Maybe we should all become Czech nurses

I wasn't sure whether or not to be horrified by this article in the New York Times, which describes a private surgery clinic in Prague that offers a choice of signing bonuses for prospective employees: German lessons, extra weeks of vacation, or free cosmetic surgery.

I decided, yes, horrified. Horrified that the health care situation in the Czech Republic is so desperate, horrified that plastic surgery has become akin to a free set of steak knives with purchase, horrified that the surgeons offering free elective cosmetic procedures aren't horrified.

Are my standards too high? Or am I just normal?

Plastic surgeon + Chickens + YouTube = Awesomeness

Plastic surgery is truly all around us. The folks at Foster Farms have a new commercial depicting a "shady plastic surgeon" and some chickens... Check out this hilarious video at YouTube, via the Foster Farms site.

Getting busy in San Jose

A gorgeous day in downtown San Jose. I woke up early, snagged a nice parking spot in the shade, and settled myself in at the SCORE workshop for startups and existing businesses.

I'm not sure why, but I was surprised - pleasantly - by how many people were taking the workshop. Seems like there is no lack of entrepreneurial spirit here in Silicon Valley. A lot of interesting ideas and stories, as we went around the room introducing ourselves (no one fell out of their chair at the mention of this "young lady" [God bless those SCORE volunteers!] being a plastic surgeon looking to grow her business).

The folks representing SCORE today were as wonderful as I'm starting to expect. They're a bunch of characters, to be sure, but they've got this show down pretty pat. Smooth and well run, with no sympathy for latecomers or cell phones, this was one of the better organized events I've been to. I suppose you wouldn't expect anything less from an organization of such high-powered and experienced executives.



I absorbed a lot of good information today; it might have been more, had my phone not been ringing madly during the first hour (actually, more like vibrating disturbingly often in my hip pocket - violators of the blatant cell phone rule had to toss $10 to the charity of workshop leader Mike's choice).

I tried to take my phone calls discreetly outside - there are signs in the lobby politely directing you to do so. I compromised in the building vestibule. For that early in the morning, there were an alarming number of folks outside the Entrepreneur Center who I wasn't really interested in networking with at the time.

Later in the day, as we broke for lunch, I happily strolled around the block, absorbing a little warm sunshine, watching office workers emerge from indoors, and strangely, some workers dismantling an ATM. This is the Cathedral Basilica of St. Joseph, looking stunning in the midday light today, just around the corner from the SCORE offices.



On the way back, I passed this entrepreneur, hard at work slinging dogs. On a warm summery day, the smells were so tempting - but I try to save my annual hot dog quota for the Chicago dogs at the ballpark.

Making sense of static

It's articles, or in this case "press releases" like this one, that really frustrate me.

I think it starts out with noble intentions - an attempt to educate people about how to choose the cosmetic surgeon that is best for them. But as you keep reading, it turns into this rather odd bashing of plastic surgeons. Clearly, this press release was written by someone who is not a fan - or maybe even someone actively trying to discredit the field of plastic surgery.

Allow me to refute a few quotes, taken directly from the "press release":

"Unlike cosmetic surgery, plastic surgery focuses on repairing and reconstructing abnormal structures of the body caused by birth defects, developmental abnormalities, trauma, infection, tumors or disease."

Absolutely - in my six years of plastic surgical training, I worked intensively to correct and restore function where it was absent or abnormal. That was one aspect of plastic surgery: the reconstructive focus.

The press release conveniently omits the other focuses of plastic surgery: aesthetics. No matter what type of surgery we perform, no matter which part of the body is involved, we have a omnipresent concern guiding every move. How do I help my patient, and how do I do it in the most aesthetic way possible?

Everything we do as plastic surgeons - whether it is as simple as removing a tiny little skin tag to an enormous undertaking like a complicated cancer reconstruction, or even the traditional operations you think of when someone says "cosmetic surgery" (like facelifts and breast augmentation) - we have been trained to think several steps ahead, to consider all the possibilities for skin and scars and soft tissue and healing, to create a surgical plan with our patients, and to make it happen in the way that we feel will result in the best outcome for our patients.

Even outside of the dedicated time spent learning about "pure" cosmetic surgery, "cosmetic" training is thus interspersed throughout our plastic surgery residency. We learn how to do rhinoplasties when patients come in because they have trouble breathing through their noses; we learn about breast lifts, reductions, and augmentations when breast cancer survivors have procedures on the other breast for symmetry; we refine techniques used for tummy tucks when trauma victims need complex microsurgical tissue transplants to save their legs. So to say that plastic surgery is very "unlike cosmetic surgery" is a very unfair assessment.

"Residency programs in dermatology, general surgery, obstetrics, and gynecology, oral and maxillofacial surgery, ophthalmology, otolaryngology, and plastic surgery do not include training on every cosmetic procedure."

At face value, that statement is true. Not every physician gets training on every little thing that's out there in the world of cosmetic surgery. That is why there are fellowships, courses, and continuing medical education.

But if you look carefully at each of those specialties (not even all of those fields train surgeons), all of them have relatively narrow backgrounds compared to the breadth and depth of training achieved in plastic surgery. Dermatologists specialize in skin diseases, general surgeons in most of the thorax and abdominal contents, OB/GYNs in the female reproductive organs, OMFs in problems related to the face/teeth, opthalmologists in eye-related issues, and ENTs in ear, nose, and throat-related things.

