Saving Baby Boy Green

Jessica Green was getting impatient. She was 19 weeks pregnant and waiting for her ultrasound images at Whitehorse General Hospital, but it was taking forever. She’d never had to wait this long before. Her fiancé, Kris Schneider, had already headed back to work for the day, and Green wanted to do the same. She told the receptionist that she would pick up the images later and headed out. It was late October in Whitehorse, the capital city of Canada’s northern Yukon Territory, and winter was beginning to set in.

The ultrasound technician caught up to her in the parking lot. Green couldn’t leave, the tech said. She needed to be admitted, right away. Green remembers responding with some sort of instinctive, mulish refusal: “I can’t.”

But she knew her pregnancy was considered high-risk: She was 37, she’d conceived via IVF, and she was carrying twins. She followed the tech inside and headed up to the maternity ward, where she learned that her cervix was shortening precipitously, a precursor to labor—it was already down to 1.1 centimeters, less than half of what it should have been. A baby’s lungs and guts take a long time to fully develop in the womb, and her tiny babies still lacked the abilities to breathe or digest food on their own. But the barrier between them and the outside world was fading away.

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Nik Mirus

Within a few days, a doctor performed an emergency cervical cerclage—effectively, he sewed her cervix shut—to protect the twins. That procedure came with serious risks: Both twins might die. But doing nothing might also mean losing them, so Green and Schneider had opted for action. After the surgery, Green gritted her teeth through a week of strict bed rest at home, but then pain and heavy bleeding chased her back to the hospital, where she was admitted and given morphine, fentanyl, and laughing gas while the staff waited to see if her labor would hold off. When she began to dilate again, the doctors removed the cerclage sutures before they could tear through her cervix. She and Schneider now lived in her hospital room. Contractions, irregular but powerful, came and went for days.

All hope of the twins reaching full term was gone. The couple simply hoped to reach what neonatologists call the threshold of viability: the point at which medical science has the ability to keep a premature baby alive outside the womb.

A full-term human baby can seem helpless at birth, but in comparison to a preemie that baby has an impressive toolkit of skills. Aside from their underdeveloped lungs and guts, babies born too early don’t yet have the reflexes or muscular control to suck and swallow simultaneously. They are prone to cranial hemorrhage, and sometimes a heart duct remains open. Their skin is thin and fragile; the veins glow eerily. They are sensitive to sound, to light, to touch. Their eyelids may still be fused shut, and the tiniest preemies may not yet even have the ability to close a fist around your finger—that essential early act, the moment when they take possession of you.

Over several decades, doctors and nurses have become better at grappling with all of these obstacles. The threshold still varies widely depending on a baby’s circumstances and on the care available immediately at birth. But advances in drugs, technology, and methods of care have pushed that line earlier and earlier, and today there are preemies growing up, healthy and whole, whose survival would have been unimaginable a generation ago. These days, the line between birth and death generally lies somewhere between 22 and 25 weeks’ gestation. Green and Schneider could only pray that they would get there.

Jessica and Kris take Owen for a hike through the woods behind their house.

Kamil Bialous

Whitehorse is a small city, home to roughly 25,000 people, that sits along the only highway to Alaska. Schneider works for the post office, and Green is self-employed as a massage therapist, acupuncturist, and osteopath­-in-training. The hospital where she lay bearing through jagged contractions was not equipped to deal with preemies younger than 35 weeks. So as they waited and hoped for her labor to subside, they made plans to get to Vancouver, to the neonatal intensive care unit where the very tiniest and sickest babies in British Columbia and Yukon wind up.

On November 10 one of the amniotic sacs began to leak—the one containing Baby A, who lay on the bottom of the uterus. (These were fraternal twins, so each had their own placenta and sac.) Green and Schneider were loaded onto a small plane and flown more than 1,000 miles south to Vancouver, and in the early hours of November 11, Green was admitted to BC Women’s Hospital. Viability was in sight. They were at roughly 22 weeks—and, after a hard conversation with their physicians, they had agreed that the doctors would attempt to resuscitate the twins if they made it to 23 weeks. The babies’ heartbeats were still strong. Green went to sleep; Schneider crashed out on the floor beside her.

A few hours later, Green woke up feeling that something was wrong. A nurse came in, took a look, and rushed her to labor and delivery. The umbilical cord attached to Twin A, the girl they’d named Maia, had slipped out of the uterus and into the birth canal. Maia had no heartbeat. Now doctors had to deliver her as fast as possible before her movement through the birth canal triggered labor in Baby B, the boy they called Owen.

This meant Green had to push, even though she knew Maia wouldn’t survive. She asked the doctors to put her under, to let it happen without her participation, but they couldn’t—a C-section would risk Baby B too. Do it for Owen, someone said to her.

Maia came out weighing just 12.3 ounces, minuscule and bruised. The nurses handed her to Green and she held the little body against her chest. “I think she’s still alive,” Green said. But Maia was gone. Hospital staff dressed her tiny body in tiny baby clothes, sewn by volunteers. They took her photo, took casts of her feet—collecting mementos that her parents might spurn now but want to have later. Green was anesthetized and her cervix was sewn shut once more.

For 12 more days she remained in the hospital, enduring regular inspections of her cervix by a pack of doctors who were watching for signs of infection. Every extra day in utero could give Owen a better chance at life, but if the amniotic sac became infected, it could take him. How soon should they induce? How long could they safely wait? It was another seemingly impossible life-or-death decision.

