Professional Development Fund – Evaluation from Karen Wells

The CCML Education Committee awarded funding from the Professional Development Fund to Karen Wells so she could attend the MCMLA Annual Meeting in St. Louis.  Part of the requirements of the award are that awardees submit an evaluation to Council Quotes to share information learned.  Below are Karen’s comments about one of the General Session speakers – Clifford Stoll.  Karen would recommend this speaker to others.

Clifford Stoll, billed as a US astronomer and author, and also known as the digital forensic systems administrator, from Lawrence Berkeley National Lab, who tracked down hacker Markus Hess in 1986, was our keynote speaker.  We learned from Cliff, name noted from his personally crossing out the “ord” on his name tag, that he had a Whipple Procedure, following a diagnosis of a tumor of the pancreas.

Cancer of the pancreas occurs in 5 out of every 100,000 people every year and is one of the deadliest forms of cancer. It is estimated that this year 32,000 Americans will be diagnosed with cancer of the pancreas.

As you may already know, pancreatic cancer may be symptomless in the early stages of development.  In fact, in 80% of patients, the tumor is often advanced when first found.  That is, it has already metastasized and in these patients, it cannot be cut out at the time of identification.  It is the 4th cause of cancer death in the US.  And the prognosis is poor: Wikipedia reports:  “for all stages combined, the 1- and 5-year relative survival rates are 25% and 6%, respectively, for local disease the 5-year survival is approximately 20% while the median survival for locally advanced and for metastatic disease, which collectively represent over 80% of individuals, is about 10 and 6 months respectively.”

Did you know cancer of the pancreas is not necessarily one entity?  Approximately twenty different tumors have been described under the common term of “cancer of the pancreas.” Each of these tumors looks differently under the pathologist’s microscope, each requires distinctive treatments, and each carries its own prognosis.

A patient with pancreatic cancer may feel pain when the tumor bears down on close-by nerves or other organs. When pain drugs don’t suffice, some patients receive injections around abdominal nerves to block the pain.  Others treatments include severing the nerves.

Patients with pancreatic cancer may present with weight loss, appetite loss, fatigue, and depression.

A pancreaticduodenectomy or Whipple procedure is performed only in specific cases.  Criteria include: the patient has to be very healthy to survive this large operation, and the cancer must not have metastasized nor invaded local structures.  Therefore, since most of the cases of pancreatic cancers are found in the late stages, Whipple procedures are done in a small number of cases, and it is also often done for tumors occurring in the head (first part) of the pancreas.

As I mentioned, it is not a small procedure.  It involves removing the pancreatic head and the curve of the duodenum together (pancreato-duodenectomy), making a bypass for food from stomach to jejunum (gastro-jejunostomy) and attaching a loop of jejunum to the cystic duct to drain bile (cholecysto-jejunostomy).

This is the world that our keynote speaker, Cliff Stoll, came from recently.  If we pause just a few moments and place ourselves in this major event, as Cliff Stoll himself, we can feel the myriad of emotions that must have flooded his mind and the minds of his family and loved ones.  As an illustration, Cliff mentioned that his daughter, who is definitely NOT touchy-feely, rarely verbally expressed any affectionate words to Cliff whatsoever.   However, she called him, perhaps perfunctorily, upon learning of his diagnosis and subsequent surgery, said, “I LOVE YOU, DAD,” and true to her non-touchy feely nature, quickly said goodbye, and hung up.  And to the US Astronomer, World Speaker, Great Physicist, International Author, and Computer Hacker Sleuth, those three words meant so much to this man, now and forevermore: a dad, with a daughter he greatly loves.

On the way to the airport, I was fortunate enough to find myself the solo passenger with none other than Cliff as the other solo passenger.  Again, he told me the story about his daughter on the phone, and about now how he would volunteer merrily to wash the dishes (a task her formerly hated,) noting how horrible it was to be in the ICU with “tubes coming out of every orifice.”  He also told me that he has reduced his public speaking now but only does so when there are “fun events,” to attend… although he still home-schools teens in physics.  And so you see, I am reading into this, that his focus has shifted a bit by this whole experience, and this is also why he was so enthusiastic to come to this convention—motivated by the medical librarian who came to his aid to help him with his reference question.  Remember, now that a “reference question” some days to us Librarians seems so aloof, so far-off, so “just another reference question.”  But to someone out there, it is a very personal, very exclusive, very significant, very, very delicate and distinctive special event!!

