Anniversaries - An excuse for reflection

I have been in Raleigh for six years.  And what a six years it’s been!

The time has seen a son born, friends made, colleagues arrived, and patients cured. Since anniversaries are an excuse for reflection…

The most incredible thing I have learned in this time is not to underestimate people.  I have seen so many people, in such dire circumstances, exude levels of poise and dignity I didn’t know people had and don’t think I am capable of.  To keep one’s sense of humor and humanity despite pain, nausea or a general lousy feeling is a truly magnificent feat. It shows one’s soul to the world, eases suffering and comforts family and friends. It is grace.

Technically, we as surgeons are much better now than when I came to Raleigh six years ago. Advances in minimally invasive surgery have revolutionized what we are able to do while decreasing pain and hospital stay. The future is bright! I work with many device manufacturers, and I can say from first-hand knowledge that new working materials and devices are soon arriving that will further expand our capabilities and deliver these advances to so many more people regardless of whether they are treated in small rural hospitals or large university settings. 

The spirit of innovation is not confined to the youngest. My adapting single site laparoscopic surgery, a very demanding technical skill, was prompted by my senior partner using it first. Rather than resting on his laurels, Dr. Jerry Stirman challenged all of us to continue to improve for the sake of our patients. He is a mentor to many of us in the surgical community and a treasure for those of us who know him.  Thank you, Dr. Stirman.

Despite what I thought six years ago when I moved here from Los Angeles, Raleigh is not a “small town.” We are blessed with a very educated population and an equally educated, savvy medical community that rivals Boston, Rochester, Minnesota or any other place in the world. We are innovators, from our medicine to our computers, biotech and other cutting edge industries the Triangle is known for.  With such progress in just six years, I can’t wait to see where we will be in another six years.

Tanning Booths - A Public Health Threat

Our society has an inconsistent history of establishing priorities that protect us.  We outlaw dangerous drugs such as marijuana and cocaine, but only limit other dangerous substances such as alcohol and cigarettes. Our health system, working hard to treat things we can’t help, is straining under the weight of things we can; diabetes, obesity, sedentary lifestyles, and tanning booths.

Tanning booths?

Yes, tanning booths.

Perhaps it seems silly at first glance. Tanning booths provide that lovely copper hue by bombarding the recipient with profound amounts of ultraviolet (UV) rays. UV rays are the part of the electromagnetic spectrum associated with cancers of the skin, most notably melanoma. And melanoma, a potentially lethal form of skin cancer, is becoming more common. Over 3.5 million people will be diagnosed with melanoma this year alone and mortality has risen nearly 700% in the past 3 decades. 

This important topic was discussed recently at the annual meeting of the Society of Surgical Oncology. As Surgical Oncologists, we see the impact that cancers, such as melanomas, have on patients and families. We decided to take action.

A special session was held with the intent of developing a position paper on this important topic. Our intent was to alert the public about the dangers of tanning booths and formalize and publicize our concern. Recent studies have found that the use of tanning beds during adolescence increases the risk of subsequent melanomas almost 200%.

With this known risk, other governments have begun to ban the use of tanning beds. Brazil and, as of 2014, New South Wales, Australia, have recognized the risk tanning beds pose and have outlawed them. In the US over 30 million people use tanning beds. Most are teenage girls, who, on average, use tanning beds over 20 times a year.

Is this really a public health problem? I think so. I appreciate the ability of consenting adults to engage in behaviors that are risky. But children? Do teenagers have the legal ability and responsibility to judge the risk of tanning?

I know what some of you will say. Should our exposure to the sun be regulated as well?  That would be like trying to outlaw carbon monoxide. But carbon monoxide, a significant by-product of cigarette smoke, is regulated by the federal government. Cigarettes, like alcohol, are regulated because of the well-established threat to our health. In my opinion, tanning beds fall into the same category.

In these troubled economic times, we should support small business. The tanning industry, mostly owned by small business owners, is a $2.6 billion dollar a year industry. But what cost, especially over the long term, does this have on health care expenditures as a nation?  Probably more than $2.6 billion a year in costs, loss of productivity, and quality of life.