On November 22, at about 24 weeks gestation, Green spiked a fever. The next day Owen was delivered by emergency ­C-section. Schneider held Green’s shoulders while the delivery team worked on the other side of a raised curtain. They caught a glimpse of their tiny son, wrapped in plastic to trap his body heat, before he was wheeled away in an incubator. At 1.4 pounds, Baby Boy Green was admitted to the neonatal intensive care unit at BC Women’s Hospital. He had a 60 percent chance of survival. The NICU would be his home, and the center of Green and Schneider’s world, for nearly five months.

Neonatology is a relatively young field. The first incubators for babies were invented in the 19th century, adapted from poultry incubators to create a stable and warm environment intended to simulate the womb. These early incubators were cumbersome creations of glass and metal. To fund them, they were put on public display—with living preterm babies inside them—at exhibitions across Europe and North America. Incubator babies were regular attractions at Coney Island and occasionally on the Atlantic City boardwalk throughout the early decades of the 20th century. A total of 96 preterm babies in incubators were shown to visitors at the 1939–40 New York World’s Fair. (Eighty-six of them survived.)

By the 1960s and ’70s, neonatology had graduated from carnival sideshow to accepted medical discipline. But the basic nature of the NICU hadn’t changed that much from the Coney Island days: A typical nursery held rows of incubators, a tiny baby lying behind the plastic in each, with parents mere spectators of their day-to-day care.

Doctors’ abilities to keep preemies alive a half-century ago was limited. Patrick Bouvier Kennedy, the third child of John and Jacqueline Kennedy, was born five and a half weeks premature and died just 39 hours after his birth—today he would be considered only a moderate preterm baby, not in the danger zone at all. Several treatments, often working in combination, have driven that dramatic improvement. Among the most important are the invention, in the 1980s, of an artificial version of a natural lung lubricant that preemies initially fail to produce enough of on their own; antenatal steroids, widely adopted in the 1990s, to jump-start a likely preemie’s lung development even before birth; continual tweaking of the mechanical ventilator and the incubator, which is now far more complex, offering controlled levels of moisture and ambient oxygen in addition to providing heat; and the ability to deliver nutritional solutions intravenously to babies who can’t yet eat.

When Owen was born, neonatal units around North America were increasingly adopting a family-focused model of care: Parents of preemies and other infants receiving treatment in the NICU were encouraged to join on rounds with the medical staff, to touch and hold their babies more, to change diapers and help with feedings, and to be more involved in decisions—especially life-or-death ones. Ten or 15 years ago, many hospitals had firm rules: They would not agree to resuscitate babies born at or before 23 weeks, say, and they would not recommend the practice before 25 weeks. Now the American College of Obstetricians and Gynecologists recommends that physicians, with the parents’ input, at least begin to consider resuscitation as an option at 22 weeks.

Back when Green and Schneider were waiting in Whitehorse, they’d had a tough conversation by phone with Sandesh Shivananda, a senior neonatologist and the medical director of the NICU at BC Women’s. He’d told them that, at 22 weeks, the twins would have less than a 5 percent chance of survival. At 23 weeks, they would have a better chance at life, but high odds of living with severe neurological complications. Even at 24 weeks, they would likely spend several months in intensive care. He’d talked to them about the difference between “active care”—working to save a preemie’s life, and “compassionate” care—easing its way from birth into death. Discussions around extreme preterm births—generally defined as 28 weeks or earlier—are similar to the ones around end-of-life care: What kinds of extraordinary measures will we deploy? For how long? To what end—saving a life, or just prolonging it?

The policy at BC Women’s is to lay out the potential outcomes for parents and to work with them to form a plan, aiming for realism without being overly discouraging. It’s a delicate dance, and Shivananda’s goal is to give parents as much information and as much control as possible: to give them some ownership, some sliver of power, over their nightmare.

Kris Schneider at home with Owen in Whitehorse, Canada, 14 months after the baby was born.
Kamil Bialous

The N.I.C.U. is both paradise and inferno. It’s a place of modern miracles, where babies whose lungs are too small to draw breath are made to breathe, their tissues forcibly inflated and deflated by tubes connected to machines; where parents burn quietly while they watch each new heartbeat register on the glowing screen above their baby’s incubator, unable to look away, in a slow immolation that can last for days or weeks or months.

“Off the bat,” Schneider says, “they tell you, ‘He’s going to be a champion for two or three days,’ and then he falls off a cliff.”

“And then,” Green says, “you fall off a cliff.”

Owen was immediately diagnosed with extreme prematurity and respiratory distress. He was also vulnerable to sepsis. In other words: He couldn’t breathe and was at risk of a severe infection. He was intubated in the delivery room, and his issues piled up from there. In the first week of his life, he was given drugs to help a valve in his heart close properly, and more drugs for his blood pressure. When he was a few days old, he had what appeared to be a seizure—more drugs. His kidneys were too small and new to function fully—more drugs. He received antibiotics for the possible infection he was born with, and then more for a suspected case of pneumonia, thought to be caused by his ventilator. He had a breathing tube down his throat for 45 days and a feeding tube threaded through his nose for four months. He received a steady supply of morphine to numb the pain of the treatments keeping him alive.

If someone so much as spoke too loudly near his incubator, his oxygen levels could drop, setting off alarms from the monitors. He received seven blood transfusions in his first two months. “It was just so tenuous,” Schneider says. Green wondered, in those early days, if they had made the right decision for their son. It was an agonizing 22 days before they were allowed to hold him.

When another baby was having a bad day, its monitors beeping out constant alarms as it struggled to grow and live, the couple felt relief that today was not their bad day—and the awful certainty that their turn would come soon enough.

