugs and processed foods—but not a nickel if we change what we eat. The cardiology community and American Heart Association demonize fat based on flawed science. Hospitals profit from tests and procedures, but again no money from diet therapy. There is a world epilepsy population of over sixty million people. Most of those people begin having their seizures as children, and only a minuscule percentage ever find out about ketogenic diet therapies. When I realized that 99 percent of what had happened to Charlie and my family was unnecessary, and that there were millions of families worldwide in the same situation, I needed to try to do something. Nancy and I began the Charlie Foundation (charliefoundation.org) in 1994 in order to facilitate research and get the word directly to those who would benefit. Among the high points were countless articles, a couple appearances of Charlie’s story on Dateline NBC, and a movie I produced and directed about another family whose child’s epilepsy had been cured by the ketogenic diet starring Meryl Streep titled First Do No Harm (1997). Today, of course, the diet permeates social media. When we started, there was one hospital in the world offering ketogenic diet therapy. Today, there are 250. Equally important, word about the efficacy of the ketogenic diet for epilepsy spread within the scientific community. In 1995, we hosted the first of many scientific global symposia focused on the diet. As research into its mechanisms and applications has spiked, incredibly the professional communities have found the same metabolic pathway that is triggered by the ketogenic diet to reduce seizures has also been found to benefit Alzheimer’s disease, ALS, severe psychiatric disorders, traumatic brain injury, and even some cancers. I

A comprehensive study of this foundational assertion published in 2000 in the high-gravitas journal Pediatrics by CDC and Johns Hopkins scientists concluded, after reviewing a century of medical data, that “vaccination does not account for the impressive decline in mortality from infectious diseases . . . in the 20th century.”47 As noted earlier, another widely cited study, McKinlay and McKinlay—required reading in virtually every American medical school during the 1970s—found that all medical interventions including vaccines, surgeries, and antibiotics accounted for less than about 1 percent—and no more than 3.5 percent—of the dramatic mortality declines. The McKinlays presciently warned that profiteers among the medical establishment would seek to claim credit for the mortality declines for vaccines in order to justify government mandates for those pharmaceutical products.48 Seven years earlier, the world’s foremost virologist, Harvard Medical School’s Dr. Edward H. Kass, a founding member and first president of the Infectious Diseases Society of America and founding editor of the Journal of Infectious Diseases, rebuked his virology colleagues for trying to take credit for that dramatic decline, scolding them for allowing the proliferation of “half-truths . . . that medical research had stamped out the great killers of the past—tuberculosis, diphtheria, pneumonia, puerperal sepsis, etc.—and that medical research and our superior system of medical care were major factors extending life expectancy.”49 Kass recognized that the real heroes of public health were not the medical profession, but rather the engineers who brought us sewage treatment plants, railroads, roads, and highways for transporting food, electric refrigerators, and chlorinated water.50

One by one the Essence Awards honorees were called onto the stage. First went civil rights leader Jesse Jackson, then movie director Spike Lee, followed by comedian Eddie Murphy, and then Dr. Benjamin S. Carson. Ben stood and walked forward to the stage. It was one of the most surreal moments of his life. He wondered how he belonged in the same category as those around him on the stage. It was hard for him to imagine that he, a pediatric neurosurgeon, was being publicly honored along with the most recognizable African American men and women in the country. As he stood onstage, staring out at the crowd, Ben thought about the path his life had taken. Who could have guessed that he, a poor black boy from a single-parent home in Detroit, would end up a brain surgeon? Certainly not those who had considered him the class dummy back in elementary school. Here he was, not just a brain surgeon, but a brain surgeon being honored for the work he had undertaken—experimental surgeries that gave children a chance at life.