I don’t know the answers, but I really want to know what people think.  Should the use of tanning beds be regulated?  Should it be restricted to people over 18?  21?  Not at all?

I appreciate the ability to talk to people in this digital form.  Please let me know what you think.

Visiting Surgeon in the Middle East: Part 17

I met Wissam at my hotel and we went to a different downtown area that was recently refurbished. It was a central area that was targeted by the Israelis in the last “troubles.” They left a few buildings in ruins to serve as a reminder of what happened. What struck me as the greatest juxtaposition, however, was the church that was adjacent to the Grand Mosque. How was that still standing, I wondered.

We ate another delicious meal (did I mention how good the food is in Lebanon?) and went to a local pub for a beer. With exposed brick, metal buttresses, and art nouveau films projected onto a white washed wall, I could have been in LA or NYC. Since my car was coming at 4:30 am to take me to the airport, we ended the night early (midnight in Beirut is very early). Wissam and I said our goodbyes. I was a little sad to see him go as I became very fond of him very quickly. We knew we’d see each other again.

I awoke very early the next morning, packed my things, and met my car outside the lobby. We drove through the deserted streets to the airport, and I realized that, somewhere on this trip several days ago, I stopped worrying so much about my safety. I think it happened in Kuwait at lunch with Wissam and the Egyptian pharmacists, as that is where I started seeing my hosts as well-spoken, thoughtful, intelligent friends very separate from extremists that claim to act on their behalf. I look forward to meeting my friends again.

Visiting Surgeon in the Middle East: Part 16

The next day, Friday, I ended up with nothing scheduled. I had hummus and Greek yoghurt for breakfast and decided to explore Beirut. Wissam was working and had to be at the office, so I was alone. I didn’t want to miss an opportunity to see Beirut. This was the first Friday (the Muslim holy day) since the death of Osama bin Laden and I was a little nervous about being alone on the streets of such a wonderful but notorious city. Having lived in New York City, Boston, and Los Angeles, I feel like I can blend in with city folk pretty easily (just look mad and don’t make eye contact). But I decided to avoid the area around Martyrs Square and the main mosques just in case there were any demonstrations or ill will toward lone American tourists.

I had a wonderful, uneventful day exploring the downtown area. I wandered over to the Corniche and walked along the sea. From a promontory I could see for miles north and south. I wondered how people that I could probably see to the south (where Hezbollah is dominant) would accept me being there on this day. I just strolled, stopping for a coffee or snack whenever it felt right. I took a lot of pictures and sent them to my 12-year-old nephew, Matthew. He, at such an early age, has the same travel bug I have and I knew he would get a kick out of seeing Beirut through my lens.

Visiting Surgeon in the Middle East: Part 15

We drove back to the hotel and I rested. The team told me I’d need it because they were going to take me out for a night on the town, and it could be late. Having watched decades of American TV news, I was a little worried what a late night on the town in Beirut would be like. Wissam picked me up and we went for a coffee at a French bistro in an open-air mall in a hilly district overlooking the city. The stores were all French chains but the atmosphere was nice in that one had the feeling of being on the street. We sat for 30 minutes chatting about our children and the funny things they do. It was time to meet the crew.

We went downtown near the central Martyrs Square. Many small, crowded streets emanated from it. One, anchored by a very crowded French brasserie, held their many bars and nightclubs. It was hopping. We settled into a nightclub and got a table. There were a variety of bands on the schedule, ranging from Arab tribal music to a disco cover band. Whatever the music, the crowd drank and danced with a fervor that took me by surprise. It reminded me of the Israeli nightclubs in Los Angeles. I couldn’t help but to think how similar everyone is. Why couldn’t they see it? Or did they. I didn’t want to ask since I was not sure of the answer I would get. The crowd was full of Lebanese, Europeans, and at least 1 American. No one cared. They just wanted to have fun. It was a good, albeit late, night.

