Farmhouse progress is proceeding well recently. This morning I got an early call; “I’m in front of the post office. Where do I delivery ?” was the greeting. I guess short, sweet, and to the point is good … but not something I practice too often. Fortunately, the caller ID said “Wisconsin” so I knew it had to be from Wilson Doors. I gave the final instructions to the driver and quickly headed out to my truck for the 15 minute drive to the job site. I arrived to see the door being prep’ed for unloading – all 44 feet in length and 3000lbs of it !

Sometimes the weather forecast changes with little notice. Fortunately, Campbell Field Airport has some very sophisticated weather reporting tools – you can clearly see that today was cool, dry, and sunny and the winds were light and variable.

Last night I dreamt I was about to perform my first solo surgery. The dream focused on the fact that, prior to the surgery, I went into the OR and reorganized the layout to accommodate the fact I am left handed. I was chastised by the attending doctor for changing the layout and told – in no uncertain terms – “you do not change the arrangement of the OR”.

I had made a few mistake in my changes and missed a few obvious alternatives. I had positioned everything such that I would stand directly in front of the surgical area of the patient. Second, I had moved the tray and thus my assistant from my right side of me to my left. My attending pointed out that for a chest surgery, it would be very crowded for me to be center over the chest and have both an assistant and instrument tray on my left as they would not be up near the patient’s head. It would also mean, if I needed help, my assistant would be too far away from the surgery. Bu standing just off center, such that my primary hand was centered over the surgery, there would be better access for a second set of hand if there was an emergency. What neither of us realized was “the obvious solution”. Unbeknownst to me, word had gotten out about the reprimand and the fall out. Shortly before the surgery, the chief of surgery asked me to meet in the OR. He asked me to take my position as if to start the surgery. He wanted me to visualize how the operation would flow and to note any complications that might arise from my organization of layout. It was clear there would be some additional challenges. The he setup for a right-handed surgery and took my position and asked me to stand across from him. I mirrored his position and then he smiled and paused. It suddenly dawned on my that the solution was not to change the layout but to change the side of the patient such that it was a mirror image. It was so simple.

All of this was, of course, a dream but it got me thinking and so I started to search the internet. It turns out my operating room layout challenge is not the real issue for left-handed doctors. A medical journal study relieved a number of considerations:

• left-handedness is prevalent in 10% of the general population but is more common among surgeons
• only 13% of left handed surgeons were provided with left handed instruments while training
  • a lack of left handed instruments during residency - “basic sets of left-handed instruments (scissors, clamps, and needle holders”
  • a lack of laterality related mentoring for left handed surgical residents
  • only one in 10 programs mentored for laterality predominance
  • one mentor wrote; “as a left-handed surgical mentor, I advise use of ‘right-handed’ instruments by the right hand and that the procedure be learned as a two-handed maneuver” – (Vivian C McAlister, Professor of Surgery University of Western Ontario)
• left handed surgeons preferred an approach that might be different from a right handed surgeon in an invasive procedure: “Mentoring by a right handed surgeon will only leave the left-handed residents to teach themselves a procedure.”
• one in 10 left handed surgeons was also uncomfortable with the idea of being operated on by a left handed surgeon; six per cent also reported concerns by patients about their laterality
• more prone to needle stick injuries than their right handed colleagueSources: “British Medical Journal  2005;330:10 (1 January), doi:10.1136/bmj.330.7481.10-f” and “Current Surgery (2004:61:587-91)”

Diagram: “In a right-handed surgeon operating on a right-sided kidney, the hand-assisted device is placed in the right lower quadrant for insertion of the left hand and dissection is performed with instruments in the right hand placed through an umbilical trocar. The camera is placed several centimeters above the umbilicus in the midline.” vs “When operating on the right kidney a left-handed surgeon places the hand-assisted port in the periumbilical location for insertion of the right hand. The working port for the left hand is placed lateral to the rectus muscle, in line with or just inferior to the level of the umbilicus. The camera is placed through a lateral trocar in the anterior auxiliary line.”
Source: Wein: Campbell-Walsh Urology, 9th ed., Copyright © 2007 Saunders, An Imprint of Elsevier

Disclaimer: I am not a doctor. I am not writing as an authoritative source. Much of the material I found was restricted to medical persons so I only found abstracts to papers and publications. Everything on the internet should be taken with a degree of skepticism since there is little or no means of verifying authors.

While blog-surfing, I found myself caught up in a simple but addictive game – Manifold. See if you can get through the levels !

Manifold - Create gravity wells and get to the exit

I just wish it had more levels I just found another version !

I’ve been wanted to understand which rooms will have sunlight at various times of the day and through the year.  It should be a simple matter of noting the shadows on each visit to the farmhouse job site assuming the sun is out and I make my site visits at different times of the day over a six month period. Almost none of that has happened so I decided to apply computer technology to the problem.

Here is a short video that shows the path of the sun at the latitude of the farmhouse and the resulting shadows. The animation depicts a full day at each of the four significant times of the year – spring equinox, summer solstice, autumn equinox, and winter solstice. It also shows the annually change of the sun’s position for a fixed time in the morning (8:00 AM) and again in the afternoon (4:30 PM).