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In a conversation on Twitter, a doctor said to me: I do anesthesia for a living, done it for hundreds of tubals I’m sure. I often think: WTF is wrong with the husband? Except when part of a C-section, tubals should be rare. Vasectomies are cheap, low-pain, extremely safe, and highly effective. Why are tubals also a burden that women must carry? An additional point: there has never been a documented death from a vasectomy. However, many women have died from anesthetic or surgical complications from a tubal ligation.

Heart disease is the Jeffrey Dahmer of modern ailments. It kills more than 25 percent of us. That’s one person in the United States dying of it every 37 seconds. Expanding fitness just a bit—the equivalent of a person improving their max running speed from five to six miles an hour—reduces the risk of heart disease by 30 percent, according to the American Heart Association. Next is cancer. It kills 22.8 percent of us. The most fit people face a 45 percent lower risk of dying from the disease, according to a study in the Annals of Oncology. Then we have accidents. They take 6.8 percent of us. If a person is in a serious car accident, being in shape drops their chances of dying by 80 percent, according to a study in the Emergency Medical Journal. If the docs have to operate—regardless of whether it’s an emergency or a planned surgery—fitter people also face fewer surgical complications and recover faster than unfit people, say scientists in Brazil.

As she made her way through the tedium of check-in lines, security lines, boarding lines, she noticed several people wearing paper surgical masks. She wondered if they were being paranoid about that new virus she’d been hearing about. As she stepped from the jetway into the plane, it struck her that for fifteen hours she’d be sealed in a metal tube with hundreds of people. She wished she’d thought to get a mask for herself. It was good she was leaving when she was; if the virus spread, it might get complicated to fly. But then she looked around at all the people cramming their wheelie bags into overhead bins, adjusting their neck pillows, scrolling through the in-flight video choices, and dismissed the idea. Restless humans. You’d never stop them traveling.

Eleven people have been killed as a result of violence targeted at abortion providers: four doctors, two clinic employees, a security guard, a police officer, a clinic escort, and two others. Anti-abortion extremists are considered a domestic terrorist threat by the U.S. Department of Justice. Yet violence is not the only threat to abortion clinics. In the past five years, politicians have passed more than 280 laws restricting access to abortion. In 2016, the Supreme Court struck down a Texas law that would have required every abortion clinic to have a surgical suite, and doctors to have admitting privileges at a local hospital in case of complications. For many clinics, these requirements were cost prohibitive and would have forced them to close. Also, since many abortion doctors fly in to do their work, they aren’t able to get admitting privileges at local hospitals. It is worth noting that less than 0.3 percent of women who have an abortion require hospitalization due to complications. In fact colonoscopies, liposuction, vasectomies…and childbirth—all of which are performed outside of surgical suites—have higher risks of death. In Indiana in 2016, Mike Pence signed a law to ban abortion based on fetal disability and required providers to give information about perinatal hospice—keeping the fetus in utero until it dies of natural causes. This same law required aborted fetuses to be cremated or given a formal burial even if the mother did not wish this to happen.

In 1984, a psychologist named Roger Ulrich studied patients recuperating from gallbladder surgery at a Pennsylvania hospital. Some patients were assigned to a room overlooking a small strand of deciduous trees. Others were assigned to rooms that overlooked a brick wall. Urlich describes the results: “Patients with the natural window view had shorter post-operative hospital stays, had fewer negative comments in nurses’ notes . . . and tended to have lower scores for minor post-surgical complications such as persistent headache or nausea requiring medication. Moreover, the wall-view patients required many more injections of potent painkillers.” The implications of this obscure study are enormous. Proximity to nature doesn’t just give us a warm, fuzzy feeling. It affects our physiology in real, measurable ways. It’s not a giant leap to conclude that proximity to nature makes us happier. That’s why even the most no-nonsense office building includes a park or atrium (in the belief, no doubt, that a happy worker is a productive one).

