Surgical Boot Camp at UNMC

(To the tune of Piano Man)

It’s 9 o’clock on a Friday morn. The regular crew shuffles in.

They’ve all matched into residencies, but just before they begin:

Chickew…record scratch: BOOT CAMP.

A three and a half-week, elective course for M4s to hone their surgical skills just before graduation.

Did I mention it was optional? And that all 20 UNMC students who matched into surgical specialties opted to do it?

boot campers

Here are the overachievers with boot camp organizer Dr. Wendy Grant on the far left. Surgical Resident and Alex Trebek wannabe, Dr. Jeff Carson, is on the far right. On the first day, Dr. Grant buys them camouflage hats and labels them with the students’ last names. They can wear the hats during the month, but Dr. Grant asks for them back just before the end. On the last day of boot camp, she returns the hats back with “Dr.” before their last name.

They could be sleeping in, going out, traveling abroad, goofing off, wandering around, but they’re not.

They’re in the basement of the cadaver lab, tying knots on the incisions of donor bodies. Knot after knot after knot so that when called upon to suture in the operating room, they don’t freeze. Start to shake. Or worst-case scenario: get passed over from someone who does know how.

Surgical boot camp, now in its third year, was designed by Wendy Grant, M.D., from the Department of Surgery. She organized it to give UNMC students a leg up (or would it be a hand?) when they begin their careers as doctors later this year.

“Knot tying is the most basic, fundamental surgical skill,” Dr. Grant said. “If everyone who comes through here can be called on to tie a knot on their first day, whether it’s right-handed or left-handed, they’re ahead of the curve.”

You won’t catch Dr. Grant barking at students to “drop and give her 20” knots, but instead sketching a pancreas on the white board and peeking over the scrub-donned shoulders of her students with pride.

Thanks to those who donate their bodies to science, this course gives students the most accurate representation of what tissue will feel like in the operating room. Ortho students focus on the bones and joints. Obstetricians and gynecologists zero in on the uterus. ENTs and neurosurgeons concentrate on the head and neck.

“It’s the ultimate simulation,” said Ben Grams, who matched into general surgery at UNMC. “Having the cadavers makes it so much easier to learn as opposed to looking in a book.”

Jeremy Hosein, who matched into neurosurgery in Colorado, is practically boy scout status after tying so many knots.

“I’m 1,000 percent better,” he said. “We’ve each now tied a couple thousand knots.”

It’s not all knots. The mixture of advice and teaching comes from faculty and residents in many areas of surgical specialties at UNMC. There’s also the Laparoscopic Skills Olympics and of course, Jeopardy, held in the Medical Services Building.

categories

With categories like “Things that are Red?” (Solo cup not being an acceptable answer) “The Number After 2,” “It’s Not a Toomah,” “Orders in the OR” and “X-ray,” it’s hard for the students not to have fun. After four years of non-stop studying, they relish the relaxed environment of “boot camp.”

“It’s an opportunity to reconnect with everybody,” said Jennifer Dwyer, a soon-to-be urological surgery resident at UNMC.

Dwyer brought the bagels and coffee for her team on the day of Final Jeopardy. After correctly writing an order to “administer a fluid challenge to a 19kg child who is hypotensive,” she and her teammates were stumped by what foreign body was pictured on an X-ray.

Fishing bobbers, guessed one student? Nope. Another student shouted an answer that can’t be printed in this blog. Nope. The answer was magnets. Giggling ensued.

answer

Tom Brush holds up his team’s answer to a surgical Jeopardy question.

Their final exam was a double elimination bracket of tying 10 knots with fine suture. For many, having to do so will never be a part of their everyday lives, but it was a skill they thought impossible just three and a half weeks ago.

They opted to be here because they know it’ll make them better.

That, and it’s fun.

The scientist and his chicken soup

Oh. So that’s what we’ve come to talk to him about.

Chicken soup.

Dr. Rennard exhaled, and leaned back in his chair so his voice would carry into the open office door across the hall: “How do I feel about the chicken soup story, Lillian?”

After a knowing laugh, the answer: “It’s just been unbelievable,” Lillian said.

Dr. Rennard watches his wife, Barbara Rennard, the study’s first author, make her famous chicken soup.

Dr. Rennard is Stephen Rennard, M.D., Larson Professor of pulmonary and critical care medicine at UNMC. Lillian is Lillian Richards, office associate I, internal medicine pulmonary, charged with wrangling Dr. Rennard, and sometimes (OK, often) also all this stuff about chicken soup.