Visiting Surgeon in the Middle East: Part 14

We settled into a small conference room, and I tried to get my Mac to work. For those who routinely talk in front of audiences, I don’t need to tell you that the scariest part of any lecture is the minute before you start while you are waiting for the computer to sync with the projector. Needless to say, it didn’t. Despite my technical difficulties, we managed to get the talk projected and had a very lively discussion. The group was small, so we all crowded around my 15-inch monitor and talked as colleagues about how to do various operations. Though I didn’t have the opportunity to operate with them (the case had been cancelled), I was thoroughly impressed by their obvious expertise (and ability to describe technical facets of surgery in English). These folks, obviously, were very well educated and qualified.

I learned a lot about health care delivery in Lebanon. or example, a night in the local hospital costs about $100 compared to over $1000 in the US. For that reason, length of stay as it relates to cost is not a very big determinant in Lebanon for making health care decisions. Trying to advocate for more technically difficult operations based on a lower length of stay was not impressive to Lebanese doctors. They were most interested in whatever made an operation faster, safer, and more efficient. No matter where you are, surgeons will always put the patient’s safety first.

Visiting Surgeon in the Middle East: Part 13

We picked up the area manager and the local sales rep and drove to Byblos. We headed north on what seemed to me to be their version of Pacific Coast Highway. The road hugged the rugged coast and overlooked beaches and resort areas. The sun was out and the water was sparkling. It felt a lot like California, especially the traffic. The 40 miles took about 2 hours. We arrived in Byblos a little early, and I was offered a tour.

Byblos is a 3000-year-old Phoenician city that, according to my tour guides, was the place of the first alphabet. There were ruins from that era, Roman, and Byzantine. We walked around the cobblestone streets lined with fossil and religious icon sellers. We settled in to a restaurant on the ancient harbor and ate a meal of fresh fish, hummus, and a variety of other incredibly delicious treats. I could really get used to this.

After a 2-hour lunch, we arrived at the private hospital in Byblos. It was small with a dirt parking lot that the local kids used as a soccer field and had a beautiful view of the sea. Unlike the other private hospitals I saw on this trip, there was neither marble on the walls or a foreign staff. Few women wore headscarves, and the men were dressed casually. As with everywhere I visited, everyone was entirely warm and gracious. The staff had even prepared a back table with local sweets made of nuts and honey.

Visiting Surgeon in the Middle East: Part 12

Wissam’s brother picked us up at the airport and they quickly dropped me off at my hotel as I think Wissam was anxious to see his mother. The hotel was a trendy American chain that was in a bustling downtown area. The first thing that struck me after my time in Saudi Arabia and Kuwait was the bar. I checked in, dropped my things in my room, and decided to have a nightcap to celebrate my safe exit from the Arabian Peninsula at this precarious time. I sampled a local Northern Lebanese white table wine. Despite my low expectations (and, perhaps, Californian affectations) I was blown away by the complex flavors. This was not a response to being in wine-free countries as this experience was replicated over the next few days. The Lebanese can make wine!

The next morning Wissam picked me up, and we stopped by their corporate office in Beirut to get the rest of his team. From my hotel in downtown near the Mediterranean, we headed east past the infamous Green Line, a flashpoint and heavily contested area dividing the Muslim and Christian sections of Beirut. Though life on the street seemed to be going on just like in any other big city, I could not help but notice the occasional pockmarked building and soldiers around armored personnel carriers on every corner. Interestingly, however, the soldiers were always outside of their vehicles chatting with folks on the street. If they were not worried, I wouldn’t be either.

Visiting Surgeon in the Middle East: Part 11

I had the afternoon to myself. Rather than sleeping, I decided to wander around Kuwait City and check it out. The beachfront along the Persian Gulf was gorgeous. I had expected it to be full of freighters and tankers, but none were in sight. Rather, there were mostly jet skis catching air and doing tricks over their wakes in the Gulf. Am I really right next to Iran? The city is bustling, with any empty space the host of a large, multimillion-dollar construction project. I explored the area and found a lovely park along the water. I followed it and was accompanied by every facet of Kuwaiti society, rich and poor, native and immigrant. No matter where people come from, a beautiful coast will always serve as enticement to get people outside.

