10 minute read
Editorial
from ACMS Bulletin February 2022
by TEAM
Experience Counts
RiChaRD h. DaFFneR, mD, FaCR
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Life is a journey of learning. The human brain is like a small computer with almost unlimited storage space. In medical school we were given large amounts of information, some of which we wondered if we would ever use. Each one of these facts, however, was stored in one of our cerebral recesses, to be recalled at the appropriate time – if ever. Likewise, the other things we learn on life’s journey are available for recall to be used on a moment’s notice. And sometimes, those facts or skills may have been learned decades before.
Every summer (except for 2020, due to the pandemic), for the past 40 years, I have been attending a scout camp in North Carolina with my troop. Many years ago, the camp program included several challenge events that would test the outdoor skills for the scouts and their leaders. Mark, one of our younger leaders, entered a team from our troop. Our four-person team consisted of Mark, Jim, Debra, one of the moms who accompanied her sons to camp, and me. Mark and Jim are Eagle Scouts. I had only achieved the Star rank as a boy. However, I had completed the highest level of adult leader training – the Wood Badge program, which emphasized not only leadership skills, but also honed our outdoor skills. Debra had no outdoor skills, but more importantly, was a mature adult.
The event presented five challenges to each team, which began when each team member was given a mountain bicycle to ride through the course. At the first station we were given three wooden ridge poles (used for tents) and a coil of rope and told to use those materials to devise a way to move one member of our team and their bike to the next station. Mark, Jim, and I quickly lashed the poles together in a triangle, put the triangle over our own bikes and carried Debra and her bike to the next station. We did this without the triangle falling apart, and without Debra or her bike falling off.
The next station was at the waterfront where we were given three inflated inner tubes, life vests, a canoe, two paddles (for the four of us), and more rope. Our challenge was to move our team and our bikes across the lake. We quickly tied the inner tubes to the triangle to make a raft and securely lashed the four bikes on top. Then the four of us got into the canoe. Mark sat in front, and I took the stern. Mark, the youngest of our team was overpowering my paddling and I told him that he could paddle, and I would steer. We made it safely to the other side of the lake without tipping over or donating a bike to the lake. Once there, we removed our bikes and were told to follow the trail to the next challenge, after we left the canoe and our makeshift raft.
At the next station, our challenge was for each member to raise a log on a rope over a bar that had been lashed between two trees. Mark, Jim, and I quickly tied a timber hitch and raised the log. Fortunately, the rules allowed us to coach Debra so that she could tie the timber hitch and likewise, raise the log.
The same station had an additional challenge. One member of our group had to light a strike-anywhere match using a hand axe (hatchet). We elected Jim, a machinist, whom we knew from observation on previous service projects, that he had a knack for precision and excellent hand-eye coordination. He lit the match on the first attempt.
Our final challenge was to make a small fire and burn a string suspended two feet over a fire. As we started our fire the wind began blowing the flames sideways, away from the string. We gathered ourselves on the windward side of the fire to form a human windbreak, and completed our assigned task, long before any of the youth teams appeared. The camp staff in charge told us that we had set a record for the shortest time for completing the challenges for the whole summer.
Debra was impressed. She said,
“Well,” I said, “We had three advantages. First, we had teamwork; second, we had adult problem-solving skills; and third, three of us had better scouting skills than any of the members of the other teams. Experience counts.”
Several years ago, at our own scout camp I was summoned by Scott, one of the camp medics, an EMT, to advise him on the removal of a turtle hook (a large fishhook) from a camper’s leg. He had spent an hour trying to coax the barb free using the “string method”, something I had never found to be successful. When I arrived and assessed the situation, I said, “Well, now it’s time for Plan A.”
I looked at the boy and told him to grit his teeth, and as he did, I quickly advanced the hook until the barb had penetrated the skin. I then cut the barb off with the wire cutter on my Leatherman® multitool and pulled the remainder of the hook back out. This was classic wilderness first aid, something I had originally learned decades earlier when I was a Boy Scout. While Scott was dressing the punctures, I called the Emergency Department at Allegheny General and asked the attending staff physician if the boy needed to be given antibiotics. The hook had come directly from a new package and had never been used, so I was advised to look at the wound in the morning and check for any signs of infection. The next morning, the boy was fine. Again, experience counts.
I did my diagnostic radiology residency in the “Pre-CT era” in the early 1970’s. Our main imaging modality was radiography, supplemented by gastrointestinal barium studies, intravenous urography, and angiography. The development of ultrasound and CT in the mid to late 70’s and MRI a decade later dramatically changed diagnostic imaging and made many of those old studies obsolete. My partner, Irwin (Irv) Beckman, who also trained at the same time as me, and I were the senior members of our group. Irv and I became the “go-to guys” for any unusual findings on chest or abdominal x-rays. (I was also the expert on bone x-rays). Experience counts.
I trained at Duke, which like UPMC today, was considered a leading tertiary care institution. I also worked as faculty there for seven years. There, in addition to the “usual” diseases and injuries, we frequently encountered medical exotica. Most of us will agree that once exposed to an unusual finding or a rare disease, we will never forget it. Figure 1 is a close-up view from a chest x-ray on an infant with irritability, soft tissue swelling, and tenderness in his jaw and clavicles. There is periosteal new bone formation along the lower mandible and both clavicles (arrows).