And this chicken soup stuff never stops. It happened again, just the other day. This time it was Martha Stewart mentioning it in a syndicated “Ask Martha” column. Yes, Martha said. According to a “recent” University of Nebraska Medical Center study, chicken soup, while not a cure, could help alleviate symptoms of the common cold.

It never stops.

Go ahead, Google the words Rennard chicken soup and the search engine comes up with about 5,330 results in .21 seconds. None of them, as far as we can tell, are about any other Rennard or any other chicken or any other soup.

People love it that a scientist actually has studied whether chicken soup might be good for you, when you have a cold, just like your mom says.

Dr. Rennard, UNMC’s inaugural scientist laureate, is a world-renowned chronic obstructive pulmonary disease (COPD) researcher. Well, he’s world renowned for his COPD research within scientific circles. To the rest of us, thanks to a 1993 study that’s proven to have gone not viral, but retroviral, he’s world renowned as Mr. Chicken Soup.

“It’s been 20 years,” Dr. Rennard said.

“That’s the funny part,” came Lillian’s voice, from across the hall.

Barbara Rennard’s chicken soup comes from her grandmother’s recipe.

It’s like a musician, who has done great work for decades. But we, the public, can’t get that one, long-ago hit song out of our heads.

Right?

Well, no, Dr. Rennard said. It’s not like that at all. “It would be kind of like,” he said, and then paused for a good 10 seconds, trying to think of what it would be like.

“OK, so Charles Dodgson,” Dr. Rennard finally said. (Charles Dodgson? Pen name: Lewis Carroll.) “It’s kind of arrogant to compare yourself to somebody like that. But, he got to be really famous for ‘Alice in Wonderland.’

“He was actually a serious mathematician,” Dr. Rennard said.

“But nobody cares about that other stuff.”

This all happened because Dr. Rennard had also always heard the folk wisdom, from cultures all over the world, that chicken soup helps colds, and he loves that kind of stuff – he studied folklore and mythology at Harvard. But he also is a scientist. He lives to find the truth of things, to figure things out.

And, his wife makes chicken soup. Wonderful chicken soup. Magical chicken soup. It is Barbara Rennard’s grandmother’s recipe, and if any chicken soup could cure colds, it would be this one.

TV stations across the country have shown Barbara Rennard making chicken soup, and a station in Cincinnati even uses some of the footage as “B-roll” on Mother’s Day. How do we know? A childhood friend called her: “Barbara! I just saw you on TV!”

Why not look into it?

What we did in the laboratory was actually very rigorous,” Dr. Rennard said. “Admittedly, we did it for the fun of it. Because we were amused by it like everybody else.”

And?

“What ourwork shows is that there are ingedients in common foodstuffs that might have anti-inflammatory actions. That old adage, that if it helps you, it might not be wrong.”

And so it is that Dr. Rennard, renowned COPD scientist, will be forever cited for his research on chicken soup.

Barbara Rennard and Dr. Rennard go over some of the research inspired by her chicken soup.

How does he feel about that? Well, when the subject is first broached, his body language did not scream enthusiasm. But, the longer Dr. Rennard talked, it was clear chicken soup is like that rascal uncle you can’t help but love. With every memory, he couldn’t help but smile. It’s been a fun ride. Besides, he may as well roll with it. It’s never going away.

Leaning: “Do you think people will finally stop calling about the chicken soup story, Lillian?”

“No,” Lillian said.

“I think when you finally retire we’ll give them your home phone number,” Dr. Rennard said.

Chicken soup has given Dr. Rennard three great career highlights, the kind few scientists are lucky to get:

• His wife Barbara, the study’s first author and head soup chef, always loved listening to Bob Edwards on National Public Radio (NPR). Guess who was interviewed by Edwards about chicken soup and managed to get his wife in on the call? “He talked to me for 10 minutes. He talked to her for the whole rest of the hour!” Dr. Rennard said. “And my wife’s friends were listening to NPR radio and said, ‘That’s Barbara Rennard!’ ”

• When Dr. Rennard’s hometown paper, the St. Louis Sun, was doing a chicken soup story for its Sunday magazine, it asked him for a photo. Well, it is his wife’s grandmother’s recipe, he said, and she was from St. Louis. How about a photo of her? It ended up being an old photo of Barbara Rennard’s grandmother cooking with her two young daughters, Barbara’s mother and aunt. Heartwarming stuff. “I got my mother-in-law’s picture in the newspaper,” Dr. Rennard said. A man can’t do much better than that.

• Dr. Rennard and chicken soup were a question in Trivial Pursuit. Every parent can relate: of all the work he has done, it was nice to finally have something his kids thought was pretty cool.