We then went to the airport en route to Beirut. Our flight was uneventful, except the time the pilot asked the passengers to put on their seatbelts as we were going over “unstable air.” I looked at the GPS and saw we just entered Iraqi airspace. I am still not sure if the pilot meant that as a matter of fact or a political joke.

We landed at Rafiq Hariri International airport. I was first struck by the beauty of it being right on the Mediterranean, but was later entranced at the incredible efficiency of that airport. At Raleigh-Durham, I expect to wait at least 20 minutes for my bag. In Beirut, Lebanon my bag beat me to the luggage carousel. My only quick stop was at customs, where a young woman in a Lebanese military uniform spent a long, uneasy 5 minutes (felt a lot longer) pouring over every page of my passport. No one else on my flight from Kuwait City got that treatment and, frankly, I was feeling a little discriminated against. Is this because Lebanese people have such a hard time getting visas to the US? I asked Wissam, a Lebanese citizen, and was told she was making sure I did not have an Israeli stamp in my passport. If one was found, he told me, I would be refused access into Lebanon. Though this same restriction is on the books in most Arab countries, it is most strictly enforced in Lebanon I was told. An American with an Israeli stamp landing in Riyadh or Kuwait would likely be harassed and “interrogated,” but it is only in Lebanon that one would be unequivocally denied access.

Visiting Surgeon in the Middle East: Part 10

We took a cab and went through new high-rise after high-rise to our hotel. Hungry, we stopped by the Lebanese restaurant at the hotel where they were showing a Madrid vs. Barcelona soccer match projected onto the side of the building. We ate delicious Lebanese cuisine that Wissam said rivaled his mother’s and watched the match. We smoke shisha (tobacco in a water pipe) and enjoyed the evening. A good match, and, oh, what great food. The hummus was crisp and lemony. The meats were lean. Oh, so good.

The next morning we woke early and went to the outskirts of Kuwait City to operate with some Kuwaiti surgeons. Surgery is such a small world that the Kuwaiti surgeons and I immediately bonded over a mutual friend who, though Kuwaiti, trained in California and Texas and now practices in Minnesota. Our world is a small one. We, together, completed a fairly complicated case with little drama. The OR’s were clean, large and filled will folks who were obviously very well trained. They challenged me on why I did certain things and how I could do it better. I liked this dialogue. I liked the fact that they did not just accept what I was doing but wanted to know why. These guys, I told myself, were going to be great surgeons.

We finished our case early and decided to go to lunch. I was taken to a restaurant on the Persian Gulf known for their fish. The local reps, all Egyptian pharmacists, joined us. This was the only conversation I had on this trip that was political and, wow, was it informative. As an American, I think we tend to get a perspective that may not be representative of Arabs. We had a long, frank discussion over phenomenal seafood, fragrant shisha, and a desire to understand one another. It was quite an education…. And meal. The Persian Gulf glistened, and I reveled in the luxury of having frank discussions with people of different perspective who could teach me their perspectives.

Visiting Surgeon in the Middle East: Part 9

We checked in, got our seat assignments, and uneventfully went through customs and security. Still insecure about current events, I kept a careful watch over each person and made sure that, even with my back to the terminal, I could watch everyone via a reflection in the large windows over the tarmac. I was not going to be a headline in tomorrow’s Al Jazeera.

Despite my consternation, our shopping in the terminal and boarding on the plane to Kuwait City was uneventful. The flight was pleasant, as they served my new favorite coffee with cardamom.

Kuwait, used to having Americans, has a fairly easy visa process for us in the airport. To pay the 3 dinar fee for the visa, I had to go to an ATM since they didn’t accept credit. At the ATM, I asked for 100 dinars, never thinking that our American Greenback was less valuable than the Kuwaiti currency. I gave the money to Wissam to pay for the visa, wondering why he asked me why I got so much cash for our short stay. I figured the value would be like $30, not the $350 that the bank charged me. How could the dollar be that meaningless against the Kuwaiti currency? Wissam, showing a tremendous amount of restraint despite his ignorant new friend, never said a thing, though I know he caught on to my mistake.