Finally, Cliff told me that his pancreatic mass was diagnosed as benign.  BENIGN.  Read it.  That means the mass was probably a clump of dead cells. Benign tumors are caused due to cell overgrowth.  The word “benign” usually means inoffensive, but many tumors may not be truly so inoffensive and non-damaging.  Some can transform into cancer, and in Cliff’s case, the symptoms he was experiencing would not have gone away because the tumor cells anchor there. They are not transformed into healthy ones over time and do not replace the dead cells.  In fact, they hinder healthier cells from producing and nurturing.

So now let’s get back to our keynote speaker, Cliff Stoll.  We conference goers may have been captured by the single-surfaced Klein bottles, and astounding single-sided mobius strip scarves and hats that he showed us.  Yes, this is a physicist, mathematics, statistics, numbers-loving kind of a guy!  But there is a bigger story here, it seems to me–this is a man that is incredibly and wonderfully alive, JUMPING AROUND, MOVING HIS HANDS IN RAPIDLY FLUTTERING MOVEMENTS FOR EMPHASIS, MOVING AROUND FROM TABLE TO TABLE,  SMILING, JOKING, SOOO SPORADIC, SOOO CONTEMPORANEOUS, and to his own wonderment ENGAGED in doing, since this life-changing surgery that happened, in his very own specific and unique life, the things he now conceives as the most important things to do.  And telling us the things he loves the most!  This is, in fact, an illustration of one of the most NON SINGLE SIDED men out there.  Indeed, he is extraordinarily multi-sided and multi-faceted, with many, many talents, and many sides of complexity to his personality, intellect, emotions, and mannerisms.  He is a man whose life events have caused him to change his priorities—And now he CHOOSES, RELISHES, and indeed, IS PRIVILEGED, as a mark of respect, to pay tribute, to us medical librarians at MCMLA!!

Priorities, priorities… I have changed mine so many times in my life too!!  Having been through a lay-off from Exempla Lutheran Medical Center, I have also been re-examining my priorities.  One of the things I have discovered about myself is how much I have just loved to work in the Hospital environment.  At Exempla, it was partly the doctors, partly the nurses, partly the incredibly smart and talented Exempla librarian colleagues, who are dear friends, who I met in the Exempla system.  And it was also partly all the incredibly enthusiastic and energetic (and I might mention: totally untainted!!) graduate library school students I met, who faithfully showed up, day after day, week after week, some of whom even came back and continued to volunteer after finding gainful employment somewhere else, or having completed their MLS degrees.

And now I remember, because of Cliff’s talk, why we are ALL there.  It was really all about the patients, those very unique and special individuals, who we all were working to help.

So fundamentally, I must say, that I feel so grateful to have been a part of it.  I just know that someone out there, like this man Cliff, was touched by something we as Librarians, Library Technicians, Library Volunteers, and Library Graduate Students, did in the course of our work at Exempla Lutheran Hospital.  I know that each of you has a story too, about the work that you do, and I guess therein lies the incredible value in the credible, authoritative information that we, as Library staff, give to all our clientele.

Thank you all for your support and encouragement throughout my career, as your professionalism, compassion, and sharing meant all the difference in the world to me.  I am especially grateful to CCML for the financial commitment for my travel to MCMLA, and to the staff and members of MCMLA and nominating committee for the honor of being the recipient of this year’s award.

Sincerely,

Karen

This might be a little tough to swallow

                “Accidental ingestion” (by humans) is a phrase that turns up in the medical literature more frequently than it really should, given our current location at the top of the animal kingdom totem pole. It turns out that in this arena humans of all ages don’t do much better than our close relatives in the pet world.

                The pets I have in mind are a couple of the dogs who have spent time in my family over the years.  Leaving out the truly gag-inducing things that most dogs will eagerly sniff at and then scarf down, one of ours actually chewed open, disassembled, and then ate a good portion of a package containing a bicycle reflector light.  We suspected that there was an element of “oh yeah? Take this!” involved, since we had had the audacity to leave her alone in the house for a couple of hours, and she had not at that point learned to work the TV remote.  Still, there’s a possibility that the red plastic was cherry flavored and had just the right level of crunchiness.