The couple moved into Ronald McDonald House, a charity-run residence on the hospital campus reserved for out-of-towners whose children faced life-threatening illnesses. Schneider took leave from his job; Green canceled months of scheduled appointments with her clients. Back home, friends took in their two dogs and raised more than $12,000 to help them make up their lost income. Green was as sleep-deprived as the mother of any other newborn: waking up repeatedly in the night to pump her milk and freeze it for when Owen was strong enough to digest it. She spent her days sitting beside his incubator, reading children’s books to him in a whisper, refusing to allow herself to dwell on anything except his survival. “I remember walking into the NICU and making a choice—my feelings of anger, my feelings of grief, I really tried to keep them out of the NICU because he was so sensitive,” she says. “I swear to God that he could sense the energy you brought in.”

The nursery was kept as quiet as possible, but Green and Schneider were uncomfortably, intimately aware of the other parents hovering over other incubators nearby. Their feelings about those other parents were complicated. They’ve formed lasting connections with some, but in the NICU, envy and sadness and anger mingled with their solidarity. When another parent’s baby was having a bad day, its monitors beeping out constant alarms as it struggled to grow and live, Green and Schneider felt relief that today was not their bad day—and the awful certainty that their turn would come soon enough. On one of the first days, Green glimpsed twins in side-by-side incubators, and suddenly anger and jealousy—and the pain of her loss—shot through her. One day in late January, a new mom arrived with a daughter, Bronwyn, born at 28 weeks. To Green, the baby seemed so much more stable than Owen. But after nearly 200 days of treatment in the NICU, Bronwyn died.

Technology is essential to neonatology, but there’s a critical human side to the science of saving preemies too. In the late 1970s, something happened in Bogotá, Colombia, that would begin to bridge the divide between the incubator babies and their parents. A lack of equipment and concern about the risk of hospital infection led doctors at San Juan de Dios Hospital to send stable preemies home with their mothers instead of incubating them. The doctors instructed the mothers to hold the babies continuously, bare skin on bare skin, vertically against their chests, and to feed them only breast milk whenever possible. When mothers started doing this, the area’s low survival rates for larger preterm babies tripled. The close contact seemed, in some ways, to replicate the womb better than an incubator—at least one in an underfunded hospital. This practice is now well known as kangaroo mother care and was written up in the Lancet in 1985. The paper’s authors didn’t endorse the home-care option for babies with access to modern NICUs. “Nevertheless,” they wrote, preemies in a hospital setting “could benefit from similar emphasis on education and motivation of mothers and early skin-to-skin contact.”

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Three decades later, while Green and Schneider adapted to life in the open NICU, an experiment built in part on the Bogotá breakthrough was unfolding in two rooms down the hall. For the first time in North America, some new mothers could receive their postpartum care in the same private room where their infants received their neonatal care. The same nurse who checked a baby’s oxygen levels and drew blood from his tiny arteries would also be checking his mother’s cesarean incision site or monitoring her for excessive bleeding.

The program was part of a reimagining of the entire NICU at BC Women’s. Around 2010, hospital administrators had invited past patients to consult on the design for a new building. They gave the former patients a cardboard model of the hospital and a handful of Lego figures. One woman kept moving the mother Lego character next to the baby. Why, she asked, couldn’t she just get her care with her baby nearby? The answer was rote and unsatisfying. It’s just not done that way. Postpartum is postpartum, and the NICU is the NICU.

But the idea of private rooms where parents could spend more time with their babies had been on the administrators’ minds. “Mothers tell us, and it’s in the literature, that the most stressful event of having a baby in the NICU is being separated from baby,” says Julie de Salaberry, the director of neonatal programs at the hospital. This was about more than just alleviating parental distress too. One research paper, from Sweden in 2010, found that private NICU rooms reduced babies’ hospital stays by an average of five days. In fact, plenty of medical literature now shows that restoring parent-child connections helps improve the lives of the tiniest preemies as surely as the drugs and the tubes and the machines do.

BC Women’s opened the doors of its new building in late October last year. The new NICU, made up entirely of private rooms (including a dozen built for integrated mom-and-baby care), is intended to safely facilitate breastfeeding and skin-to-skin contact, the most basic human interactions that were once off-limits to sick babies.

Jessica Green and Owen, who so far has met every developmental benchmark for his corrected age.

Kamil Bialous

Even though Owen was at B.C. Women’s before the new building opened, skin-to-skin contact was a part of his life as soon as he was stable enough. In between the rounds of drugs and tests, he’d spend hours curled up on Green’s or Schneider’s bare chest, listening to their heartbeats and their breaths, so much stronger than his own. After about two months, Green and Schneider began to believe that he would make it. Finally on April 7, 2017, after four and a half months of blood tests, of tubes and wires, of constant monitoring of his oxygen levels, Baby Boy Green was discharged. Schneider had flown back to the Yukon a week earlier to get their small townhouse ready; he retrieved the dogs from their long stay with friends; he set up a bassinet in his and Green’s bedroom. He met Green at the airport—his initial amazement of how other people were living their lives free of the hypervigilance and fear of the NICU finally subsiding. Owen slept the whole way home.

Owen is now 16 months old, and happy almost all the time, smiling and content to roll around on the townhouse floor. He’s pale, blond, and blue-eyed; he makes eye contact and grins at strangers. He can breathe on his own now, but his lungs are fragile; a chest cold could put him back in the hospital. For months after they brought him home, Green and Schneider kept a sign fixed to his carrier that read: “I’m a Preemie! NO TOUCHING! Your germs are too big for me!” They keep hand sanitizer with them at all times, and bottles of it sit on tables and shelves around the house. Early on, they wiped down everything they brought into their home that Owen would come in contact with—bottles, toys, new furniture—with disinfectant. On Christmas Eve, they called ahead to check if anyone at their intended dinner party had a cold; some of Green’s clients will cancel, penalty-free, if they feel a bug setting in. “You want to be normal,” Green says of their protocols, but you have to resist the urge to let things slide.