Now I wouldn't raise an eyebrow if someone were to consult an opthalmologist (especially someone with further oculoplastic training) for a eyelid lift or blepharoplasty instead of a plastic surgeon. But if your friendly local dentist is now offering a special on breast implants? That I'm not so comfortable with.

The America public is pretty smart. They're far more educated that ever before, with access to more information (for better or worse, as in the case of this particular press release) and a highly attuned bullsh*t-o-meter. It takes work, but I have faith in you out there - confidence that you will take the time and sense to sift through the staticky messages of cyberspace.

(photo from iStockphoto)

And now we can call it a party

A very special occasion?

Incredibly, a plastic surgery-themed cake, seen in this photo (scroll down after clicking) which caught my eye at Cakewrecks, one of my favorite places to rubberneck when I'm trolling the internet.

My compliments to the baker, although the Botox and Restylane do look suspiciously like tubes of toothpaste. . . although I suppose no one really wants to see needle and syringe-shaped fondant on their otherwise tasty cakes.

Searching for a suitable excuse

I suppose I could claim that I have been traveling through the remarkably lush desert landscape of Zion in search of answers. And I did, if you can count a brief, breezy national park shuttle ride during a quick family sidetrip to Utah.

Incredible landscape, with amazing hikes (the shuttle driver/tour guide Bob mentioned a 900 foot vertical drop on one side of the trail and 1200 on the other, with only a chain to hang on to on the way to Angels Landing). Sounded great, but best saved for a day when I wasn't in kitten-heeled sandals and escorted by slightly less adventure-minded aunties.

But that is a fairly poor explanation for a lack of attention to this blog thing. Apology accepted?

Back to the regular world. . .

With the last several months relentlessly insisting that this just might be the absolute worst time in history to go into private practice in plastic surgery, I remain confident in Duet. That pigheadedness surely is a prerequisite for a small business owner (who ventures into entrepreneurship without believing that their idea is amazing and wild success forthcoming?).

But I really do believe in the concept and philosophy we have at Duet Plastic Surgery: two women plastic surgeons who work together for our patients. The statistics out there are pretty stark; over 90% of cosmetic surgery patients are women, but less than 10% of plastic surgeons are women. There is definitely a latent desire for female plastic surgeons. People, especially women, get so excited when I explain what I do.

It happened again today, at my first counseling session at SCORE. Jennifer and I divided and conquered today; she went to an eWomenNetwork lunch, and I sought advice from Wes and Dick at SCORE in downtown San Jose.

I found SCORE through the Small Business Administration website - free counseling with experienced executive volunteers - just what we needed. Wes and Dick - two distinguished gentlemen with extensive business and financial backgrounds, but not so much plastic surgery knowledge - were captivated by the idea of Duet. We spent an hour brainstorming about how to increase our visibility and grow our business. It was reassuring to hear that Jennifer and I have intuitively been making a lot of good business decisions (reaching out to groups with whom we have personal connections, developing strong partnerships) and identifying the areas that need more work (putting our financials into black and white).

Wes and Dick were incredibly helpful and came up with some ideas we would have never discovered on our own. I only wish I had found them sooner. There is a SCORE workshop next week that they recommended, and I've already scheduled a follow up session the week after.

In the meantime, I have homework to do.

The strangeness of intimacy

A week or two ago, in the operating room, I startled myself.

At this point in career and training, there aren't too many surprises left.

But at one time, everything was new.

Every medical student remembers their time in the anatomy lab, some more fondly than others. You really discover that the human body is a mystical place. There is definitely a feeling of disgust and embarrassment, and then the feeling of sacrilege - wondering, what right do I have to do this? Then there is the feeling of privilege - thinking, what an incredibly generous gift and how lucky I am to learn. And then, well, you just settle in. Just another day in the anatomy lab.

You go through the same process with surgery. You're filled with awe and fear for your first real, live operation. I am looking inside someone's body! I am touching someone's liver! I am putting someone's pieces back together! But the magic and mystery wear off, as you grow short on sleep, can't remember the last decent meal you had sitting down, and struggle to recall if you've showered recently.

I remember one of the first cases I scrubbed in on, as a fresh third year medical student. The medical details are somewhat fuzzy, now going on eight years ago, but I remember the intimidating chief resident . He was well known for his "pimping", which meant that he enjoyed torturing medical students with endless questions about relevant clinical topics and esoteric surgical trivia. I had been steadily ignored through the hours-long case, probably after dodging a few softball questions. As I was trying to sleep upright, hands clamped in a death grip on a retractor holding something large and vital out of the pertinent surgical field, I heard an authoritative voice sharply calling my name. The chief resident! Was talking to me! He asked, Do you know how to sail? I was oddly flattered that he wanted to know something about my personal life, but no, I didn't know how to sail. He said, Let me teach you. He grabbed the retractor out of my hand, saying, Like this. Hang on and lean back. And that was the end of our conversation.

Since then, as a participant in the surgical world, not only are you putting hands on and in ordinary (and not-so-ordinary) people, but you are in closer physical proximity to colleagues, people who are supervising you, and people whom you are supervising, than you could have ever imagined. All in a way that would be absolutely socially unacceptable in any other situation. Your hip here, his arm there, her hand reaching in between. And all that separates you, making it okay, making it routine, making it just part of work, is a sterile glove, a thin surgical gown.

Thousands of cases later, the odd mystique of surgery - with its intimate access to secrets of the human body, hardly anything separating you from them - has faded into the background of work.

At least until that moment, when I was startled. Startled by the warmth of another person, another life, felt through my gloved hand.