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Life and Death on the Front Lines of Pediatric Surgery

Catherine Musemeche, MD

Publication Year: 2014

As a pediatric surgeon, Catherine Musemeche operates on the smallest of human beings, manipulates organs the size of walnuts, and uses sutures as thin as hairs to resolve matters of life or death. Working in the small space of a premature infant’s chest or abdomen allows no margin for error. It is a world rife with emotion and risk. Small takes readers inside this rarefied world of pediatric medicine, where children and newborns undergo surgery to resolve congenital defects or correct the damages caused by accidents and disease. It is an incredibly high-stakes endeavor, nerve-wracking and fascinating.

Small: Life and Death on the Front Lines of Pediatric Surgery is a gripping story about a still little-known frontier. In writing about patients and their families, Musemeche recounts the history of the developing field of pediatric surgery—so like adult medicine in many ways, but at the same time utterly different. This is a field guide to the state of the art and science of operating on the smallest human beings, the hurts and maladies that afflict them, and the changing nature of medicine in America today, told by an exceptionally gifted surgeon and writer.

Published by: Dartmouth College Press

Title Page, Copyright Page, Series Page, Quote

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pp. ix-x

From the beginning, pediatric surgeons had to insist on their very existence at the same time that they were inventing the techniques and tools that would enable them to save the lives of the most vulnerable members of our population, our children. C. Everett...

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1. The Thread of Life

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pp. 1-14

“Stitch,” I say to the scrub nurse. I hold out my hand, waiting. Instead of keeping up with me, the next suture ready to slap into my palm, she’s hit a snag trying to pull the suture out of the package and load the needle in the gold-handled needle holder. I wish I could reach across the...

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2. Bunny Rabbits, Boston, and Babies

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pp. 15-30

Never underestimate the capacity of a peripheral nerve to retain IV fluid. These are the words I hear in my head as I bend over a baby’s leg, straightening it, taping it down, and prepping it with Betadine swabs. This internal coach, the voice of my former chief of surgery, is neither random nor imagined...

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3. The Shortcut to Survival

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pp. 31-47

During an exploratory laparotomy a surgeon cuts through the skin and muscular layers of the abdomen, inspects the organs within, and tries to find a cause for a patient’s symptoms. A mix of excitement and anticipation accompanies the beginning rituals of a major operation...

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4. Inside Out

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pp. 48-62

Only moments had passed since she was pulled out, smeared with blood and dripping amniotic fluid, from a six-inch incision in her mother’s uterus. Slippery loops of intestine hung free from her tiny belly like a tangle of garden hose, having escaped her body through a hole in her abdominal wall...

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5. Going to Extremes

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pp. 63-83

Baby X.’s honeymoon is about to end, sooner than expected. We crowd the blood gas analyzer, watching as it spits out white snippets of paper stippled with fateful numbers. His oxygen level is drifting lower, from mere sag to full-on collapse, while...

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6. Battlegrounds to Playgrounds

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pp. 84-102

By the time the four-year-old boy arrived in the emergency room, his heart was still beating, but his body was broken beyond repair. His mother had left him for just a minute to answer the phone in their Harlem high-rise apartment. And that was all it...

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7. The Weight of the Future

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pp. 103-119

“Will the table go any lower?” I asked. The patient’s trunk, large and imposing as a sack of cement, protruded higher than normal above the operating room table. The table height had to be adjusted to accommodate the height of his abdomen; otherwise I wouldn’t be able to...

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8. Something to Celebrate

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pp. 120-136

I couldn’t help but notice. I hadn’t seen them in several months, maybe six or so, but the last time I saw Rachel’s mother, she had had a full head of hair. “Rachel shaved it,” she told me. “It’s cute,” I said. I glanced at her daughter’s own hairless head. Only a few...

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9. Tiny Tools for Tiny Bodies

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pp. 137-153

Without looking up I extend my hand to the side and slightly behind me, expecting to feel the featherweight of the neonatal chest retractor drop lightly into my palm. Instead, something more like a shovel hits—an adult Balfour retractor, about ten...

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10. Lessons

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pp. 154-167

“Have you ever done anything to kill a kid?” Dr. R. asked me shortly after I had begun training with him. He was a slightly stooped, gray-haired man with bushy, unruly eyebrows. The bow tie he wore signaled that he was an absolute expert on every topic in surgery. He rocked back and forth on the balls of his wingtips and...

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11. Small

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pp. 168-185

Imagine being asked to operate on a patient you cannot examine, a patient floating in a small, dark, murky container. You will be working underwater. You will not be able to keep him entirely still, move him into optimal position before cutting, or attach to his...

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12 | The Lost and Found

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pp. 186-204

At three in the morning on Christmas Eve we meet for the first time, sitting side by side in bolted-to-the-floor faded turquoise chairs. You are the father of a newborn who needs an emergency operation...

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pp. 205-206

Pediatric surgeons get to work with two never-ending sources of inspiration— kids, who live for today and remind us that having fun should be a priority, and their parents, who continually show us, especially when a child is in the hospital, that there are no limits to the power of love. I am...


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pp. 207-224


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pp. 225-230

E-ISBN-13: 9781611686357
E-ISBN-10: 1611686350
Print-ISBN-13: 9781611684421

Page Count: 248
Publication Year: 2014