The literature now shows that restoring parent-child connections helps improve the lives of the tiniest preemies as surely as the drugs and the tubes and the machines do.

So far, Owen has met every developmental benchmark for his corrected age—he’s within the expected height and weight, and has the motor skills you would expect in a baby who was born on his mid-March due date, instead of late in the previous November. His only limitation so far is his unwillingness to swallow solid foods—possibly an aversion from the weeks he spent with a tube forced down his throat. Eventually he’s expected to catch up to his chronological age, but a medical team will be monitoring his neurological and motor development (among other things) until he’s 4 and a half years old, to see if any hidden legacies of his early birth and his time in the NICU emerge.

In November, Green and Schneider marked the first anniversary of Maia’s birth and death—and then, less than two weeks later, they celebrated Owen’s first birthday with friends at a snow-covered cabin outside town. It will always be that way: Every milestone for Owen will be paired, for his parents, with a reminder of what they’ve lost. But Green strives to appreciate her daughter’s short life. She likes to think about what Maia might have experienced or perceived in utero. She would have heard her parents arguing, Green figures. She would have heard the family’s dogs barking. She would have heard laughter. She also wants to find the right way for her son to know that he had a sister, and that they were born on opposite sides of a flexible, shifting line that we are gradually pushing back but whose exact location we might never be able to pin down.

In the old NICU at BC Women’s, there was a bulletin board with notes and pictures from parents who’d already done their time. Green saw one from a mother who promised the current crop of parents that the fear and anxiety of the NICU would fade with months and years. “I thought, there’s no way,” she says. “How am I ever going to relax again?”

But it turned out to be true. She has begun to forget the language of hemoglobin and oxygen desaturation and outcomes and odds. She’s forgetting what it felt like to be afraid all the time. She’s forgetting the sound of the monitors beeping, the alarms going off, the glow of the screen as it announces each new heartbeat.

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Eva Holland (@evaholland) is a freelance writer based in Canada’s Yukon Territory.

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You Lied Your Way Into A Job As A Surgeon! Can You Avoid Killing Anyone Long Enough To Collect Your First Paycheck?

Surgeons. The masters of the flesh. The gatekeepers of the organs. The doctors who get to shave patients.

These are the green-wearing gods who know that the human body is but a chessboard, and that the nipples are the king and queen, and the belly button is the opposing king or queen.

Today, finally, you are beginning your journey as one of them.

You have already gone through the arduous process of becoming a surgeon. After calling the hospital over and over every day for three weeks straight and praising Tylenol in the deepest voice you could muster to whoever picked up, being hung up on by countless doctors and nurses, you finally hit the big time.

Yesterday, you managed to get the chief of medicine on the line, who offered you a job after a mere 50 minutes of you bellowing to her about the white-and-red pill. Congratulations!

Okay. Being a surgeon is sweet as hell. You get to wear patients’ clothes around a hospital once the chemicals put them to sleep, you can eat as many tortilla chips as you want, and you can hide all of your favorite DVDs and family heirlooms inside toxic waste bins, the one place thieving pricks are too grossed out by to steal from.

Cool. But the best part of being a surgeon, bar none, is that incredible surgeon paycheck.

It’s no secret that surgeons are paid well, as every single day at 8 p.m., hardworking surgeons all over the world reap the fruits of their labor: a plastic bag filled with $600, given to them by their chief of medicine on their way out the door, in addition to a goodnight kiss on the forehead.

Exactly. So now that you’re a surgeon, you better do everything in your power to make it your $600 payday, because there is one universal stipulation that could jam you up: If a surgeon kills someone, everything completely goes to shit.

1) For starters, once a surgeon kills someone, they are NEVER allowed back in a hospital, ever. Even if you just want to go to hang out or to meet new lovers.

2) Your professional reference completely goes out the window. If a new job calls to ask about you, instead of a recommendation, the HR department hands the phone off to the absolute sickest pervert patient they have, and lets them air out whatever they’ve got kickin’ around up in their minds.

3) Lastly—and this one is the worst of all—you don’t get paid a dime, which would mean all of your efforts to become a surgeon were for NOTHING.

So, if you want to get to that sweet paycheck, you’re going to have to make it through one entire day as a surgeon without killing someone.

The hospital. The place where people come when they are bored to take off their pants and scream. This will be your new surgeon home, and today is your first day of work. As far as anyone inside is concerned, you are now a fully qualified surgeon, so if you want those 600 clams, you’re going to have to hold your own and stay off everyone’s radar.

“Please give me a surgery.”

Ah, shit. A sick kid is waiting for you right inside the lobby, and he looks all kinds of fucked up.

“I need a surgery pronto. I am dying, and it feels like none of my bones are connected to my other bones. I also have a rash that comes and goes. Please do surgery to me with your other doctor friends.”

“If you don’t give me a surgery right now, I will scream. I will scream so loud and for so long, and I will point at you the whole time. It will go on for so long that the rest of the doctors here will have no choice but to send you to jail.”

That was close. You’ve pissed your pants real good, and now you’re in the bathroom splashing your pants with water, the best way to clean pants that you’ve urinated in.

“You sure know your way around cleaning a pair of pissed pants, sport. Not bad at all.”

You look over and see that it’s the hospital’s janitor talking to you. He somehow opened the door in perfect silence while you were inside splashing your pants, and has been watching you for upwards of 90 full seconds.

“I’ve been watching you for upwards of 90 full seconds, and I can tell just by looking at you, you’re no surgeon.”

“Easy, easy. I’m not gonna rat you out. I’m gonna help you.

