Table of Contents
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To caregivers of all varieties,
especially to those who have always cared for and supported me:
my wife, Kelly Butler Holtz; our children, Aaron and Judy;
and my parents, Merriman and Carolyn Holtz
THANKS
This book would not have been possible without the support of John G. Hunter, M.D., Mackenzie Professor and Chairman of Surgery and Karen Deveney, M.D., Professor of Surgery, Vice Chair of Education and Residency Program Director at the Oregon Health & Science University (OHSU) in Portland. They agreed to open their program to me to help the public they serve better understand the work they and colleagues do every day and every night. The staff members who work with them, including Residency Coordinator Robin Alton, Pam Sidis, and Erin Anderson were always helpful.
Liana Haywood of the News and Publications staff deserves special notice for her persistent efforts to clear the way. Jim Newman and Tamara Hargens-Bradley both helped champion the project. Christine Deckers assistance was appreciated and will be missed.
Of course, the heart of this project is the team of residents and surgeons at OHSU. They allowed a visitor to shadow them, ask questions, page them, and pester them day and night. Here are the names of some who helped.
Attending Surgeons
John Barry, M.D.; Kevin Billingsley, M.D.; Bruce Ham, M.D.; John Ham, M.D.; Karen Kwong, M.D.; Greg Landry, M.D.; Tim Liem, M.D.; Robert Martindale, M.D.; John Mayberry, M.D.; Erica Mitchell, M.D.; Greg Moneta, M.D.; Richard Mullins, M.D.; Robert ORourke, M.D.; Susan Orloff, M.D.; Stephen Rayhill, M.D.; Martin Schreiber, M.D.; Brett Sheppard, M.D.; Donn Spight, M.D.; Donald Trunkey, M.D.; Jennifer Watters, M.D.
Fellows
Charles Kim, M.D.; Renee Minjarez, M.D.; Aaron Partsafas, M.D.; David Shapiro, M.D.
Residents
Aric Aghayan, M.D.; Alexis Alexandridis, M.D.; Cyrus Ali, M.D.; Amir Azarbal, M.D.; Adam Baker, M.D.; James Ballard, M.D.; Jeff Barton, M.D.; Daniel Brickman, M.D.; Nathan Bronson, M.D.; Jeffery Brown, M.D.; Emily Bubbers, M.D.; Brian Caldwell, M.D.; Jimmy Chim, M.D.; David Cho, M.D.; Dara Christante, M.D.; Daniel Clayburgh, M.D.; Molly Cone, M.D.; Rachel Danczyk, M.D.; Birat Dhungel, M.D.; Raphael El Youssef, M.D.; Michelle Ellis, M.D.; Kristian Enestvedt, M.D.; Michael Englehart, M.D.; Loc Fabricant, M.D.; Brian Farrell, M.D.; Megan Frost, M.D.; Guang Gao, M.D.; Arvin Gee, M.D.; Ryan Gertz, M.D.; Michael Grant, M.D.; Esther Han, M.D.; Karin Hardiman, M.D.; Adrienne Heckler, M.D.; Winnie Henderson, M.D.; Crystal Hessman, M.D.; Yin-Kan Hwee, M.D.; Shiney Isaac, M.D.; Terah Isaacson, M.D.; Brian Jones, M.D.; Jason Jundt, M.D.; Modjgan Keyghobadi, M.D.; Sajid Khan, M.D.; Laszlo Kiraly, M.D.; Chris Komanapalli, M.D.; Marcus Kret, M.D.; Sandeep Kumar, M.D.; Nicholas Kunio, M.D.; David Dae Lee, M.D.; Tim Lee, M.D.; Jessyka Lighthall, M.D.; Jean Lin, M.D.; Katrine Lofberg, M.D.; Carl Luem, M.D.; Alosh Madala, M.D.; Kristen Massimino, M.D.; Laura Matsen, M.D.; Lyudmila Morozova, M.D.; Melanie Morris, M.D.; Stephen Noble, M.D.; Pat OHerron, M.D.; Marc Orlando, M.D.; Timothy Osborn, M.D.; Alan (Scott) Polackwich, M.D.; Glenda Quan, M.D.; Arun Raman, M.D.; Jennifer Rea, M.D.; Gordon Riha, M.D.; Mitchell Sally, M.D.; Kelli Salter, M.D.; Chitra Sambasivan, M.D.; MaryClare Sarff, M.D.; Scott Sklenicka, M.D.; Mary Sorensen, M.D.; Nick Spoerke, M.D.; Elliot Stephenson, M.D.; Ashley Stewart, M.D.; Jason Susong, M.D.; Julia Swanson, M.D.; Nick Tadros, M.D.; Brandon Tieu, M.D.; Rakhee Urankar, M.D.; Phil Van, M.D.; Tammy Washut, M.D.; Charlotte Weeda, M.D.; Wei Wei, M.D.; Nathaniel Whitney, M.D.; Daniel Wieking, M.D.; Victor Wong, M.D.; Sharon Wright, M.D.; Lianjun Xu, M.D.; Douglas York, M.D.; Minhao Zhou, M.D.; Liyan Zhuang, M.D.; Karen Zink, M.D.
