— Anesthesia residency graduation speech — 1984 —
Traditionally, the two ‘chief residents’ of the graduating anesthesiology group were asked to deliver talks at the graduation banquet. Being one of the two chief residents, I was called upon. Following is the tongue-in-cheek farewell speech that I wrote and delivered at the graduation banquet of the Department of Anesthesiology at Kansas University, shortly before I finished my residency. In attendance were all of our professors and residents, plus their spouses.
“Ladies and gentlemen, As a means of expressing my thanks to all of you that I have worked with during my residency, I would like to share with you the 14 most important things that I have learned during my residency here at Kansas University Medical Center.
1) I have learned from Dr. ______ (a native of Great Britain) that Americans don’t speak English, they speak American. Dr. ______ has made a concerted effort to teach myself and other residents the proper King’s English with correct pronunciations, such as pneumoenKephalogram, cerv-I-cal, ep-EE-dural, I-liac crest, sequ-EE-lee, an-ee-sthetize, b-ee-ta blockers, mel-EE-na, normal sal-I-ne, and my personal favorite, the I-lioingu-I-nal nerve. The one phrase that I found we do pronounce the same is ‘bilateral carpal tunnel syndrome’ (Dr. ______ suffered greatly from this syndrome). I am going to miss your “foreign” accent, Dr. ______.
2) I have also learned another language here in Kansas, that being TEXANESE. Unfortunately, my sense of social etiquette and taste prohibits me from sharing with you any of the colorful phrases I’ve heard, with the exception of “fixin’ to”, which, loosely translated, means “in the process of”. I’m not sure if I will miss these earthy Texanese phrases which seem to emanate so freely from Texan lips, but I do know that I will sorely miss my Texan friends I have made while at KU.
3) I have learned from Dr. ___ that it is indeed possible to combine a career in geology and anesthesia.
4) I have learned from our beloved Dr. ______ that it is possible to provide an obstetrical anesthesia epidural service without slowing the labor of parturients using the widely acclaimed Marcaine 1/16% technique. I hasten to point out that we haven’t provided much pain relief for the laboring women, but we have achieved our primary goal of not slowing their labor. I have the distinct clinical impression that we could accomplish the same results with a concentration of 1/32% Marcaine as well.
5) All of us that have rotated through Dr. ______’s pain clinic have learned that the proper medical term for a full-blown Grand Mal seizure is “mild tw-EE-ching”. ______, wanting to experience “mild tw-EE-ching” firsthand, conducted a unique experiment in the pain clinic. Under the guise of doing a stellate ganglion block in an elderly female patient, he prepped the skin and proceeded to inject 1 cc of 1/4% Marcaine directly into her right carotid artery. Within 30 seconds, he gained a profound understanding of “mild tw-EE-ching”. Drs. ______ and _______ discovered a lot about their own anal sphincter tone as well.
6) Dr. ________ taught me much about the proper use of diplomacy and congeniality on the telephone. My best lesson came on the night that a 3rd-year medical student paged us at 2:00 am, asking us to pass a nasogastric tube down a patient in Room 44A. Dr. ________ redefined the term “diplomacy” that night.
7) During my residency, I have become proficient at performing epidural blood patches. I am particularly indebted to Dr. _________ for my mastering of this technique. Inevitably, about 2 days following one of Dr. _______’s shifts on the Labor & Delivery unit, we would get a consult from an obstetrics resident about a recent parturient who was now at home with an excruciating occipital headache which became unbearable when she sat up or stood up. I thank you, my friend, for giving me so many opportunities to practice the placement of blood patches.
8) Dr. ________ taught me much about fortitude and dedication when I discovered that he has carried on with his life and become a success DESPITE the humiliating experience of being “arm-drug” in the State Wrestling finals championship match.
9) Dr. ________ has taught me how to convince a laboring woman NOT to have a labor epidural, should I ever want to do so. Dr. _____ amazed us all when he only did THREE epidurals during his entire month on the Labor and Delivery unit. I couldn’t understand why he had done so few until one night on call I observed him explaining the pros and cons of an epidural to a laboring patient. The discussion went thusly: “Good evening, Mizz Black, I’m Dr. _______, and I understand that you have requested an epidural for labor. I feel obligated to explain to you what that entails. First I will insist that you lay on your left side and curl up into a tight, cramped ball, which will be very uncomfortable for you. You will need to hold that position for about 45 minutes because that is how long it will take me to place your epidural. I will be plunging a 4-inch epidural needle into your lower back, and I will need to do that without any local because I don’t want to distort my surface landmarks. The epidural needle itself is about the diameter of a Bic pen. As you might imagine, the epidural space is very small, so there is a very high likelihood that I will overshoot the space and penetrate your spinal canal and central nervous system. This will cause two very serious problems. First, you will get a headache like you have never experienced before, making it impossible for you to sit or stand for about two weeks. Secondly, since we are never sure where the spinal cord ends in the spinal column, there is a 50/50 chance that I will harpoon your spinal cord, rendering you paraplegic for 9 to 12 months. Most of my patients have done well with a wheelchair or walker until they have regained normal function and sensation in their lower extremities. Now, Mizz Black, don’t rush into this decision. Take your time. Why don’t we see how you do without an epidural until to get to 9 or 10 cm dilation, and then if you still want an epidural, I will come back and we can talk more at length about it.”
10) I have learned from Dr. _______ a rather unique method of diagnosing the presence of pulmonary nodules. I will briefly describe his technique. First, he attempts an intercostal nerve block, during which he deftly pops the needle through the pleura and into the thoracic cavity, giving the patient a 20 to 25% pneumothorax. This complication necessitates several chest radiographs to follow the course of the pneumothorax, and a radiologist serendipitously picks up the nodules while perusing the X-rays. I like your style, my friend.
11) Dr. _______ has taught me many unique things. I have greatly enjoyed my association with him. He has taught me why his favorite groups are Ry Cooter, The Police, and the Mormon Tabernacle Choir. He has taught me why his favorite beer is Lite Busch from Miller. He has also taught me that it is possible to consume three bottles of beer simultaneously, and that it is also possible to smoke three cigars simultaneously. I am not sure at what stage of my life this information will become important.
12) Dr. _______ taught us all a unique way to say goodbyes to guests at a hot tub party. Again, social decorum prevents me from elucidating the details, but there are certain persons here tonight that will give you specific details on a one-on-one basis should you desire them.
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