In George Orwell’s Animal Farm, under the dictatorship of the alpha pig, Napoleon, the pigs who represented the nomenklatura of the farm chant the slogan “four legs good, two legs better,” after initially declaring “four legs good, two legs bad” during their revolution. They clearly understood the luxury afforded by a bipedal lifestyle, because in rising on two legs, you get arms and hands which can do many things like caress a baby or wield a cudgel. What the pigs in the parable weren’t realizing were the consequences of a bipedal lifestyle.
When Lucy, the Australopithecine, bipedal hominid ran about on two legs, she did have the use of two arms and hands. Possibly an adaptation to living in tall grasslands with few trees, the ability to stand tall like meerkats, allowed the biped to see far into the horizon for big cats who probably loved the big brained hominid for the high calorie meal inside the hard skull -many fossils from this time show puncture marks from the incisors of medium to large cats.
The walking and running put heat stress on the brain, and the tool use which happened incredibly early and is observed in the chimpanzee, likely drove the selection for a larger brain (more neurons will allow for one to lose some neurons to heat stress but stay in the game), but it created likely the first problem for our ancestors -discharging a cantaloupe sized head through a pelvis that was small to begin with but now also reshaped for bipedalism. We still suffer from a childbirth process that no other mammal faces -birthing a less than fully cooked baby -a tradeoff for that giant head.
Standing also meant the load bearing was shifted 90 degrees with long term consequences. For our ancestors who only lived about 20-40 years if the chimps are correct, this wasn’t a big deal as arthritis and tendinitis didn’t preclude eating and breeding and didn’t affect them until they were old. But with modern sanitation and social structures, we are reaching 100 years and the majority of the problems of the integument -the bones and ligament, the low back pain, the sore knees, the ratchety hips, can all be explained by our bipedal lifestyle. Your arm is 30-50 pounds of meat and bone and supported only by muscles off your spine, and your blood vessels and nerves traverse a narrow passage through these muscles and your first rib. Your diaphragm with 5-10 pounds of heart, lungs, and blood sits on first branch artery off of your aorta. Your veins, designed to drain blood from your organs, have to do so with over a meter of static water pressure and your sump pumps only work when you are walking. Muscles and their tendons are stretched tight in the odd way that upright walking and running demands, compressing blood vessels and nerves. All of this weight is put on your feet which have to deal with up to a ton of pressure with running…
I’ve talked about this concept many times before but never had a chance to put it together like this talk. I may write an article. Looking back, I did this blog post (Link).
I am grateful to Ms. Mei Nortley and Mr. John Raphael for the invitation to give this talk.
My list of favorite things this year is simpler than in the past, in respect for the difficulties of the past year. Everything is under $300, and I use these every day. Treat your surgeon well and she will give you a nice scar.
1. Lenovo Ideapad Duet. Cloud computing has diminished the need to carry processing power unless you are editing Pixar films or playing super high resolution video games. For composing words on the go, and sketching diagrams for patients, and putting together powerpoints, this Chromebook hits the sweetspot of price, battery life, and quality. It comes with easel stand and attached keyboard with trackpad. An Apple Magic Keyboard for the iPad costs more than the Duet! Battery life is easily all day, and in tablet mode, streaming movies is great. It fits on the stunted traytables on airplanes well because of its petite size. I drew this sketch for planning an arch repair on it. Can’t beat the price at $249 and cheaper with discounts. I got mine as a open box at Best Buy for $200.
Sketch made on a Lenovo Duet
2. Theragun Mini. It is a stereotype that middle aged Asians buy giant massage chairs, which are AMAZING, but if you want something more manageable, the Theragun Mini is the ticket. It is a personal massager designed for deep tissue massage, with a lithium ion battery built in. After a long day of operating, all the aches are pulverized by this machine.
Theragun Mini
3. Masterclass Subscription -During pandemic, diversions like enrolling in an MBA program and Youtube yoga, are the hot ticket, but for someone with a short attention span in need of non-work diversion, these classes are great! Penn and Teller teach magic. Steve Martin teaches comedy. And FBI hostage negotiator Chris Voss teaches high stakes negotiation. All of these highly relevant to a vascular surgeon. Trust me.