I take it that you’re in here lying to be a surgeon, hoping to get ‘The $600 Bag Treatment,’ huh? Well, you’ve got a friend in me. I’ve seen it before, and I’ll see it again. All you gotta do is make it until 8 p.m. without killing a soul and you’re in the clear. So whadya say you come lay low with me for the rest of the day, spend some time hanging with a new bud so you don’t end up killin’ no one before you get that money?”

“I, uh, how do you mean?” he says, visibly becoming self-conscious about the entire interaction so far. “I’m just tired today, so if I’m acting weird, that’s what that’s about, probably. Allergies are being weird, too.”

“Follow me!” the janitor says before sprinting down the hallway. You do your best to keep up with him as he weaves in and out of patients and doctors before you finally arrive at a huge metal door. He slides open the rusty door to reveal a set of long, winding stairs that lead to a dark, desolate basement, and turns to you with a half smile.

“It’s not delivery, it’s DiGiorno,” he says before letting out a quick, uncertain laugh, looking over his shoulder at you to kind of check in and see if you’re laughing or anything at what must have been some sort of joke.

“That was dumb, never mind,” the janitor says, shaking his head as his shoulders slump, trying to explain his joke before slowly progressing into full-blown self-deprecation. “I was thinking, like, how in the old commercials, I’d be the delivery guy and you’re the pizza—I don’t know, forget it. It was dumb. Sorry.”

You follow the janitor down the stairs and into the basement of the hospital, and lo and behold, it’s a full-blown bachelor’s pad! The janitor has stocked the place with some of the best things: a ping-pong table, a “Forever 27” poster, an old-timey popcorn machine, and a bunch of orange pill bottles filled with Frosted Cheerios.

“This is my chill zone. I’m down here almost all the time, which is why the hospital is filthy and patients always seem to get sick immediately after they get better.”

“We got all day, brother, so we could either sit down and talk about that important-looking guitar I have mounted on the wall over there, or we could stand near the stairs and wonder if Slash has ever signed a guitar and sold it for $20,000 online before, or maybe we could lay down on the ground and trade stories about the most expensive thing we’ve ever mounted on a wall. Your call.”

“I can’t lift my arms above my waist because of a power-washer accident.”

“You got a good eye, kid,” he says as though you brought it up completely unprompted, proudly looking up at the guitar he somehow mounted unnecessarily high on his wall.

“Believe it or not, Slash signed that guitar, and I was lucky enough to spend all of the money I have on it. I usually don’t do this for anyone, but for you, I’ll climb all the way up there and get it if you want to hold it.”

“I’d climb anywhere for one of my boys.”

“I’ll put a very wet towel over them. I’m sure that will be fine.”

You’ve killed! You’ve killed!

You put the janitor in grave danger by selfishly asking him to grab his Slash guitar off the wall. After the janitor put a soaking-wet towel on top of his countless basement wires in order to walk over to the wall and begin his climb, he was immediately electrocuted and fell crashing to the ground without the ability to raise his arms and break his fall. It’s unclear if it was the electricity surging through his body that did him in, or if it was the way his neck snapped on a nearby stool because of the horrible, unnatural way he fell. But either way, he is definitely dead, and it is your fault.

You’re no longer a surgeon, and you can kiss that bag of $600 goodbye.

As you go back up the stairs and start heading toward the lobby, you can hear that he starts to follow you, but then locks himself in the bathroom you were in earlier and begins screaming at himself in the mirror for messing up what could’ve been a nice day. His screaming gets louder and louder before it comes to a halt after you hear the sound of him snapping his mop over his knee in fury.

“I need you to give me a surgery right now.”

Ah, damn. It’s the sick kid from earlier.

“I feel like I’m on a boat at all hours of the day, and my elbows are dry. I need you to cut me open and drain me out, if that’s what it takes, and to please get me home by later today.”

You pick the kid up, throw him over your shoulder, and walk through the hospital looking for a good room to cut him open in. After 20 minutes, you finally find the room with all of the surgeons in it, and you slam the kid down on the empty table they’re all staring at.

Now all eyes are on you. You’re going to have to step up and say something pretty incredible to get all of these surgeons on your side.

You’ve killed! You’ve killed!

After you said that ridiculous, dumbass comment, every surgeon in the room became furious at you and began hammering you with questions about your qualifications. You tried mumbling through more Tylenol facts, which went much worse in person than it did on the phone, and somewhere during your 25-minute verbal beatdown from the other surgeons, the kid died on the table.

You are no longer a surgeon, and you will never get a plastic bag filled with $600.

Share Your Results

Everyone starts nodding and smiling and patting each other on the back. Good shit.

“Ha, nice,” a woman says, whose voice you recognize from the phone as the chief of medicine at the hospital. She quickly anesthetizes the patient to finally stop him from grabbing and clawing at everyone’s surgical masks, and within seconds the little spaz is sleeping.

At that moment, the tallest doctor you’ve ever seen walks into the door wearing a backwards hat and confidently drinking Barq’s Root Beer out of a 2-liter bottle.

“I’ve never seen you around here,” he says after putting the root beer down firmly into the lap of the unconscious kid and eyeing you up and down suspiciously. “Enlighten us, fresh meat. Now, what surgery are we performing on this little man, exactly?”

Ah, this guy is onto you. Need something big here to throw everyone off your tracks.

“Doctors, you two can be mean to each other in the parking lot all day long if you want to, but that’ll be enough fighting in my hospital,” says the chief of medicine after banging her fist down onto the kid’s chest like a gavel to get everyone’s attention.

“This little boy is in dire need of a heart transplant. We need to start immediately.”

