Cold hands, bright eyes, and tuberculosis… Happy New Year!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from fellow AWS members -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
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Lauren Poindexter
MD Candidate, Class of 2015
Virginia Tech Carilion School of Medicine

Nearly every child lining the Pasadena Tournament of Roses Parade route on New Year’s Day in Southern California is bundled up to their noses in oversized parkas, gripping onto their parents hands tightly so as not to get lost in the excitable mass of humanity. Long before the start of the parade at 8:00am, bright-eyed children pull adults this way and that in attempts to touch the vibrant flowers, seeds, and grasses of the floats, stare at the huge costumed parade horses, and say hello to the perfectly-positioned musicians of the marching bands. Fascination and wonder predominates. Families are honored, a community gathers, rival football fans cheer, the nation celebrates a new year. Since the first Rose Parade in 1890 and the first Rose Bowl Game in 1902, the scene has only grown larger and more fantastic. New Year’s Day is my favorite holiday!

However lighthearted the modern festivities appear, few know of the original purpose of the Rose Parade and its roots in medical history: it was a nineteenth century small-town public relations stunt to entice the families of tuberculosis patients to relocate to Pasadena. Their target audience was East Coast citizens trapped in frigid, blustery winters.

The founder of Pasadena’s exclusive society, the Valley Hunt Club, was, himself, an East Coast transplant, former “consumptive,” and mastermind of the first Rose Parade. He established his club in 1888, the same decade when Prussian scientist Robert Koch identified the Mycobacterium tuberculosis organism, and at a time when physician specialists in America espoused the healing benefits of “climatic therapeutics” for tuberculosis sufferers.

Physicians in those days recommended their patients receive modern tuberculosis treatment and rest in temperate locales – ideally ones offering drier climes, mild winters, and warm temperature ranges. Through the late 1800’s and early 1900’s, international medical journals, textbooks, and newspaper articles included the Greater Los Angeles Area in their purported list of ideal regions. The Valley Hunt Club’s goal was to capitalize on this movement.

The 1890 Rose Parade featured a festival atmosphere of many athletic competitions and a parade of floral-bedecked horse-drawn carriages held under a sunny blue sky in the “dead of winter.” Vivid roses draped over horses necks and bundles of bright juicy citrus fruits wowed the 8,000 attendees. Foot races were run, children rode ponies, and visitors gushed in letters to their families.

Amidst the sprawling citrus groves and well-established ranches, newly constructed mansions sprouted in Pasadena. A residential spectacle dubbed “Millionaire’s Row” consisted of an impressive line of winter retreats commissioned by Eastern magnates desperate for a seasonal escape. Famous residents included the Wrigleys of chewing gum fame and the Gamble family of Proctor & Gamble. Average citizens also sought treatment for tuberculosis in this region. Pasadena’s “Ballard Pulmonary Sanitorium” was well-known for its excellent outcomes and its success was complimented by donations of dollars and volunteer time from members of local women’s clubs. By 1910, Pasadena was one of the fastest growing cities in the US.

When the Valley Hunt Club could no longer financially sustain the wild success of the Rose Parade, the non-profit Pasadena Tournament of Roses was created, eventually choosing William Wrigley’s winter mansion as its home base. Today, the parade progresses down the original “Millionaire’s Row” (now Orange Grove Boulevard) and past the Wrigley Estate. As a young child, I, too, was overwhelmed by the fantastic experience of the Rose Parade and fondly remember the years when we would spend New Year’s Eve at my grandfather’s townhouse across from the Wrigley Estate. He had ventured to Southern California as a young man to start his family in this beautiful region and was a strong supporter of the Tournament’s community involvement.

Though I’ve since migrated back east for medical school, and my grandfather has passed away, I look forward to every opportunity to head home to Pasadena for this annual celebration. Spending time with my family on a crisp January morning watching scores of floats, marching bands, and equestrian units, plus a raucous college football competition, is my favorite way to start a new year. Now I know to credit this event to the Valley Hunt Club… and tuberculosis!

* Tradition dictates that no parade will be held on a Sunday, therefore January 2nd is an alternate date.