And so, Dr. Rennard will continue to work tirelessly on COPD (“It’s the third-leading cause of death in the United States and it’s not a household word,” he said). And he will continue to take phone calls about chicken soup.

Dr. Rennard adds carrots under his wife’s watchful eye.

Because those calls keep coming. Lillian used to try to keep track of a stack of news clippings, but it grew too much. This year alone Dr. Rennard and his chicken-soup study have been cited nationally by Martha Stewart, Men’s Fitness and the Huffington Post, among others.

It’s the media-exposure equivalent of a golden goose. It just keeps giving, year after year.

Few have done as much to put UNMC in the public consciousness as has Dr. Rennard’s research on his wife’s wonderful chicken soup. And, while he said he isn’t quite sure of all the logic behind why, Dr. Rennard does know that any time national media mentions UNMC, it is, as Martha herself might say, a good thing.

“It doesn’t show up in my annual productivity, things I’m responsible for,” he said.

What? How can that be? That’s a huge contribution to the university. How is all this not noted in his file?

“Lillian!” Dr. Rennard said. “So, Kalani thinks that we need to record in ADIS all the chicken soup interviews.”

“I quit,” Lillian said.

Show Me That Smile

 

The following is the second in a series of guest posts by UNMC third-year medical student Eric Nagengast, who is taking a year off from med school to  serve with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

I have no need for an alarm clock in Guwahati.  Like the roosters on the farms of Nebraska, the crows here alert everyone to the first sign of daylight around 4:45 a.m. At 5 a.m. the drivers begin bleating their horns on the street below, and by 5:30 a.m. the elder men of Guwahati clear their lungs, throats and sinuses with an aggressive, hacking cough. After years of breathing the Indian air, I probably would have to do that too, but the sound is certain to end any hope of a few more minutes of sleep.

I get up and efficiently use the 60 seconds of hot water my shower allows me each morning. A long hot shower is one of the things I miss the most about home. After a quick breakfast of one of the twenty protein bars I brought with me, along with some local fruit, I am out the door and thrust into all that is India.

street

The streets of Guwahati.

India has a way of overwhelming all your senses all the time. The first thing I notice is the thick, polluted air. I will never get used to it as it’s my least favorite thing about Guwahati. The air is so polluted that some members of the team use an inhaler. Next is the noise. On my walk to the hospital, I am honked at by rikshaws, cars, buses, motorbikes and bicycles. In India it is custom to honk anytime you are approaching another vehicle or a pedestrian. Since the streets are crowded with both, the result is continuous honking. Of course, I see plenty of things that would be completely out of the ordinary back home like monkeys, massive amounts of garbage or a fight between stray dogs.

ericmonkeys

You can imagine why everyone in the Delhi airport double-and triple-checked my connecting flight. Why would an American want to travel to this poor, isolated part of India?

When I step into the ward, I am reminded why I am here. The most deserving patients in the world fill the large room full of 40 hospital beds and today they will receive care they have waited many years for. The operating room in the Guwahati Comprehensive Cleft Care Center is just awesome! I learn so much assisting the expert surgeons here. There is not a center in the world that does more cleft operations.

operatingroom

Nagengast assists a surgeon from the Democratic Republic of Congo who spent four months at the center learning cleft surgery. Before arriving he had never done a cleft operation. The surgeon, who goes by Desi, is now back in the Congo providing care for his people.

Yesterday’s patients are being discharged and today’s are undergoing preoperative assessment. I look for patients to interview for our quality of life study. Our goal is to determine how living with a cleft affects the quality of life for a person and his or her family. I interview a 14-year-old boy and his father. This boy has a cleft palate. His father makes $3 a day mining coal. For 14 years, this boy has lived with a defect in the roof of his mouth that leaves his nasal cavity open to his mouth. You can imagine the difficulties this has caused with speech and eating among other things.

The next patient is a 40-year-old woman with a cleft lip. This woman has lived 40 years without seeing a surgeon for something that would have been fixed at three months of age in the United States. At the center, I have seen patients as old as 65 with unrepaired clefts. I will say it again; these are the most deserving patients in the world.

boybefore boyafter

Patients without access to surgical care exist in many parts of the world. It is not just cleft lip and palate that they suffer from, but also obstructed labor, injuries, appendicitis, and on and on. Most of you reading this probably have had at least one operation, and if not, someone close to you has. What would life be like if you did not have access to safe surgery?

The greatest advancement in surgery in the coming decades will not be a new, high-tech invention. Instead, it will be finding a way to deliver surgical care to the people who need it most, and I hope to be a part of this discovery.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.