4. Moleskine Backpack -I have struggled with overly heavy work bags, but need to carry my computer and some papers and maybe a water bottle, pens, a powerbank, some cables. I find black vinyl laptop bags generally horrible to look at, and too easy to overpack. Expensive leather designer bags carry a similar price as a handbag from Gucci or Louis Vuitton, and would not survive a day without getting scuffed. This backpack from Moleskine, yes the notebook company, is both beautiful to look at but practical as well. It is water resistant and holds everything I need for the day. Has a measured number of compartments and inner panels for pens, cables, and cards, and is well padded for carrying your electronics. Looks great, and would survive medical school.
Moleskine Backpack -not just for notebooks
5. Freewrite Traveler -a writing appliance, a typewriter. The original Freewrite was designed to look like a typewriter, and the spirit of the machine is it takes away all the distractions of the internet for the focus of plain paper. The Traveler is the second machine by the Freewrite people, and offers the same focused writing in a portable package. Not for everyone, this one, but if you like writing, if you must write, this is amazing. It features a Kindle-like e-ink screen, and you type without the ability to edit. Everything you write goes to the cloud of your choice, including Dropbox and Drive, and so you won’t lose it. It has internal space for thousands of pages, and a 4 week battery life. If you hope to write the Great American Novel, this is the gadget for you.
Freewrite Traveler for the Hemigway in you
6. LED UV Blacklight -If you’re of a certain age, Spencer’s Gifts was one of the stops you made at the mall, and you always checked out the blacklight section, with its fluorescent posters and purple lamps that made your white shirt glow. As a surgeon, you want a Wood’s Lamp, but most hospitals do not have one, and most nursing staff have no idea what you are talking about. Good thing is that there are many cheap but powerful LED Blacklight options that emit UV light. This is great to have in the OR for a fluorescein test of gut perfusion (link). Take it camping in the deserts around here and you can see the scorpions at night! Or you can torture yourself by breaking it out at the next hotel you stay at and visualize all the glowing “protein stains.” Under $10, but slightly more for the higher power ones.
portable LED blacklight!
7. Old School iPod -This is as close as you can get to getting a Walkman without dealing with the inconvenience or poor sound quality of cassette tapes. In 2004, these were cutting edge, and Apple to its credit still supports file transfers of purchased (but not streaming) music files. The cool thing about these is that if you can do a carotid endarterectomy, replacing the battery and upgrading the memory are nothing, and there are many videos on line to show you how. These units are cheap to find on eBay, and there is nothing cooler than carrying around 10,000 songs in your pocket, without the need for a network, meaning uninterrupted music in the OR without relying on the network.
An iPod I purchased in 2006, upgraded to 32gB from original 8gB, just replaced battery for third time, still works.
8. Golf Ball Stamps -These stamps are meant to mark golf balls, but they are incredibly useful for graphically marking up a printed list. Each of these symbols represents a status or an action, which lets me look at a list at a glance and remember exactly what needs to happen. At pro shops everywhere.
Meant for golf, repurposed to act as semiotic markers on lists
9. Swiss Army Knife -the first one I got was as a graduation gift from my dad, thought technically not a gift as superstition dictated I purchase it from him for a dollar, it was the same as this one which is currently my fourth, bought at a Boy Scout camp for about $10. I keep one in my checked luggage for use at my destination for opening bottles, uncorking wine, cutting salume and cheeses, tightening screws, and when the occasion arises, performing an appendectomy (need a hotel sewing kit). This one also has tiny forceps and a toothpick.
With this, I can do several life saving operations.
10. Skirt steak -rarely seen any more shrink wrapped at chain groceries, you generally have to ask the fellow behind the counter or know a butcher. This diaphragmatic muscle used to be cheap. Considered offal in many places, this formerly cheap meat ended up being the go to meet for tacos and street cart barbecues in Asia, but don’t sniff at it. As it is not a structural muscle, it is not tough, has great flavor, and while leaner than traditional steak cuts, not devoid of fat like a filet (which is not my favorite) giving it enough buttery fat tones to remind you it is meat. Because it’s harder to find, that means the people who supply it know beef. Here in Abu Dhabi, I ordered this from the CarniStore in Dubai. Dinner is served.
A Surgeon's Notes 