Top Knife

[Howard Berkowitz]

> From: KMATTOX at aol.com
> Date: Sun, 9 Dec 2007 11:12:56 -0500
> To: trauma-list at trauma.org
> CC: sweldon at bcm.tmc.edu; Redstart at aol.com; nikki at tfmpublishing.com; Narong-Kulvatunyou at ouhsc.edu; asher_hirshberg at yahoo.com
> Subject: Top Knife
> 
> To the inquirer regarding the book, Top Knife.    
>  
> This book was principally the intellectual property of Asher Hirshberg, and  
> I assisted in organization, ideas, and re-writing and re-writing.    The 
> brilliant editing and keeping focused and organized was the secret skill of  Mary 
> Allen, and the cleaver and accompanying illustrations was the talent  of Scott 
> Weldon.  Each of these 4 elements contributed to the unique style  of this 
> book.  It has now been translated into German, Japanese, and,  now, Portuguese.   
>   
>  
> HOWEVER.........This is NOT a book to read to prepare you for your  
> examinations.  No charts, No references, No mention of evidence based  science exists 
> anywhere in this book.   It is merely a talking style  as if a faculty is 
> assisting a senior resident through the most difficult trauma  case of his life.    
> It addresses thought processes in an  unconventional style.     

Ken, I gave my response before I read this note, and I'm pleased that I did perceive the style as you meant it. I've never heard your voice, but, as I read it, it was if someone was talking to me.

Some of my areas are in information systems and monitoring tools for the OR. Reading Top Knife gave me a number of ideas about supplemental displays that might help a surgeon, which are only in the general idea stage at this point. The Holy Grail, of course, is something that supplements the surgeon's direct vision, not replaces it, and has to deal with the very difficult problem of making the views of instrumentation consistent with the orientation of the surgeon's view.

There are times where hearing a really silly idea is a stimulus to finding a better way. A few years ago, I was working with a transportable military surgical facility. I specified a flat-panel display, on swivel motor mounts controllable by the surgeon, or at least by the circulating nurse -- the application was in orthopedic surgery where the X-rays are important. 

The project officer said that the monitor was too expensive, and said that the X-rays could be sent over from the radiology unit. I pointed out that their radiology facility was fully digitized, and that images were viewed either on a screen, or printed on a high-resolution printer. Again, I suggested simply putting a monitor in the OR, but was told that radiology would print the images. Since these would not be transparent, they couldn't go onto a light box, and I tried to point out the difficulty in reading them, by reflected light, in the OR. 

The project officer then inquired if the printer could take (expensive) transparency stock and print the equivalent of conventional film X-rays, which could then be taken to the OR and put on a light box.

At that point, I wondered where the nearest neurosurgeon might be, given how hard I was beating my head against my desk (it was a conference call).
>  
> To prepare for your examinations, I would strongly  recommend that you read 
> one of the standard texts. 
>  
> It is published by TFM Publishing in London and is available on many  book 
> distributing companies including Barnes and Noble, Amazon.com, Majors Book  
> Store, the publisher direct, and many other sources.      
> 
> Kenneth L. Mattox, MD.
> 
> 
> 
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