“Doctors, that’ll be enough talk about whether or not there are actually types of surgeries or not, because there simply is not a correct answer,” says the chief of medicine after banging her fist down onto the kid’s chest like a gavel to get everyone’s attention.

“This little boy is in dire need of a heart transplant. We need to start immediately.”

“Doctors, please stop winking at each other,” says the chief of medicine after banging her fist down onto the kid’s chest like a gavel to get everyone’s attention.

“This little boy is in dire need of a heart transplant. We need to start immediately.”

After noticing that no one is reacting to you pissing yourself, you look around and realize that every surgeon in the room has also already pissed themselves. Then you remember that surgeons are constantly pissing themselves during surgery, like bicyclists during races, for reasons completely unknown.

The chief of medicine takes out a toolbox from underneath the surgery-room sink and hands each surgeon a tool. She takes each tool out one by one and starts passing them down the line. One doctor gets a small shovel, one gets a large knife, another gets a pickax, and on and on it goes, until you finally end up with the flashlight!

“Um, yeah, that’s my flashlight, pal. I’m always the flashlight man around here,” says the root-beer doctor.

“No,” interjects the chief. “New guy can hold the flashlight today. I have a good feeling about this.”

Your new rival is stunned. He shoots you a dirty look, threateningly crosses his thumb over his neck, and then does it again with his other thumb, but slower. Then he quietly mouths something that you didn’t really get a good read on, but from what you did see, your best guess is that he was saying something like “Fracking mountains,” or “Simply delicious.” Then he is handed the worst tool: the blood napkin, the tool that wipes up all the loose goo and pus.

“Ah, c’mon, man. Quit it. What the hell.”

The surgery is now well under way. The chief is slicing and dicing and moving parts around left and right. It’s pretty much a one-woman show.

Most of the other doctors are using their tools just to kind of scrape some bones and stuff when they feel like they should get in the mix, usually after not doing anything for a couple minutes straight and getting nervous that someone will notice how they’re not really that crucial to the operation.

You’re getting bored by the whole thing at this point, but at least you’re holding your own with these docs and, most importantly, haven’t killed anyone yet.

Surgery still going. Getting kind of repetitive. A couple doctors shuffled out for a minute and came back with crackers, but the crackers are all gone now. You didn’t even notice they had crackers until there were only, like, four left in the sleeve, so at that point, asking for some really wouldn’t have been cool.

Surgery is getting boring.

Surgery is boring as hell.Your arms got tired from holding the flashlight up, so you put it down for a minute and no one seemed to notice. You’re back up now.

Kid woke up and started screaming LOUD, but now he’s sleeping again.

“You were scared!” “No, you were scared!” “I wasn’t scared, you were scared!” The surgeons are all ragging on each other and having fun again. Finally got some juice in the room. Whole crew got a good laugh out of that one.

Woah, wait a minute. Oh, man. You see something inside the kid’s body. Wedged deep in between his rib cage and his liver, there looks to be something shining and throbbing, and you’re pretty sure you’re the only one who sees it.

Two doctors broke away from the surgery about 15 minutes ago to arm wrestle on a nearby stool, and the rest of the surgeons have all one-by-one walked over to form a circle around them so they can gamble. Meanwhile, the chief is still hacking away at this kid’s organs with all of her might, and seems way too dialed-in to notice the game changer you’ve found.

You’ve killed! You’ve killed!

You thought you were being a hero by yanking out what you thought were some sort of wet, shining metals, but were actually the poor kid’s veins. You are no longer a surgeon, and can go ahead and kiss that sweet paycheck goodbye.

“Those are veins. They are not ‘evil copper and metals sticking out of this poor bastard’s guts.’ Do not call them that.”

Damn. Misread that one. The chief is totally onto you now.

“But I appreciate you speaking your mind when you think something is amiss,” she continues, looking up and making eye contact with you for the first time. “That takes a commitment to the job that some of my other doctors lack at times,” she says, motioning to the doctors across the room who are now attempting to disguise their arm-wrestling gambling ring by draping a hospital gown over the two meaty, dueling arms.

The chief reciprocates your unblinking eye contact and begins nodding in perfect unison with your nodding. This goes on for a good 20 seconds or so, the grunts of the two arm wrestlers and the slaps of cold, hard cash hitting the tile becoming the only sounds in the room.

At that moment, you and the chief simultaneously feel a romantic charge between you, and it feels beautiful and right. But that romantic feeling is immediately followed by a simultaneous paternal feeling, but it’s unclear who is the parent and who is the child. Then the two feelings of physical attraction and familial protectiveness fuse together into one singular emotion, and it feels disgusting to both of you.

“Yeah, yeah, go catch up with them. I’ll hold it down over here, cool,” the chief kind of half-mutters to herself and to you while shaking her head and getting back to surgery.

You walk over to the gambling circle and see the two exhausted surgeons pulling and pushing as hard as they can to win. The two doctors are so evenly matched that their arms aren’t moving or shaking in the slightest. If it weren’t for the veins about to explode out of their temples and the tears streaming down their faces, you’d have no idea how intense the duel was.

All of the other surgeons are quietly going apeshit. Almost all of them are either gently pounding their chests, gingerly slapping the ground, or shaking their fists in the air, all the while whispering bad arm-wrestling advice like “Win the skin!” or “Make him smooth!”

It’s definitely a pretty sweet scene, and you decide that you want to get in the mix.

As you go to ask the doctor next to you, your rival doctor steps in front and interrupts:

“Looking to get in on the action but lacking the funds, newbie? Don’t worry, fresh meat. I got you covered. Also, we’re rival doctors, just in case that wasn’t clear.”

Whoa, pretty cool to get a rival doctor on your first day on the job. That probably usually takes years.