Visiting Surgeon in the Middle East: Part 8

We checked in, got our seat assignments, and uneventfully went through customs and security. Still insecure about current events, I kept a careful watch over each person and made sure that, even with my back to the terminal, I could watch everyone via a reflection in the large windows over the tarmac. I was not going to be a headline in tomorrow’s Al Jazeera.

Despite my consternation, our shopping in the terminal and boarding on the plane to Kuwait City was uneventful. The flight was pleasant, as they served my new favorite coffee with cardamom.

Kuwait, used to having Americans, has a fairly easy visa process for us in the airport. To pay the 3 dinar fee for the visa, I had to go to an ATM since they didn’t accept credit. At the ATM, I asked for 100 dinars, never thinking that our American Greenback was less valuable than the Kuwaiti currency. I gave the money to Wissam to pay for the visa, wondering why he asked me why I got so much cash for our short stay. I figured the value would be like $30, not the $350 that the bank charged me. How could the dollar be that meaningless against the Kuwaiti currency? Wissam, showing a tremendous amount of restraint despite his ignorant new friend, never said a thing, though I know he caught on to my mistake.

Visiting Surgeon in the Middle East: Part 7

Our patient continued to do well and, with my pride barely in tact, I left the hospital. With several hours until my flight to Kuwait, my local host, another Palestinian pharmacist, took me on a drive around Riyadh to see the sights. Architecturally, Riyadh has many world-class building. The only problem is that one can rarely see them due to the orange dust from the desert that continually shrouds the city. As a westerner, I saw many familiar chain restaurants and stores. But there was nobody in them…or anywhere. The streets are deserted. Sporadically, one might see a man walking on the street to a store, but you’d never see a woman. Never. I wondered where all the women were hiding.

We stopped in the corporate office to pick Wissam up before he and I were to go to the airport and onto Kuwait. The office was in a nondescript building in central Riyadh near several restaurants and clothing stores. Upon exiting the elevator, we encountered several men, none Saudi, smoking cigarettes in the corridor. They were very friendly and we exchanged pleasantries. I don’t think they were used to seeing Americans there, as their protracted gazes, though friendly, betrayed their confusion in seeing a Westerner at their work place. They all invited me in and were anxious to tell me about what corporate division they worked for.

On the way to the airport, we stopped and got a coffee. Strong and aromatic…delicious.

Visiting Surgeon in the Middle East: Part 6

We were to do a laparoscopic low anterior resection for an older man with colorectal cancer. The OR was large, but sparse. There were no booms descending from the ceiling like OR’s in the US. A single tower of German laparoscopic equipment greeted me like an old friend from high school. This was not the operating room that I expected from a country where most of my dollars were going. Driving around Saudi Arabia, one is struck by the size and opulence of the shopping malls. This was not on par with those malls.

Despite the shortcomings of the facilities, the technical skills of the surgeons and staff more than made up for it. I operated with a female surgeon who was very gifted. Together, we excised a very difficult, large cancer with little blood loss and a lot of fun. It WAS fun. Technically, we had synergy and, as surgeons, that is very hard to come by. After making short work of a tough tumor, we went back to the Chief’s office where the familiar sign was hanging. I went in anyway without knocking. Everyone was in their familiar places. A traditional Saudi lunch was ordered.

This consisted of grilled, lean chicken and rice served in the center of the table. Each person uses his hands to roll the rice into a ball and eat the chicken. Though I like to think of myself as manually deft, I felt uncoordinated as my rice fell apart before getting to my mouth and my chicken fell to the floor. My colleagues smiled graciously, but I felt they were wondering how I could operate on people yet drop my rice all over the floor. Actually, I was thinking the same thing.

Visiting Surgeon in the Middle East: Part 5

Wissam, who lives in Riyadh, had things to do and sent his associate to pick me up. Another Palestinian pharmacist met me outside and we were off to the Riyadh Military Hospital. Again, no parking.