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from fellow AWS members -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
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Minerva Romero Arenas, MD, MPH
Resident

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas Eve because in the Catholic faith it is the celebration of the birth of Jesus Christ. My family traditionally gave us kids gifts on Día de Los Reyes Magos (The 3 Wise Men), which correlates to the gifts presented to Jesus. In addition to reflecting on the spiritual meaning of the Christmas holidays, I also like to take time to think about the previous and upcoming years and to remind my family and friends how special they are to me.

What are some family traditions you have related to this holiday?
Being Mexican in the US means my family celebrates both cultures. We still celebrate primarily on Christmas Eve, we pray and sing carols, and have a Posada. Dinner varies - traditionally turkey is on the menu for this day- but we change it up according to what everyone wants to eat. One of my favorite memories was when my grandmother showed my cousins and I how to make tamales. Other years we have enjoyed catered Chinese or Indian food. After having lived in the US many years we adopted the tradition of exchanging presents on Christmas morning. On January 6th, we try to continue the tradition of eating King's cake.

Do you have a good memory of patient care during a time you worked during
the holiday?

I've had several years in residency that I could not travel back home for the holidays. I am thankful for technology like FaceTime, which enabled me to share some special moments with my family while away. Nonetheless, during the holidays the patients who are in the hospital are usually very sick & grateful to have us around helping keep an eye on them in their recovery from surgery or trauma injuries. I have to admit that some of my favorite memories are sharing food with nursing, our mid-level providers, attendings & OR staff. In particular, I am thankful for having co-workers and mentors who have invited me to join them for dinner.

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from fellow AWS members -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Kandace P. McGuire, MD, FACS
Assistant Professor of Surgery
Director Breast Surgical Oncology Fellowship & Premenopausal Breast Services
Magee Womens Hospital of UPMC


What holiday do you celebrate and what is the special meaning of this
holiday to you?
My family and I celebrate Christmas. We have celebrated many ways on many days and on multiple continents over the years! To me, Christmas is about family and giving. I love reconnecting with those I have lost touch with and being able to give to them and others during the holiday season.

What are some family traditions you have related to this holiday?
We have many family traditions, but my favorite is our annual trip to NYC. We take our son to see the tree in Rockefeller Center and to FAO Schwartz. We also take him to a restaurant that wouldn’t normally be “kid-friendly”. Last year we went to Le Cirque. He was such a little gentleman; they invited him into the kitchen to make his own dessert with the pastry chef! The 80 year old owner stopped us on the way out and complimented us on our well-behaved child. Pretty special!

We also have a tradition of giving to a child in need every year. I try to choose a boy who is about the same age as my son, so that he can pick out gifts that he would like and then give them away. Every Christmas morning we try to remember how special this Christmas must be for the little boy to whom we gave.

Do you have a good memory of patient care during a time you worked during
the holiday?
I was on trauma call for Christmas Eve my second year of residency. A funny story is a family of four who came in after a minor motor vehicle collision. They were spread out throughout the trauma bay: mother, father, two boys. Unfortunately, Dad was driving without a license and when the cops came to talk to him, you could hear one of the boys from around the corner yell, “Is Dad getting arrested AGAIN?!?”
Luckily, the cops gave him a summons and let him go home to enjoy Christmas with his family.

A nice memory is later that night, going across the street from the hospital to the only restaurant open, a diner that served the hospital and the local Philly old-timers. The entire trauma team crowded into a booth, ordered black and white milkshakes and burgers and traded war stories. We were blessed by no major traumas that night and no sad endings. It was one of my most memorable nights on call during my residency.

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from members of the Association of Women Surgeons -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
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Amalia Cochran, MD, FACS, FCCM
Blog: amaliacochranmd.com
Twitter: @amaliacochranmd

One of my favorite traditions during residency grew up from a tradition back home in Texas. I’ve long believed that tamales are Christmas food, and when I moved to Utah for residency, I started the tradition of a tamale dinner at my house on Christmas night for my co-residents, friends…anyone who wanted to drop by.