“That’s my coat over there,” he says, pointing to a white lab coat being worn by one of the arm-wrestling surgeons. “Go ahead and take my wallet out of the pocket and take out as much money as you want.”

He then lets out a weird little laugh and looks around to see if anyone else is laughing. One other doctor did laugh, but he’s in the middle of a conversation with another surgeon, so you’re pretty sure the laugh had nothing to do with your rival.

“I have coats all over this hospital that you wouldn’t know a thing about,” he says, raising his fist up to your chin real quick, trying to get you to flinch. You stand your ground and don’t flinch at all, though, and he sheepishly brings his fist back down to his side.

You’ve killed! You’ve killed!

In a brilliantly executed scheme, your rival tricked you into reaching into the coat of one of the doctors who is arm wrestling. When the arm wrestler saw you trying to steal his wallet, his mix of adrenaline and dangerously high blood pressure caused his heart to explode.

Your misconduct has resulted in a death, meaning you can no longer be a surgeon, and you will never see that sweet, sweet bag o’ cash.

Ejaculation after Prostate Surgery

Many men wonder about sexual function and ejaculation after prostate cancer surgery. Dr. Bryan Wong goes over what men can expect after surgery.

Dr. Bryan Wong, M.D., is a specialist in genitourinary malignancies involved in clinical trials and the development of novel therapies to treat patients with cancer. Board certified in internal medicine, hematology and medical oncology, Dr. Wong earned his medical degree at the Temple University School of Medicine in Philadelphia.

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Malpractice Medical TURP Transurethral Resection Prostate Surgery 3

Medical Malpractice and Patient Education Company Patient ED @ 617-379-1582 INFO
Your doctor will then…
…lift your penis upward.
A well-lubricated instrument called a resectoscope is then gently inserted into the urethra.
When the resectoscope reaches the back of the penis, your doctor will pull the penis downward in order to create a straight path into the prostate.
Using this tool, your doctor will then scrape excess tissue from the prostate, restoring it to its normal size. Medical Malpractice
Tissue removed from the prostate may be sent a laboratory for analysis.
When the surgery is complete, your doctor will remove the resectoscope. Your doctor will probably ask you to wear a temporary Foley catheter.
A Foley catheter is a narrow tube inserted through your urethra and into your bladder. The catheter is connected to a bag that is attached to your leg by a strap. While the Foley catheter is in place, urine will pass from your bladder into the bag. You will not need to urinate into a toilet. Medical Malpractice
The nurse will show you how to change the bag when it is full. An appointment will be made for you to return to the doctor's office in a couple of days to have the catheter removed. As soon as the anesthesia wears off and you feel comfortable, you'll be allowed to leave.

Medical Malpractice and Patient Education Company

TURP Transurethral Resection Prostate, Penis and Bladder – PreOp® Surgery – Patient Education

– Patient Education Company
Your doctor has recommended that you undergo a Trans Urethral Resection of the Prostate – or TURP. But what exactly does that mean?

The prostate gland is a walnut-sized organ that is part of your reproductive system.

It provides some of the fluid contained in semen.

The prostate is located just under the bladder and behind the testicles.
The urethra — a hollow tube that carries both urine and semen to the penis — passes through the prostate.

In some men, the prostate gland becomes enlarged. Symptoms of an enlarged prostate include:
Patient Education
* a full bladder feeling even when the bladder is empty

* pain when urinating

* weak urinary stream

* infertility

* and sexual dysfunction.

To relieve you of your symptoms, your doctor feels that you would benefit from a surgical procedure called TURP.

TURP is designed to relieve symptoms by reducing the size of the prostate.
It is also a diagnostic procedure. Tissue removed during a resection of the prostate or TURP is routinely screened for the presence of cancer.

So make sure that you ask your doctor to carefully explain the reasons behind this recommendation.

Your Procedure:

On the day of your operation, you will be asked to put on a surgical gown.

You may receive a sedative by mouth and an intravenous line may be put in.

Once on the table, your feet and legs will be placed in an elevated position with your knees apart.

The nurse will swab the penis with an antiseptic solution.

Your doctor will then lift your penis upward.

A well-lubricated instrument called a resectoscope is then gently inserted into the urethra.

When the resectoscope reaches the back of the penis, your doctor will pull the penis downward in order to create a straight path into the prostate.

Using this tool, your doctor will then scrape excess tissue from the prostate, restoring it to its normal size.

Tissue removed from the prostate may be sent a laboratory for analysis.

When the surgery is complete, your doctor will remove the resectoscope. Your doctor will probably ask you to wear a temporary Foley catheter.

A Foley catheter is a narrow tube inserted through your urethra and into your bladder. The catheter is connected to a bag that is attached to your leg by a strap. While the Foley catheter is in place, urine will pass from your bladder into the bag. You will not need to urinate into a toilet.

The nurse will show you how to change the bag when it is full. An appointment will be made for you to return to the doctor's office in a couple of days to have the catheter removed. As soon as the anesthesia wears off and you feel comfortable, you'll be allowed to leave.

Patient Education Company

Prostate Cancer Surgery – BBC

*Contains graphic images of surgery* Surgeons remove a cancerous prostate from a middle aged man and explain the reasons why men should check their prostate regularly. Free medical clip from BBC Worldwide.

TURP Transurethral Resection Prostate (penis) Surgery – PreOp® Patient Education

TURP Transurethral Resection Prostate Surgery – PreOp® Patient Education – StoreMD™ for Physician videos:
Patient Education Company
Your doctor has recommended that you undergo a Trans Urethral Resection of the Prostate – or TURP. But what exactly does that mean?

he prostate gland is a walnut-sized organ that is part of your reproductive system.

