Wednesday, May 5, 2010

An Intimate Conversation with the Adam's Apple

Larynx - antero-lateral view, with external mu...

It's doubtful anyone would seriously use cricothyroidotomy in a song lyric -- I guess we can't have everything. Still in all, there is such a thing as poetic justice, since a cricothyroidotomy can save a life by creating an airway when it's impossible to do so by intubating, i.e. inserting a breathing tube into a patient's trachea. This is what handsome, daring TV docs do with a switch blade borrowed from a gang member, sterilizing both the knife and their patient's neck with a splash from a bottle of Jack Daniels another gang banger conveniently has in his pocket.

If you feel around the thyroid cartilage located midway from your chin and the base of your neck, you'll feel a little peak. Move your fingertip downward and you'll feel a little space followed by another ridge below that. The space is precisely where Dr. Young and Handsome makes his incision, following it by inserting the barrel of a pen, a hollow coffee stirrer, or whatever the prop guys think will make women swoon from week to week. It's an intimate conversation with the Adam's Apple.

Anyway, this what I learned to do today -- perform a cricothyroidotomy. How to make women swoon was apparently taught in another group and naturally, I missed out on that one. Nevertheless, it was exciting for me to learn a procedure because, for one thing, I know very few of them and for another, in psychiatry we rarely do them. Surgeons get scalpels, hemostats, clamps, and all kinds of neat things to work with, but in psychiatry, our primary tool is ourselves.

True, we have medications, but unlike those who are new to the field and presume psychiatric illness can be cured with a swift turn of the pen on the ever-ready prescription pad, veterans know psychiatry to be, probably, the most interpersonal of medical specialties. We can't repair broken hearts with a new valve like our cardiothoracic surgical counterparts. And even though our incisions are bloodless, they cut deeply, and healing takes time. Lots of time and lots of patience.

Psychiatry is still medicine, however, and particularly so in osteopathic medicine where we take the mind-body interface seriously. The challenge is to maintain an awareness of the presence of one while treating the other. This is why I enjoy learning the skills of physical medicine -- they work on the larger context of the organ I know the best and frequently realize I understand the least. People are incredibly complicated and yet, as the Psalmist writes, "fearfully and wonderfully made." There's no end to what you can learn and every day brings forth something new.

(Psalm 139:14; Creative Commons image via Wikipedia)
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