At first, quite a few of them thought it was an intriguing and strange tradition, but it was always a fun evening. By Christmas of our PGY-6 year, one of my classmates looked at me as she was eating her tamales and confessed, “I’m going to miss this next year when I’m in Minnesota.” While I got to have my Christmas tamales with my Mom the next year- and was back in Texas for my fellowship - it definitely wasn’t the same.
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Brittany Bankhead-Kendall, MD, MSc
Resident

This Christmas my family and I will be navigating the waters that the "Match" has bestowed upon us- living on separate sides of the country. My surgery residency is in Michigan, and my husband's emergency medicine residency is in Texas. He and my son decorated our tree while we "FaceTimed." No parent likes to be away from their children, especially during holidays. But I think Christmas is about traditions, making traditions, and yet sometimes breaking them to remember what's really important.

AWS' Clinical Practice Committee pilots a TweetChat

Over the past few years, the Clinical Practice Committee has periodically read and discussed books which have provided beneficial tactics for added success in the management of our professional and personal lives. This activity has truly been enjoyed by the committee members. In search of ways to share this activity with the larger membership, we decided to pilot a tweet chat. 

The committee’s experience with twitter ranged from zero to those who frequently tweeted. Armed with some basic guidelines from the Healthcare Leadership blog and the buffersocial blog, the CPC had its first Tweet chat on November 10. 

The book for discussion was Success Under Stress by Dr. Susan Melnick.  This book was reviewed by Dr. Sasha Adams in the August issue of eConnections. Dr. Adams led the discussion for the tweet chat. There were seven participants. A few of us had some problems initially seeing the stream of conversation, especially if we were using Tweetchat.com. Those who used HooteSuite.com as the platform for the chat had absolutely no difficulty following the stream. 

In the end, everyone was able to contribute final thoughts about key messages gleaned from the book:

1. Prioritize
2.  Pick your battles
3.  Control what you can- your 50%
4.  Be intentional rather than reactive
5.  Don’t just be reactive; anticipate
6.  Have control of your time; be purposeful
7.  Don’t let stress control the situation

Though a little challenging, we successfully made it through our first tweet chat!  We look forward to hosting another Tweet chat early next year featuring the Surgical Career Guide, due to be released in January, 2015.

Ergonomics-A Call to Action-When Helping Others Harms the Surgeon

By: Celeste Hollands, MD, FACS 

Why was everyone shocked when shortly after my partner retired I told them he was only 62?  He had had a heart attack and back surgery during his career.  He walked with a limp and had to sit to operate due to years of standing in the operating room without regard to his own well being so he could provide outstanding surgical care to the children he served.  We give our time selflessly, our reimbursement is diminished, there are certain health hazards to a job where you stand on your feet, but must we sacrifice our health?  Isn’t there a better way to partner with industry to develop instruments and devices that are ergonomic or can be made ergonomic for all that use them?

We all remember our childhood and think back to what has changed as we have grown up and grown older.  I remember riding in the “way back” of our Volkswagen beetle-3 little kids delighted to be in that special secret place where only us kids would fit.  Did my parents love us? Of course they did.  Were they smart and educated? Yes.  Safety devices such as seatbelts were neither widely available nor used at that time. When safety devices were developed, they were designed for the 50^th percentile male.  So seat belts, especially the 3-point restraint systems naturally did not “fit” many smaller men, most women and almost all children.  Car seats and booster seats were designed, kids were moved to the back seat to avoid injury from air bags which were the newest “safety” device and on and on it goes.

Surgical devices and surgical instruments are largely similar in design approach.  Those of us with smaller hands cannot operate many of the instruments in the manner that was intended.  We have adapted in many cases-that is what we do-to provide the best care for our patients.  Many of the adaptations result in work related injuries-either from misuse or repetitive use injuries in instruments that were not designed for small hands.  Some injuries are not related to hand size at all, just repetitive use of instruments or surgical systems that were not designed with the user-the surgeon-in mind.

Injuries related to the ergonomics of minimally invasive surgery (MIS) have been investigated and reported.  Youssef and colleagues (1) analyzed the risk to surgeons from side standing and between the leg standing positions during laparoscopic cholecystectomy. They concluded that the American side standing position posed risks of injury to the surgeon due to increased physical demand and effort resulting in ergonomically unsound conditions for the surgeon.   Esposito and colleagues (2) reported on work-related musculoskeletal disorders (WMS) of the upper extremity in pediatric laparoscopic surgery.  Their work parallels the work of Park and colleagues (3) in that the longer you have been performing MIS and the larger your caseload the more symptoms you report and experience. 