The importance of a group seeing one another may sound trivial, but it can be deadly serious. Until recently when medical teams gathered to operate on a patient, studies showed that they often did not know one another's names before starting. A 2001 John's Hopkins study showed that when members introduced themselves and shared concerns ahead of time, the likelihood of complications and deaths fell by 35%. Surgeons, like many of us felt they shouldn't waste time with the formalities of seeing and being seen, for something as important as saving lives, yet it was these silly formalities that directly affected the outcomes of surgeries. It was when [the surgical team] practiced good gathering principles that they felt more comfortable speaking up during surgery and offering solutions.

I met a man in Baja California who left his life in Texas to start fresh. He said he’d had a family, but it “got complicated,” so he left. Now, in his sixties, he lives on the beach in a camper van. When I spent two summers in Alaska as a teenager, I remember seeing the same thing. There were so many grizzled men with wrinkles acquired from wrongdoing. They came to Alaska to forget and to be forgotten. The state seemed full of them. Patagonia is like that, too. The ends of the earth. The places that do not ask follow-up questions. I know I have it in me. In a small, frightening way, I have felt it when I’ve failed and my soul hardens like a statue. I’ve felt a surge of shame flip some switch and turn me cold. Meticulous. Surgical. I won’t live like that. It takes a safe and wide love to teach a man that it’s possible to fail and remain. —

Now there is no normal process except death which completely clears the brain from all past impressions; and after death, it is impossible to set it going again. Of all normal processes, sleep comes the nearest to a non-pathological clearing. How often we find that the best way to handle a complicated worry or an intellectual muddle is to sleep over it! However, sleep does not clear away the deeper memories, nor indeed is a sufficiently malignant state of worry compatible with an adequate sleep. We are thus often forced to resort to more violent types of intervention in the memory cycle. The more violent of these involve a surgical intervention into the brain, leaving behind it permanent damage, mutilation, and the abridgment of the powers of the victim, as the mammalian central nervous system seems to possess no powers whatever of regeneration. The principal type of surgical intervention which has been practiced is known as prefrontal lobotomy, and consists in the removal or isolation of a portion of the prefrontal lobe of the cortex. It has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier. However, prefrontal lobotomy does seem to have a genuine effect on malignant worry, not by bringing the patient nearer to a solution of his problems but by damaging or destroying the capacity for maintained worry, known in the terminology of another profession as the conscience. More generally, it appears to limit all aspects of the circulating memory, the ability to keep in mind a situation not actually presented. The various forms of shock treatment—electric, insulin, metrazol—are less drastic methods of doing a very similar thing. They do not destroy brain tissue or at least are not intended to destroy it, but they do have a decidedly damaging effect on the memory. In so far as this concerns the circulating memory, and in so far as this memory is chiefly damaged for the recent period of mental disorder, and is probably scarcely worth preserving anyhow, shock treatment has something definite to recommend it as against lobotomy; but it is not always free from deleterious effects on the permanent memory and the personality. As it stands at present, it is another violent, imperfectly understood, imperfectly controlled method to interrupt a mental vicious circle. This does not prevent its being in many cases the best thing we can do at present.

Expanding fitness just a bit—the equivalent of a person improving their max running speed from five to six miles an hour—reduces the risk of heart disease by 30 percent, according to the American Heart Association. Next is cancer. It kills 22.8 percent of us. The most fit people face a 45 percent lower risk of dying from the disease, according to a study in the Annals of Oncology. Then we have accidents. They take 6.8 percent of us. If a person is in a serious car accident, being in shape drops their chances of dying by 80 percent, according to a study in the Emergency Medical Journal. If the docs have to operate—regardless of whether it’s an emergency or a planned surgery—fitter people also face fewer surgical complications and recover faster than unfit people, say scientists in Brazil.

We are witnessing a shift in the political tectonic plates throughout the whole of the Middle East and beyond into Africa, and the west’s apparently surgical involvement will probably do little more than generate some short-term satisfaction that we are doing something. It is not that I am morally squeamish about bombing IS fanatics. Rather, I think we ought to recognise that we are little more than bystanders to a war that is so much bigger than we ever imagined, and so much more complicated than the rhetoric of terrorism or limited conflict allows. Since the second world war, we have got used to the idea that big war is a thing of the past. But no more. This is the third world war. And this time we are on its fringes.