The courtyard of the hospital was bustling. I was amazed to see people of all colors and ethnicities going into the hospital. The women were dressed in everything from African robes to Asian dresses, though they all had their heads covered (and some their faces). I figured that this hospital was likely a large training hospital for people across the Muslim world.

With much trepidation, I gave the security guard my passport in exchange for a temporary badge (he was not interested in my North Carolina drivers license). We walked the narrow, crowded corridors and found the office of the Chairman of Surgery, our destination. A sign on the door in English read “Meeting in Progress. Do not enter.” We went in anyway.

There, with his feet on his desk, junior faculty and residents nearby, and a cigarette in his mouth, was the Chief. We were warmly greeted and offered the residents’ seats. Noticing my quizzical look, he confessed that the sign was an attempt to keep the administration away so he could smoke in his office. It made me realize that the traits one needs to become a department chairman are the same everywhere in the world.

Visiting Surgeon in the Middle East: Part 4

Since we had some time before our flight to Riyadh. I, not wanting to spend much time in an airport given the day’s current events, suggested we get a Turkish coffee on the way. We went to a very stylish coffee bar that would not be out of place in New York, LA, or London and ordered. We had to order and pay immediately because the call to prayer (one of five daily) was about to sound and all businesses had to close. Our coffee and snacks came just as the call to prayer went out and we ate. We finished before the prayer was over and tried to leave quietly. But the doors were locked. All the employees had left to pray and we were alone and locked in the café. We went into the kitchen and found the cooks, interrupted their prayers, and were let out the back (where the nonmuslim employees were smoking cigarettes).

We got to the airport, checked in, and waited for our flight to Riyadh (my paranoia again surfacing and seeing conspiracies in my fellow travellers). After an uneventful flight, we landed in the middle of the Saudi desert in Riyadh. The terminal was beautiful, floor to ceiling marble and waterfalls. The first thing you notice when leaving the terminal, however, is that everything…I mean EVERYTHING, is covered with orange dust. The air tastes like dust. It’s everywhere.

I checked into the hotel and went to my room to get a few hours rest before going to work. Every TV station had news of bin Laden, and that made me nervous. I looked out my window to plot my escape and realized that, even though it was the second floor, my room was next to the roof of another building where people could easily get into my room. I did not sleep well that night, as I kept peering out the window to make sure no paramilitary terrorists were coming for me.

Visiting Surgeon in the Middle East: Part 3

One of my over-riding philosophies in laparoscopic surgery is to use technology to make as few incisions and possible and, when necessary, make them as small as possible. This was not possible in Saudi Arabia. Their scopes were wide and lacked the HD I am used to. I operated with two very talented surgeons (one Saudi and one Sudanese). As a testament to the skills of my colleagues, we completed the case laparoscopically and the patient did very well. They showed me how to maximize the use of their instruments and I, in return, introduced them to some new techniques and instruments we use. I think we all came out of the case better surgeons with new skills.

The first case took a little longer than expected and we hurried to a private hospital for an afternoon case. What a difference! Though parking was still difficult and I had to walk a while in the Saudi heat in my dark wool suit, I was amazed at the luxury of the private hospital. The floors were immaculate white marble. The walls were freshly painted. The laparoscopic equipment was mounted on booms. Very modern. The case, another difficult rectal cancer, went well. The Saudi surgeon, like so many I know in the US, spent the entire case teasing the anesthesiologist, his partners, and the nurses. In an act of true hospitality, I think I was the only one spared. It was a lot of fun.

Visiting Surgeon in the Middle East: Part 2

My alarm went off 5 hours later and I got ready for a long day in the OR. I turned on CNN as I dressed just as the news regarding Osama bin Laden broke. I have to admit, I had a momentary panic as Wolf Blitzer told me Osama was dead and, by the way, originally from the very city I found myself in…Jeddah, Saudi Arabia. My email alert immediately started going off as multiple alerts from the State Department to Americans travelling in the Middle East went out. They warned me to not go outside if possible. Then my mom called (how did she know already?). I looked out my window onto the Red Sea and did not see any crowds gathering or mass demonstrations. I called my new friend and host for the trip, Wissam, and asked what I should do. He reassured me that it would be fine, as the Saudis did not really consider him Saudi anymore. With his reassurance, we went off to the hospital to operate. I did, however, spend a lot of time looking over my shoulder and pretending I understood the Arabic people spoke around me.