Women performing laparoscopic surgery report more hand and shoulder symptoms than men and seek treatment for these symptoms more often even though they have been in practice a shorter time.  This finding is from work by Sutton and colleagues (4).  These findings seemed to be independent of glove size and probably more related to instrument handle size and design and/or table height. 

A recent discussion thread on the ACS Women Surgeons community focused on flexible endoscopes and the lack of ergonomics for those with smaller hands.  A number of good suggestions came forth for adapting safely to this challenge.   These tips included how to best use an assistant; how to position yourself, the patient and  the table; and how to manage the dials and grip and manipulate the scope.  This is all very valuable information however the tips do not solve the issue for those with small hands.  One discussant brought forth the knowledge that there was an adapter available that could be obtained from the company rep that helped with manipulating the dials.

If surgeons are discussing ergonomics and these work related injuries at all, it is likely behind closed doors, in a more private, more intimate setting-like the locker room or lounge since that is often where you immediately feel the mental and physical strain of the operation or procedure you just completed.  It is when you have the time to readjust your focus for a moment to yourself that you are more likely to share your symptoms with those around you. 

Ergonomics and surgeons’ work related injuries are an important topic.  Some of the ergonomics are relative to all surgeons and some will be unique to those with smaller hands and of smaller stature.  Identifying the magnitude of the issue and then designing studies to document it while partnering with industry to fix it is the next step.

We can wear support stockings, “sit when you can”, adjust table height, assume good posture and be mindful of our physical and emotional health. I remember when I was a resident one of the cardiothoracic surgeons was taking off his support hose in the lounge after the case and he told me that if I stayed a surgeon long enough that eventually gravity and low pressure systems in the body would be my enemy.  He could wear support hose to help his legs but there were other things he could do little to manage.  After 16 years in practice following 9 years of training, Mark, I get it!  We can do our part to manage and control these ergonomic issues. We cannot remanufacture instruments and devices. 

I encourage you to share your experiences here on our blog.  Let’s have a very powerful conversation that leads to meaningful results.  If someone has already stated an issue you have experienced-acknowledge it and be counted.  There is power in numbers and we need power to begin to get industry to respond and partner with us. 

1. Youseff Y, et al.  Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position.  Surg Endosc (2011) 25:2168-2174
2. Espositio, C et al.  Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery.  A multicenter survey.  J Pediatr Surg (2013) 48:1750-1756
3. Park et al.  Patients benefit while surgeons suffer: An impending epidemic.  J Am Coll Surg  (2010) 210:306-313
4. Sutton et al.  The ergonomics of women in surgery.  Surg Endosc (2014) 28:1051-1055

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays – both at home and work.

Please enjoy these delightful stories from members of the Association of Women Surgeons -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Stephanie Bonne, MD, FACS
Assistant Professor
Trauma, Acute, and Critical Care Surgery
Washington University in St. Louis

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas - I was raised Catholic and that's just the way it is!

What are some family traditions you have related to this holiday?
My mother's family is Polish, so we have a very traditional dinner on Christmas Eve with mushroom soup, fish, pierogi and picked Herring.

Do you have a good memory of patient care during a time you worked during
the holiday?
For the past several years, I've worked 6pm-6am over Christmas in the ICU. I kind of like it - there is a ton of food to eat, everyone is kind of cozy and happy. We watch NORAD tracks Santa at the nurses' station. The patient's families are usually in in the evenings and you can walk around and say hello to everyone.

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Callie Thompson, MD
Resident

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas. For me, the holiday is a time of new beginnings and hope. I love spending this time of year with my family and seeing my children enjoy the same traditions that I loved as a kid.

What are some family traditions you have related to this holiday?
My family is very big on tradition so we try to do the same thing every year. We start by going to church on Christmas Eve and this year, my two oldest children are both in the Christmas play so I am really looking forward to that. On Christmas morning we open stockings and then have to have breakfast before we move to the presents from Santa. We are open-one-at-a-time-while-everyone-watches people.

Do you have a good memory of patient care during a time you worked during
the holiday?
My favorite holiday memory in the hospital would be from Christmas day my R2 year in the cardiothoracic ICU. All of the patients were critically ill but the nursing staff decorated and had a potluck that they invited the families to participate in. I just love the memory of the atmosphere in the unit that day.