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Legal You will learn that there are restrictions placed upon you in some areas. These restrictions are for your own protection. You will be prohibited from administering medications, recording sponge counts, or carrying out direct physician’s orders regarding treatment of a patient out of your scope of practice. As soon as you overstep your limitations and boundaries and perform any of these actions, you are placing yourself in legal jeopardy. Whether functioning under the supervision of a surgeon or a registered nurse, a CST is always part of the surgical team and you must carry out your responsibilities within the scope of your practice. Never try to do a task that does not fall within that realm. All counts are significant and have important legal ramifications. When performing a count, it is crucial to ensure that the count is correct for the patient’s well-being. When you are scrubbed, you count sponges while the registered nurse observes and records the count. At any given time during a surgical procedure, the CST may request a sponge, and possibly a sharps count to take place. If you are assisting the circulating nurse in a nonsterile role, you may assist with the counts as long as the nurse verifies it. In this scenario, the nurse is legally acting as the surgeon’s agent. It is the responsibility of the registered nurse to obtain the required medications for a case. The CST draws the drugs into syringes and mixes drugs when scrubbed; during this process, the proper sequence of medication verification and labeling must occur. In any phase of your responsibilities, there are possible grounds for legal breaches. Shortcuts may cause a patient to suffer tragic complications, even loss of life. Negligence must be avoided. Both as an employed CST and as a student, you carry the responsibility to do no harm. If you should become discouraged in your role or begin to feel this responsibility is overwhelming, it could simply mean that you need a change; it isn’t always the other team players or the place of employment that are at

Parents always have the best of intentions when they wish not to impose too much on their children, but in the absence of a normative standard, something else always fills the vacuum. Today, for instance, we flatter ourselves that we are morally neutral, that we can’t comment on a girl’s behavior for fear of crushing her “sexuality,” and yet we are constantly negatively judging a girl’s body rather than praising her internal qualities. The reality is that we haven’t moved away from judgment at all; it’s just that we judge girls now for their superficial “deficiencies.” Think of the alarming increase in the number of parents who buy their thirteen-to-eighteen-year-old daughters breast implants despite the high risk of surgical complications, or consider eleven-year-old Lilly Grasso, an athletic girl of normal weight who came home from school toting a so-called “fat letter” warning her mother that her BMI put her at risk. (Twenty-one out of fifty states now mandate BMI testing in schools, with dubious results.) Then there is the large number of boys who report that they are “revolted” by girls whose privates do not resemble those of the porn stars they view online, and in 2013, a student body president at the University of Texas–Austin even felt free to share his views about how to judge a woman’s private parts, and whether they will prove to be “gross,” based on her general appearance. Is encountering such negative judgments directed against a young woman’s body and most private areas empowering? Is such an attitude enlightened for either party? Or is it more empowering to praise a young woman for her internal qualities of character? I personally feel that it is the latter.

he relied on me for surgical expertise.

In 1984, a psychologist named Roger Ulrich studied patients recuperating from gallbladder surgery at a Pennsylvania hospital. Some patients were assigned to a room overlooking a small strand of deciduous trees. Others were assigned to rooms that overlooked a brick wall. Urlich describes the results: “Patients with the natural window view had shorter post-operative hospital stays, had fewer negative comments in nurses’ notes . . . and tended to have lower scores for minor post-surgical complications such as persistent headache or nausea requiring medication. Moreover, the wall-view patients required many more injections of potent painkillers.

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intensively and extensively studied. More is known today about the safety of legal abortion than most other operations in surgical practice. The complication rate with current methods is low, and concern about potential late complications has largely vanished.43

It turns out, she says, that there is something that reliably reduces pain, distress and the risk of complications and interventions during labor. But it isn’t a drug, a scan or a surgical procedure. It isn’t a fancy birthing position, or even a state-of-the-art hospital wing. It’s having the same caregiver stay with you throughout a birth.

