Archive: Daily Archives: November 22, 2009


A Challenging Day

When I finished my residency training in 1985, I had the impression that all the great, interesting, challenging cases could be found only at the tertiary care university setting. How wrong I was, how naive I was.

In reality, every day presents the challenge of cases that defy the routine. There is a running debate among surgeons, as to who is best to take care of these patients. The young buck newly out of residency with all the latest technology, or the more experienced surgeon who may not use the latest in techniques or technology. I’d challenge the young buck to handle the following cases (and I do use the last technology).

Take last Thursday at WakeMed:

Case #1 was a 5 month old with recurrent ear infections who needed tubes. A routine diagnosis, but with small 5 month old ear canals and bulging TM’s, making an appropriate incision in the TM and inserting a tube was quite challenging. Mark up success #1

Case #2 was a 2 month old with respiratory difficulty and stidor due to collapse of his epiglottis over this airway (laryngomalacia) due to short aryepiglottic folds. After direct laryngoscopy and section of those folds, he was stridor free. Success #2

Case #3 was a child with frequent sinus infections, maxillary (check) sinuses. Her irrigations required poppin into her sinus below her eyes and irrigating with saline. Success #3 as the eyes were successfully avoided.

Case #4 Exploration of a post radiated neck for recurrent tumor. Tissues planes were non existant, necrotic tissue everywhere. I avoided opening into the carotid artery. Success #4

Plus the usual parade of tonsils, tubes, sinus cases, etc that are very routine, yet so very special to the patient and their families (and I clearly recognize and honor this). All went well and I went home a happy camper.

Every day presents new, so very interesting case. I’m blessed to be in a dynamic field that constantly requires me to search for more information and to extend my education.

Here’s to tomorrow and its challenges.

Posted by Douglas K. Holmes, MD