Leaving a beautiful scar

first_imgWindsurfer Gonzalo Giribet and pianist Vijay Iyer have also been featured in Practice, a series of profiles zeroing in on the makings of performance.A surgeon’s knot seems a simple thing, tied to keep the insides in and the outside out.But a simple knot can be harder — and more vital — than it looks. A surgeon tying a knot isn’t like the rest of us tying our shoes, unless you sometimes tie with one hand or clutch your laces with surgical instruments.For physicians who’ve delved into the mysteries of loops, throws, and ears, square knots are routine and, with an extra overhand turn, become surgeon’s knots, less likely to slip. Only when they’re mastered can they be used in procedures, where knowledge of anatomy and disease are also crucial, where a knot too loose can cause a wound to leak and one too tight can kill the tissue it encircles.“I learned by practicing constantly as a medical student,” said Terry Buchmiller, an assistant professor of surgery at Harvard Medical School and Harvard-affiliated Boston Children’s Hospital. “The nurses would let us take the extra suture that wasn’t used during an operation. They’d always slide it to the medical student so we could grab it and go back and just sit and doodle [with it] and tie knots at home.” By now, the many steps behind a successful surgery — including knot-tying — are mostly second nature to Buchmiller, who specializes in the delicate work required on small children, newborns, and, when necessary, fetuses in the womb.But in the beginning, surgery was exactly as music had been.Growing up in Cupertino, Calif., Buchmiller first picked up the violin at 7, spending hour upon hour practicing the scales and finger positions. By high school she’d performed in two symphonies. She was a music major in college, practicing five or six hours a day to master a piece: the perfect placement of her fingers, the just-so angle of the bow, the bouncing arpeggio stroke, the tremolo’s fluttering repetition. As a member of the Longwood Symphony Orchestra, the memory of those sessions is more a feature of action than reflection.“At one point, in high school, I played three to four to five hours a day; during college, as a music performance major, sometimes five to six hours a day. So it was a tremendous amount of focus on that skill.”But it was a focus held in balance. Buchmiller had taken up her pediatrician on his offer to follow him around and observe his work. She was 15 when she saw her first surgery, at the University of California at San Francisco. She was always fascinated by the ability to fix what ailed people.“That interest never waned,” Buchmiller said. “I never had to decide what to do when I grew up.”‘You walk in and there’s a performance, that one-time performance for that patient.’Though the two may seem opposites, medicine and music have pulled her along instead of apart, Buchmiller said. The way of practice taught to her by music was mirrored in medicine: Break the complex down to its composite parts, learn those parts through intense practice, and then put them together into a greater whole.“The traditional way surgery and music is taught, the way that I learned both, was to focus on the individual building blocks, each individual skill, and then learn the big picture. Very scientific and very logical at the beginning and putting in the emotional part and the nuances only when your fingers know what to do, when your hands know what to do.”Even after years of performing general surgery, there was still plenty to learn, as Buchmiller realized when she arrived at Children’s Hospital in 1995 to begin her fellowship in pediatric surgery.“I could tie knots perfectly for a general surgeon, but now let’s try some on a baby. You’ve been through nine years of general surgery training and then you were told … well, that you had an opportunity to learn to be gentle all over again. That philosophy — because we do work on babies and children — that delicacy is paramount is something that is still ingrained in my head. Every time I go into the operating room, I still hear that voice from my mentor, and maintain a critical eye for not only my fellows’ and my residents’ hands, but mine as well.”But medicine is more than craft. The surgical skills that seem important to her today aren’t physical tricks or manipulations of the scalpel, but qualities of mind: focus and teamwork.“I think one is stamina. There’s no question that the ability to stay focused is a huge piece of surgery. This intense focus — I mean, hours can go by. Music may not [require] the same stamina, musical concerts are usually for a finite time, but I think the team-building skills are fairly similar.“Whether or not you’re the head of a surgical team in the operating room or if it’s just you and a pianist, or you as part of a symphony orchestra, it’s a team.”An operation requires a unit just as a symphony requires individual musicians. Each individual has to master specific skills, whether it’s administering anesthesia or playing certain notes, for the group to realize its goal.“If you really look at the way a conductor rehearses a symphony, they break the parts down and they drill [musicians] in the parts and then, only when we know the mechanics of it, can the conductor really be free to put the whole together to make the music, interpret the music,” Buchmiller said.“Our conductor’s always trying to embed in our … heads, ‘Please don’t wait until the last week to learn the notes because I want to make the music and I can’t make the music until you all really know the notes.’”Years of playing the violin helped shape Buchmiller’s approach to medical training.Then there are the notes of the operating room, individual acts by doctors and nurses and even by increasingly sophisticated machines, beeping and whooshing and tracing bright lines. These notes, punctuated, if all goes well, by the perfect knot, will never be played in quite the same way again, but the patient will live with them forever.“You walk in and there’s a performance, that one-time performance for that patient,” Buchmiller said. “You want the scar to be beautiful, because the kids are going to have that for, God willing, 70 or 80 years.”last_img read more