It provides some of the fluid contained in semen.

The prostate is located just under the bladder and behind the testicles.
The urethra — a hollow tube that carries both urine and semen to the penis — passes through the prostatTe.

In some men, the prostate gland becomes enlarged. Symptoms of an enlarged prostate include:
Patient Education
* a full bladder feeling even when the bladder is empty

* pain when urinating

* weak urinary stream

* infertility

* and sexual dysfunction.

To relieve you of your symptoms, your doctor feels that you would benefit from a surgical procedure called TURP.

TURP is designed to relieve symptoms by reducing the size of the prostate.
It is also a diagnostic procedure. Tissue removed during a resection of the prostate or TURP is routinely screened for the presence of cancer.

So make sure that you ask your doctor to carefully explain the reasons behind this recommendation.

Your Procedure:

On the day of your operation, you will be asked to put on a surgical gown.

You may receive a sedative by mouth and an intravenous line may be put in.

Once on the table, your feet and legs will be placed in an elevated position with your knees apart.

The nurse will swab the penis with an antiseptic solution.

Your doctor will then lift your penis upward.

A well-lubricated instrument called a resectoscope is then gently inserted into the urethra.

When the resectoscope reaches the back of the penis, your doctor will pull the penis downward in order to create a straight path into the prostate.

Using this tool, your doctor will then scrape excess tissue from the prostate, restoring it to its normal size.

Tissue removed from the prostate may be sent a laboratory for analysis.

When the surgery is complete, your doctor will remove the resectoscope. Your doctor will probably ask you to wear a temporary Foley catheter.

A Foley catheter is a narrow tube inserted through your urethra and into your bladder. The catheter is connected to a bag that is attached to your leg by a strap. While the Foley catheter is in place, urine will pass from your bladder into the bag. You will not need to urinate into a toilet.

The nurse will show you how to change the bag when it is full. An appointment will be made for you to return to the doctor's office in a couple of days to have the catheter removed. As soon as the anesthesia wears off and you feel comfortable, you'll be allowed to leave.

Patient Education Company

PreOp® Patient Education: TURP Prostate Surgery

Is your prostate large? A new study may be for you!

Your doctor has recommended that you undergo a Trans Urethral Resection of the Prostate – or TURP. But what exactly does that mean?

The prostate gland is a walnut-sized organ that is part of your reproductive system.

It provides some of the fluid contained in semen.

The prostate is located just under the bladder and behind the testicles.
The urethra — a hollow tube that carries both urine and semen to the penis — passes through the prostate.

In some men, the prostate gland becomes enlarged. Symptoms of an enlarged prostate include:

* a full bladder feeling even when the bladder is empty

* pain when urinating

* weak urinary stream

* infertility

* and sexual dysfunction.

To relieve you of your symptoms, your doctor feels that you would benefit from a surgical procedure called TURP.

TURP is designed to relieve symptoms by reducing the size of the prostate.
It is also a diagnostic procedure. Tissue removed during a resection of the prostate or TURP is routinely screened for the presence of cancer.

So make sure that you ask your doctor to carefully explain the reasons behind this recommendation.

TURP Transurethral Resection Prostate via Penis Surgery

StoreMD™ for Physician Videos:

Your doctor has recommended that you undergo a Trans Urethral Resection of the Prostate – or TURP. But what exactly does that mean?

The prostate gland is a walnut-sized organ that is part of your reproductive system.

It provides some of the fluid contained in semen.

The prostate is located just under the bladder and behind the testicles.
The urethra — a hollow tube that carries both urine and semen to the penis — passes through the prostate.

In some men, the prostate gland becomes enlarged. Symptoms of an enlarged prostate include:

* a full bladder feeling even when the bladder is empty

* pain when urinating

* weak urinary stream

* infertility

* and sexual dysfunction.

To relieve you of your symptoms, your doctor feels that you would benefit from a surgical procedure called TURP.

TURP is designed to relieve symptoms by reducing the size of the prostate.
It is also a diagnostic procedure. Tissue removed during a resection of the prostate or TURP is routinely screened for the presence of cancer.

So make sure that you ask your doctor to carefully explain the reasons behind this recommendation.

Patient Education Company for info: 617-244-7591http://www.PreOp.com
Patient Education Company for info: 617-244-7591
Your doctor will then…
…lift your penis upward.
A well-lubricated instrument called a resectoscope is then gently inserted into the urethra.
When the resectoscope reaches the back of the penis, your doctor will pull the penis downward in order to create a straight path into the prostate.
Using this tool, your doctor will then scrape excess tissue from the prostate, restoring it to its normal size.
Tissue removed from the prostate may be sent a laboratory for analysis.
When the surgery is complete, your doctor will remove the resectoscope. Your doctor will probably ask you to wear a temporary Foley catheter.
A Foley catheter is a narrow tube inserted through your urethra and into your bladder. The catheter is connected to a bag that is attached to your leg by a strap. While the Foley catheter is in place, urine will pass from your bladder into the bag. You will not need to urinate into a toilet.
The nurse will show you how to change the bag when it is full. An appointment will be made for you to return to the doctor's office in a couple of days to have the catheter removed. As soon as the anesthesia wears off and you feel comfortable, you'll be allowed to leave.

Erectile Dysfunction, Penile Prosthesis and Prostate Cancer

Erectile Dysfunction and Penile implants Treatment
Dr Phillip M Katelaris Urological Surgeon Prostate Cancer Diabetes mens health and wellness
Marriage and sex and health issues
Australian leading surgeon Dr Phillip M Katelaris
produced by Westymedia David Westbrook
Australian Mens Health
www.westymedia.com