Melissa Johnson, M.D. (Emergency Medicine); Eric Reid, M.D. (Urology).
Medical Students
Jonah Attebery (MS3); Alalia Berry (MS3); Joshua Kornegay (MS3); Derek Leinenbach; Mara OBrien Colbert; Kirstie Schneider (MS4); Ian White (MS4).
Others
Norman Cohen, M.D.; Nicole DiIorio, M.D.; Sydney Ey, Ph.D.; Robert Hendrickson, M.D.; J. Mark Kinzie, M.D., Ph.D.; Zachary Litvack, M.D.; Madison Macht, M.D.; Mary Moffit, Ph.D., R.N.; Doug Norman, M.D.; Thomas Yackel, M.D.
A wave of thanks also goes to those whose names I failed to record.
All I did for them in return was occasionally deliver some sutures to the scrub tech in the OR when the circulating nurse was busy.
AN APOLOGY
In this attempt to respond to the curiosity of fans of Greys Anatomy and others, the book limits itself to the frame of reference of the showthat is, the experiences of surgery residents and the attending surgeons they are learning from. Looking at hospital care through this lens unfairly diminishes the role of nurses and others, without whom patients would be lost. I have written elsewhere about nurses, so I hope they will forgive me for not giving them their due prominence in this work.
A NOTE
The privacy of patients is protected by tradition, ethics, rules, and law. In connection with my status as a Clinical Instructor at OHSU, my observations of patient care will be used by OHSU as part of its educational and quality assessment and improvement activities. OHSU Legal Counsel Steve Conklin and Chief Privacy Officer Ronald Marcum, M.D., helped me do this work while protecting the trust and rights of patients.
To protect the privacy of patients certain descriptive details have been altered. The events described took place at various times during 2007-2009.
OREGON HEALTH & SCIENCE UNIVERSITY (OHSU)
OHSU is Oregons only academic medical center. Perched on hills overlooking Portland, it is probably the only teaching hospital that offers staff and students a tram pass so they can shuttle between the main campus and a new clinic building on the Willamette riverfront several hundred feet below.
The hospital has more than 600 beds. The hospital and associated clinics serve about 200,000 patients who make more than 700,000 visits each year. There are about 12,000 employees.
The educational programs include about 2,400 students and almost 1,000 residents. The General Surgery residency program graduates 12 surgeons each year, making it one of the largest programs in the United States. (Indiana University graduates up to 12 general surgeons a year and the University of Texas Southwestern graduates up to 13 general surgeons each year.) Surgery residents work at not only the OHSU hospital but also the Portland VA Medical Center and several community hospitals in the Portland area.
Introduction
Lets get the sex out of the way.
The first scene of the first episode of Greys Anatomy opens with Meredith Grey and Derek Shepherd waking up in her living room after a one-night stand. They dont even know each others names, much less that they will be working together at Seattle Grace Hospital. From that opening moment it is clear that the focus of the show is squarely on the personal lives and relationships of the main characters. Medicine, or more specifically hospital practice and the training of young surgeons, form the cauldron of stress and crisis and challenge in which the characters react and act, fight and love, achieve and stumble. Greys Anatomy is a medical drama... with the emphasis on personal drama. Medicine merely provides the background.