Louisiana residents, still reeling from Laura, prepare for Delta

first_imgNew Orleans may be spared the worst of the storm, although it will be hit by gusty winds and mild rain, said AccuWeather meteorologist Dan Kottlowski, with Lafayette the largest city on the storm’s eastern and more dangerous side.WalMart said it was closing many of its stores across the Gulf Coast as a precaution.On Thursday morning, Morgan City resident Lisa Mire and three friends took shelter from a light rain to pray for former colleagues facing the COVID-19 pandemic as teachers.The storm added urgency to the group’s regular get-together, she said.”We have today to prepare ourselves and our families for the arrival of Hurricane Delta,” Edwards told residents. “Let’s make it count.”The state sought and received a federal emergency declaration, he said, making additional resources available.Energy companies halted 92 percent, or nearly 1.7 million barrels per day of offshore oil output, and 62% of natural gas production, data showed. The US Coast Guard warned shippers of impending gale force winds from Port Arthur, Texas, to New Orleans.Southwestern Louisiana bore the brunt of Hurricane Laura’s fierce winds and storm surge in August. There are about 8,000 people still living in hotel rooms as a result of the devastation to homes in the southwest of the state from by Laura, Edwards said on Wednesday.When Delta reaches the northern Gulf Coast, it will be the 10th named storm to make a US landfall this year, eclipsing a record that has held since 1916. Residents of Louisiana, still battered from Hurricane Laura, fled inland or hunkered down on Thursday as Hurricane Delta barreled toward the state, growing in size and force as it spins across the warm waters of the Gulf of Mexico.The storm, packing winds of up to 115 miles per hour (185 kph), ranked as a category 3 hurricane on the Saffir-Simpson Hurricane Wind Scale on Thursday afternoon and National Hurricane Center forecasters expect it to strengthen before making landfall sometime late Friday.”They never had time to recover from Laura and now this next storm is hitting them. They never had time to get back on their feet and they didn’t think they could survive the second one,” Cathy Evans, 63, said of her daughter’s family as she helped them move out of their Lake Charles home. Evans, who traveled to Lake Charles from Texarkana, Arkansas, left with her daughter and family for Texas on Thursday evening as Louisiana was closing its flood control gates.Delta is forecast to make landfall on Friday in hard-hit southwest Louisiana, between the cities of Lake Charles and Lafayette, said Benjamin Schott, chief meteorologist of the National weather Service office in New Orleans.The storm could drive a 4- to 11-foot (1.2-3.3 meters) storm surge up Vermilion Bay on the coast, the NHC said. It could also unleash tornadoes as it moves over land and drop up to 10 inches (25 cm) of rain.”I know people in Louisiana, especially the southwest are very strong and very resilient, but they are going to be tested here,” Governor John Bel Edwards said at a news conference on Thursday afternoon.center_img Topics :last_img read more