to live until she was big enough to undergo extensive open-heart surgery. She had been followed since birth in our Pediatric Cardiology Clinic at the New York Hospital, and many of the pediatricians knew her and her family. Despite her physical difficulties she took full possession of all the hearts around her, including mine. When the time for her surgery finally came, her parents were deeply anxious. These were early days for many cardiac surgery techniques, and the risks were considerable, but without surgery, she would not survive childhood. As the senior pediatric resident, I met with Immy’s parents before the surgery to do an intake interview and summarize Immy’s long story. They were committed and ready and very pale. As we spoke, they sat close together holding hands. Afterward I took them

to her parents in relief, I asked if it was another one. “No,” her mother said, “it was the same one that was lost.” Dr. X had come that afternoon and brought it to them. I told them how glad I was that it had been found. “Yes,” her father said. “We are too.” Then he smiled. “She is safe now, no matter what happens,” he told me. The following morning, the surgery resident told me how the medal had been found. On the previous day, Dr. X had made his patient care rounds much as usual, followed by a dozen of the young surgeons he was training. But instead of ending the rounds in the ICU, he had taken them all to the laundry department in the subbasement of the hospital. There, he explained what had happened, and then he and all his residents and fellows had gone through the pediatric laundry from the day before

Pediatric chiropractic care provides a safe and natural way to manage scoliosis symptoms without resorting to invasive treatments like surgery.

If a direct hernia is obvious during an open operation, a simple Bassini repair in most children suffices.

Recently, single and multi-institution retrospective studies have shown a higher rate of postoperative stricture in patients who had transanastomotic tubes.

while pectus excavatum may be easy to hide, pectus carinatum may be obvious even with the chest covered.

But that last clinic appointment, that last time I saw Katie, I could look at her and see heaven. I don’t ask you to understand or even believe me, but I could see it. Just as clear as I can see Death. I saw heaven through Katie. It’s not that I think I see it; I know I see it, just as I see heaven in the eyes of my bratty kid or any of my other hundreds of patients. I know there’s value. I know there’s love. I know that there’s a loving God welcoming Katie into heaven. I could see it. I can’t explain it. I can’t begin to ease the stabbing hurt in Katie’s family. I won’t even try. But there is heaven.

She continued, “I had an ultrasound when I was about twenty weeks pregnant, and they found the spina bifida and hydrocephalus. I saw a bunch of doctors. Every single one of them told me all the things that were wrong with my daughter. Some people told me to abort her—you know—my child. All of these doctors told me all the problems we were going to have. “Then she was born and the doctors told me about the lesion on her back and the size of her head. She was going to be taken to the Baby Hospital away from me, and she needed surgery. All I could think about was everything wrong with her and maybe I’d made a mistake keeping her. “Then Thomas came into my room. Do you know what he said? He said, ‘What a beautiful baby!’” She paused. “No one else had called her a baby.

The Baby Hospital forces you to ask the big question. It forces you to ask about Death and heaven and God. “Truly I say to you, whatever you did for one of the least of these brothers and sisters of mine, you did it for Me” (Matthew 25:40).147 Some of the children at the Baby Hospital certainly qualify as the “least of these.” “Let’s not get tired of doing what is good” (Galatians 6:9).148 It’s a privilege to care for children. It’s a privilege to be called during the worst time in a family’s life. It’s a privilege to be entrusted with the life of a baby. It’s a privilege to be expected to study, to overcome the bureaucracy of medicine, and to feel capable of commanding an OR. It’s a privilege to operate on the central nervous system. I can see Death. And I can see Heaven. I wish I could understand the tapestry of the universe, of existence, of nature. But I can’t. But I can see some things. I can see that there is a Song of Creation. I can even hear it. I can hear it in a child’s laugh, my favorite sound. It’s beautiful. Yes. It’s worth it. Because of this:

Common sense is like a fresh, simplistic, non-prejudiced analysis of a problem that was otherwise considered complicated.

By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care.

In assessing any bronchopulmonary malformation in an asymptomatic child, the first chest x-ray should be performed 24–48 hours after birth to allow for resolution of lung fluid.

Hydrops is diagnosed when there is abnormal accumulation of fluid in two or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema.

I kept thinking how grateful I felt to have been part of this magnificent team. For five months we had been one unit, all specialists and all tackling the same problem together. The staff at the pediatric ICU and the consultants in the children's center reacted spectacularly. They rallied behind us and spent countless hours without charge, working to make this operation successful. As pessimistic as I was about the eventual outcome of the surgery, I still felt a glow of pride in being able to work side by side with the best men and women in the medical field. And the end of the surgery wasn't the end of our teamwork. The postoperative care was as spectacular as the surgery. Everything in the weeks following the surgery confirmed again our togetherness. It seemed as if everyone from ward clerks to orderlies to nurses had become personally involved in this historic event. We were a team--a wonderful, marvelous team.