The first hospital was the main public hospital in Jeddah. It was probably a training center for Muslims from all over the world as I saw people who looked Asian and Eastern European as well as Arab. We went into the locker room where an attendant from India gave us scrubs and shoes and put my bag into a locker. I was introduced to the OR staff and was taken to meet the head nurse.

The hospital was very clean but looked like almost any other 30-year-old public hospital in the world. The tile was worn, the walls had some scuffs, and finding a parking spot was nearly impossible (just like in the US). But the staff was kind and the patients grateful for the hard work of the surgeons and OR staff.

The patient was a man with a low rectal cancer. I don’t think the Saudi surgeons thought it could be done laparoscopically, but they wanted to see me try. I could tell they wanted to give me a difficult case and make me prove my mettle (this would be repeated in every hospital I visited). My first goal was avoid doing anything that would cause bleeding. Everyone was so incredibly hospitable and tried to get me all the instruments I use in the US. Unfortunately, they didn’t have many of the ones I use. The operating room was spacious and accommodated the surgical team and the several students and surgeons who were there to watch. Like most OR’s in hospitals built before the laparoscopic era, the equipment was placed in the room as if an afterthought (it was). The video monitors were small and gave a picture reminiscent of the TV pictures when we first got cable at my parents’ house in 1983.

Visiting Surgeon in the Middle East: Part 1

It wasn’t until at about 39,000 feet over North Africa that the thought finally came to me. “What on earth am I doing going to Saudi Arabia?” I was invited to be a Visiting Professor in Jeddah and Riyadh, Saudi Arabia followed by stops in Kuwait and Lebanon. My purpose was to teach surgeons there about advanced laparoscopic techniques for colorectal cases. As a surgeon and compulsive traveller, how could I refuse?

I landed at the airport in Jeddah and found the driver sent by the hotel to pick me up. With my worries of terrorism starting to crescendo, I was relieved to meet my driver, a middle aged man from the Philippines. He uneventfully drove through the ferocious rush hour traffic and dropped me off at the hotel. I called my host and we decided to meet for dinner shortly. He had a restaurant in mind where we would meet up with the Surgeons I would be operating with in the morning.

We met in the lobby and promptly got into a car with 2 other men. After introductions, I realized I just got into a car, heading north out of the city of Jeddah into the desert along the Red Sea, with essentially strangers (pharmacists) from Lebanon, Syria, and Palestine. At that point, the only thing that could have been worse in my mind was if I was in Pakistan.

After a short time in the car, I quickly realized my fears were unjust and that the men in the car with me were young professionals (like me) with families and small children (like me). They had left their homelands in search of better prospects in Saudi Arabia.

We got out of the car and I could immediately smell the salty sea air. The restaurant, as opposed to Western restaurants, had no large single dining room. Rather, there was an area outside with TV’s and rugs and multiple private rooms. The outside area reminded me of a drive-in movie where people could sit, eat, and watch TV under the stars. All were occupied by men who came in from the desert to dine. They prefer dining outside.

Before going to our private room, we ventured across the parking lot to the store where the fish were kept on ice. Row after row of fish just caught from the Red Sea were waiting to be chosen and cooked. We asked the cook to pick the best, freshest fish and shrimp and bring them to our room. As we waited for the food, our room slowly filled with local surgeons. Most wore the traditional Arab clothes and desert headdress. Water pipes were placed around the room and we all shared. I was concerned we would have little in common and the conversation would be labored. Those fears were quickly extinguished (again) as a very lively discussion about surgical technique started. Just as I was interested about how they practiced our science and art, they wanted to know how we did things in the US. We traded stories and pearls of wisdom learned over long careers, ate a fabulous meal, and finished the evening with Saudi coffee (coffee infused with cardamom). The meal ended with an invitation to go with them to operate in a clinic they are opening in Khartoum, Sudan.