                This is the same dog who in an impressively quiet and lightning-quick way inhaled most of a box of donuts that we had carelessly left under a car seat at the beginning of a road trip.  Another of our dogs turned up looking extremely guilty as she slunk through the kitchen with a wooden serving spoon that she’d taken from the dishwasher hanging from her mouth like a cigar.  In her defense, the turkey gravy it had been used for was first rate.

                But those are dogs.  They are supposed to do inexplicable things that we don’t do.  That’s one of the long-standing criteria that make them the pets and us the non-pets.

                Still, M. Guirus and colleagues in the Medical Journal of Australia reported this year on cases of “plastic from takeaway containers” being accidentally ingested.  We’ve all had take-out food (hello Big Mac) that was so delicious that we had to lick the containers and possibly even chew on them for a while to extract every last molecule of flavor, but swallowing is beyond the pale…or is it?  The authors, here at least, assume that these cases were accidental.

                Toothpicks have been going down with all of the potential nastiness you can imagine for as long as there’s been a toothpick industry.  Probably long before, because any Og with a sharp stone could certainly have whittled away at an early Elm until he had the equivalent of one of those cocktail toothpicks (minus the little plastic decorations at one end, I assume) in his opposable-thumbed hands.  But a new entry in the “swallow this” sweepstakes would have to be the hand warmer.  In a 2008 article, the team of Tam, Chan, and Lau report on the ingestion of that little hot packet by four separate individuals.  They do look delicious, don’t they?  No toxicity was reported, but I assume all were referred for eye exams.

                 Recent literature is replete with stories of dental instruments and devices being swallowed.  Examples include a “dental bur” and “root canal instruments,” so apparently not enough people read or paid attention to the Journal of Prosthetic Dentistry article from 1988 which offered a “method to prevent patients from accidentally ingesting dental devices.” It’s probably a good idea to have a method in mind.  It’s never enough just to say “If I happen to drop this six inch long spear with an evil-looking hook at the end into your mouth, please resist the temptation to swallow it…it’s pretty expensive.”

                Other things that have made the journey to the stomach include lobster shells, magnets, “a press-through package,” lead shot, moth repellents, a mysterious “unusual foreign body” (no abstract for clarification), dry ice, and ant bait.

                Spread the word that “accidental ingestion of small batteries is increasingly common” (reported in Lakartidningen, a Swedish publication).  The follow-up good news from Finland is that “not much poisonous metals are dissolved from accidentally ingested button-type batteries.”  Doesn’t the qualifier “not much” leave you feeling a bit uncomfortable in this context?

                In 1997 there was an Australian report of “accidental squid jig ingestion.”  Here one might quibble with an apparent redundancy.  Since a squid jig is a lure intended to bag an unsuspecting squid, wouldn’t any ingestion, whether by squid or by human, have to be considered “accidental”?  It also begs the question of why it was anywhere near the mouth of a human.  It must have looked delicious.

                The same question need not be asked about Ewert and Lindemann’s 1992 report of “the accidental aspiration and ingestion of petroleum in a ‘fire eater”.  The 26 year-old German man came through the ordeal with minimal damage even though HE SWALLOWED FIRE.  A fire eater’s performance is entertaining to watch, as anyone who remembers the Ed Sullivan Show can attest, but no practitioner of the art should ever be surprised by resulting heat and flame-related problems.  YOU ARE SWALLOWING FIRE.

                From the late Department of H.E.W. in 1963 comes a thorough accounting of ingestions from 1959 to 1961.  Since this compiles reports from poison control centers it leaves out objects, but it’s still fascinating in that it breaks things down into lists of brand names.  Great trivia fodder.

                Aspirin, for example, was easily the most frequent accidental ingestion, leading second place insecticides 21.8% to 5.3%.  Among the brands, St. Joseph’s led the way with 54%, followed by Bayer at 31.8%, and then a steep drop-off to also-rans such as Bufferin, Rexall, Aspergum, and Norwich.  Probably the numbers are correlated with retail sales, but it’s possible that flavor or appealing packaging played a role.  Remember that “St. Joseph Aspirin for Children” came as tasty little orange pills, begging to be munched like candy, often with that exact result.

                But clearly we have moved on.  Showing how adaptable we are as a species in response to the relentless march of technology, a 2007 report in the Emergency Medicine Journal describes “accidental mobile phone (SIM) card ingestion.”  It’s celebrated as the “Case of the Month.”  Not reported is whether it was still usable over the next couple of days as it made its journey south and thereafter.  No SD memory card ingestions reported yet, but the digital clock is ticking.