For paralyzed people the fitting and integration of an exoskeleton was a complicated affair, they told him, stretched out over months of tests, and a certain amount of surgical fusion of electrodes and nerves. For a normal person it was much simpler. It was like a bra fitting

In light of all this, it seems fitting that one of God’s great covenants with the Jewish people was a medical procedure that helped combat infection: circumcision (Genesis 17:9–14). In 2012, a task force on circumcision organized by the American Academy of Pediatrics published a review of the costs and benefits of male circumcision. In their estimation the primary benefits are a reduction in urinary tract infections among infants; lower transmission of some STDs, such as HIV and HPV; and fewer cases of penile cancer (often caused by HPV infections). To be sure, circumcision does not appear to reduce transmission of all kinds of STDs; the surgical procedure itself carries a small, non-negligible risk of complications; and some people have raised ethical issues with removing a sensitive part of an infant male’s penis. However, in an era when infectious disease was the number one cause of mortality and incurable STDs could easily cause sterility, male circumcision was probably a wise decision.

Patients diagnosed with cancer and treated with our multisdisciplinary approaches are knocked down physically and emotionally, but they pick themselves up off the canvas and struggle on. They carry the reminders of the acute and chronic side effects from cytotoxic chemotheraly and radiation-induced skin and functional-organ changes. They endure the scars, complications and impairments imposed by the blades of surgical oncologists like me. Though sometimes they want to, they don't leave. They remain. They maintain. I respect the effort, the invincible spirit, and the patients, who don't give a damn about the odds or probabilities, they are going out swinging. We are tag-team partners in oncology, entering the ring to attack cancer with every move and method we know. Hell, I'll even throw a few chairs if it will help.

José Martí is recognized as the George Washington of Cuba or perhaps better yet, as the Simon Bolivar, the liberator of South America. He was born in Havana on January 28, 1853, to Spanish parents. His mother, Leonor Pérez Cabrera, was a native of the Canary Islands and his father, Mariano Martí Navarro, came from Valencia. Families were big then, and it was not long before José had seven sisters. While still very young his parents took him to Spain, but it was just two years later that they returned to Santa Clara where his father worked as a prison guard. His parents enrolled José at a local public school. In September of 1867, Martí signed up at the Escuela Profesional de Pintura y Escultura de La Habana, an art school for painting and sculpture in Havana. Instead of pursuing art as a career, Martí felt that his real talents were as a writer and poet. By the early age of 16, he had already contributed poems and articles to the local newspapers. In 1865 after hearing the news of Abraham Lincoln’s assassination, he was inspired to seek freedom for the slaves in his country, and to achieve Cuban independence from Spain. In 1868, Cuban landowners started fighting in what came to be known as the Ten Years’ War. Even at this early age, Martí had definite opinions regarding political affairs, and wrote papers and editorials in support of the rebels. His good intentions backfired and he was convicted of treason. After confessing, he was sentenced to serve six years at hard labor. His parents did what they could to have their son freed but failed, even though at the age of sixteen he was still considered a minor. In prison, Martí’s legs were tightly shackled causing him to become sick with severe lacerations on his ankles. Two years later at the age of eighteen, he was released and sent to Spain where he continued his studies. Because of complications stemming from his time in prison, he had to undergo two surgical operations to correct the damage done to his legs by the shackles. End of part 1.

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The circulating nurse. This is a Registered Nurse who has been trained to work in the operating room. The circulator helps get the room ready, deals directly with the patient before surgery, positions and preps the patient, helps the anesthesiologist during induction, performs the surgical count with the scrub, and gets supplies during the case. The circulator also has to chart everything that happens during the case and all supplies used. This is done on computer, on standardized forms that are lengthy and considered legal documents. Many OR nurses scrub too, but it’s cheaper for hospitals to use one tech and one nurse as a team, rather than two nurses. The Anesthesiologist, and/ or Certified Registered Nurse Anesthetist. The Primary Surgeon, who may bring an Assisting Surgeon or Resident, or a Physician's Assistant, or a Registered Nurse First Assistant, or a First Assistant who is usually a Certified Surgical First Assistant. Anesthesia Technician, to get supplies ready and support the anesthesiologist. Equipment tech. Some hospitals have a designated person to help with the complicated tables, beds, microscopes, etc.

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