Fig. 1. Caffey disease in a six-month-old infant. Detail of mandible and upper chest shows diffuse periosteal new bone formation along the body of the mandible and clavicles (arrows)
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From Page 9 399 Butler St., Etna My residents thought the child had osteomyelitis. I told them this was classic Caffey disease (infantile cortical hyperostosis). This self-limiting entity, originally described by Pittsburgh’s John Caffey1 (the “Father of Pediatric Radiology”) was first thought to be caused by a virus. We now know it is a genetic disorder caused by a mutation of the COL1A1 gene that is responsible for making type 1 collagen. On interviewing the child’s mother, I learned that she had a similar illness as a small child in the 1950’s. I had seen a case with identical findings thirty years earlier as a resident. Again, experience counts. In radiology, we frequently use the term “Aunt Minnie” to describe findings or diagnoses that are considered “classic”. The term “Aunt Minnie” is For a culinary cross-country road trip, stop in this converted auto service station for a taste of roadside delights from coast to coast from Chef Anthony Tripi. Twenty draft beers and fun cocktails to boot. Adda Bazaar, 725 Penn Ave., Downtown The newest of Adda Coffee & Tea House’s multiple downtown cafes. Adda is the term for the long Bengali tradition of stimulating intellectual discourse with friends over tea and coffee. Here’s your chance to try the art of Adda, with a selection of fine teas and coffees. Three Bakery Square delights: AVP, Bakery Square, 6425 Penn Ave., East Liberty Fans of Big Burrito’s Alta Via pizza in Fox Chapel can venture to Bakery Square to try the casual California style Italian cuisine of its cousin, AVP. Enjoy seasonal vegetable-forward dishes as well as pizzas and sandwiches for lunch and dinner seven days a week.
täkō, Bakery Square, 6425 Penn Ave., East Liberty
Love the downtown Richard DeShantz jewel of a restaurant called täkō, but can’t get a reservation in the crowded space? Come enjoy its vast Bakery Square outpost, complete with 5000 square feet of space and both indoor and outdoor dining.
Galley – Bakery Square, 6425 Penn Ave., East Liberty
Galley – Bakery Square is the latest branch of the Galley restaurant incubator concept, featuring the same believed to have been coined in the 1940s by the late Dr. Ben Felson, a radiologist at the University of Cincinnati, who used it to describe radiologic findings so specific and compelling that there was no realistic differential diagnosis. Or, in other words, to paraphrase Dr. Felson: “If it looks like your Aunt Minnie, then it is your Aunt Minnie.” Veteran physicians, in all specialties, have thousands of “Aunt Minnies” stored in the recesses of their brains. They’ve “been there and seen that”. And that is why experience counts. formula as its sister sites Federal Galley on the North Side and the Strip District location. Four emerging chefs are selected to open their own restaurant within the space, with 12-18 months to win over an audience and establish their brand. You can try a little of everything from all four restaurants during the same meal – heaven for foodies. Tupelo Honey, 100 West Station Square Drive, South Side Craving fried green tomatoes, buttermilk biscuits, shrimp and grits and banana pudding – and oh yes, fried chicken and waffles? Tupelo Honey Café will open this fall in Station Square to remedy that, in style.
Con Alma Downtown, 613 Penn Reference: Ave., Downtown
1. Caffey J. Infantile cortical hyperostosis. J The new jewel of the Downtown Pediatr 1946; 29:541-559. Cultural District features insanely good Miami/Latin/Caribbean cuisine along with live jazz.
Dr. Daffner is a retired radiologist Gaucho Parrilla Argentina, 146 and board-certified curmudgeon, who Sixth St., Downtown practiced at Allegheny General Hospital The resident jewel of the Downtown for over 30 years. He is Emeritus Cultural District dazzles with an Clinical Professor of Radiology at incredible array of steaks and wood Temple University School of Medicine. fired meats with a variety of sauces and accompaniments. Takeout and dine-in available.
Wild Child, 372 Butler St., Etna
The opinion expressed in this column is that of the writer and does not necessarily reflect the The brainchild of Chef Jamilka opinion of the Editorial Board, the Bulletin, Borges, Wild Child emphasizes coastal or the Allegheny County Medical Society. and island cuisine and is sure to delight.
Mount Oliver Bodega, 225 Brownsville Road, Mt. Oliver
Chef Kevin Sousa’s new project will combine a wine shop, bar and pizzeria in the former Kullman’s Bakery space. Sustainable, biodynamic and organic wines from around the world will be featured along with a down to earth, rustic menu. Nonalcoholic wines and cocktails also will be showcased.
G’s On Liberty, 5104 Liberty Ave., Bloomfield
G’s turns former Alexander’s Italian Bistro into a seasonal scratch kitchen with creative food and cocktails. Coming in the fall.
And finally …
Chengdu Gourmet, McKnight Road, Ross Township
Chengdu Gourmet (the beloved James Beard-nominated Squirrel Hill hole-in-the-wall Sichuan restaurant that regularly inspires pilgrimages from all over Western PA) is planning an outpost on McKnight Road at the site of the former Oriental Market, in the plaza next to Red Lobster. This will offer a much larger dining space – 6,000 square feet – and an expanded dining menu. Something to look forward to in early 2022.
Enjoy, and be safe.
Dr. Paranjpe is an ophthalmologist and medical editor of the ACMS Bulletin. She can be reached at reshma_paranjpe@hotmail.com.
