2006 Travel Adventures

My memory is going, so I'll pick things up in the present.

2006 started off with a lot of planning for studio shoots, one in St. Louis and one in Dallas.

Arrived in St. Louis on a Friday in March. Picked up my 7 pieces of checked luggage, rented a mini-van, and drove towards downtown. Every time I go to St. Louis I always seem to miss my exit and wind up under the Arch. From there I think you take MLK to Euclid, or maybe that's Cleveland!?

Found my way to BJC Media Services, which has a pretty nice building adjacent to Washington University School of Medicine / Barnes Jewish Hospital. Incidentally Rachael's high school friend Sanjeev is a radiologist at this hospital.

I hauled my gear into the tv studio, and began the laborious task of tweaking for the next day's video shoot. What the hell is "tweaking" you might ask?

Well here goes. We have a roughly 40'x40' studio with some lights hanging from the ceiling and other lights on stands. 3 video cameras are on tripods. There are 3 lavaliere microphones, 3 chairs around a table, a widescreen TV which will display powerpoint slides coming from my laptop which is plugged into a scan converter, which outputs a s-video or component signal which can be plugged into the widescreen tv monitor.

All of the video signals go into a video switcher, the audio into an audio mixer. Now in this studio instead of a traditional video switcher (you know, the thing that controls the main gun of the Death Star?), we used a new device called the Tricaster. This is basically a PC into which you can plug 3 video signals, one unbalanced audio signal, and you have a switcher, character generator, chroma key generator and virtual vcr all inside the computer. In theory this is cool. In reality it is kind of clunky.

For one thing, one of the three video camera signals had interference which was synchronous with the audio, inside the Tricaster anyway. Outside of the Tricaster the signal was fine. This meant I could switch the show live to tape, with the interference, then in post-production go to the separately recorded tape from that problem camera (ISO) and re-edit the cuts. During one of the takes, of course, the deck recording this ISO feed from the problem camera did not record, so for one segment of the final DVD the audio/video interference is present. Your average tv viewer doesn't notice such things, but on a big tv or computer monitor it will be hard to miss.

Then came the audio. The 3 microphones were patched into a portable audio mixer. Listening to the audio straight out of the mixer was ok, but listening to any of the record decks or the Tricaster, there was an audio hum, most likely 60hz interference from some electrical crossover. Given the hundreds of feet of crisscrossing cables we had laid out, it was no wonder we had audio problems. In the morning one of the local camera operators planned to pick up a spare mixer and pray. The prayer worked because the audio turned out ok, albeit a little low.

Next came the previously mentioned Powerpoint in the monitor. If you watch nearly any network news show nowadays a widescreen monitor is used on set to display graphics. For the individual presentations, we have the doctor stand next to the screen and refer to the graphics as well as to the camera (audience) and we cut between the camera and the slide view. The quality of the signal from the scan converter to the video switcher is mediocre. There are black lines on the sides of the screen and the picture is a little soft. Also the powerpoint slides are not usually formatted for television, so we have to re-do the slides after the fact, tweak them in Photoshop, and then re-edit them into the final program. So using the video switcher essentially creates a rough first edit in the studio, which we then edit to eliminate ums, ahhs, burps, coughs, re-takes and pauses. If you have to cut during an on-camera shot, you just cover it with a slide, since you are laying in the slides after all.

Well during the shoot, obviously the speaker is not holding the mouse or a laptop, so we have one of those infrared doo-hickies which advance the slides in Powerpoint. Some of the time. It works for me most of the time, but for anyone else, it works poorly or not at all. So during the shoot, until we got a new battery, the presenters used a combination of hand signals, eye winks, head nods and telepathy to tell us when to change the slides.

So as you can see, if you are still awake, unless you are renting the Today Show's studio, you generally do not walk into a rented studio and start shooting immediately. You need setup time, or you pay big bucks for a broadcast studio which is always setup to do all of these things. But you pay a premium, such a premium in fact, that it is cost prohibitive if you are not doing broadcast work wiht a broadcast budget (for example $500/hour + crew as opposed to $100/hour including crew).

In Dallas a month later, we had better luck, as the studio was setup with better gear. I won't rehash that setup experience, as it was similar but different. Most of the problems were with the monitor and getting good color reproduciton on camera. I have learned since then that if you get color correction filters for the tv screen it is much less problematic (this conversation can continue invoking degrees Kelvin color temperatures and scan rate theory).

Speaking of Dallas, in addition to the studio shoot, I was there for 7 days for 2 conferences. The conferences consist of setting up our trade show display and hopefully selling lots of videos and books, our two major product lines.

The conferences were held at the Hilton Anatole Hotel, a mammoth 1980's campus. There have to be 1000 rooms, in two atrium towers, an indoor pool, an outdoor pool, running track, conference center, a chunk of the Berlin Wall, the world's largest piece of Wedgewood China and a stellar collection of Asian art and artifacts dating back over 1000 years.

The main problem with Dallas is that you can't walk anywhere. All of the hotels are along the Stemmons Freeway, thus you need to take a 15 dollar cab ride where ever you are going. Well one advantage of a week long conference is you get to try a different restaurant each night.

Breakfasts were at the hotel lobby, lunch is usually skipped, but Dinner is an opportunity to sample the local cuisine, or so to speak.

Sunday night we went to Pappadeaux, a Cajun restaurant somewhere West of downtown. I had been there in 2002, had crawfish etouffe, and had such bloating I could feel my viscera swelling up inside my abdomen. This time however the three of us polished off a platter of crawfish in about 10 minutes and I felt like a million bucks.

In 2004 on Christmas Day, we were served shrimp cocktail with a particularly horseradishy cocktail sauce. Ever since that day, my palate changed, and now the spicier the better. I have been known to have shrimp cocktail minus the shrimp for an afternoon snack. When Passover rolls around I stock up on Gefilte Fish primarily so I can have something to put my red horseradish on besides a spoon!!

Another night we went out for Mexican at a great place called Uncle Julio. It is what I would call gourmet Mexican.

The next night we went to a place called Il Sole, an eclectic Italian restaurant and Wine Bar. Little did we know, every Wed night in the Summer you get a prix fixe 4 course dinner including 4 glasses of different wines for $36. It - was - the - best - meal - at - a - restaurant - I - have - ever - eaten.

Soup - onion/tenderloin soup / Appetizer, australian lamb chops / Entree, sea bass / Dessert, tiramisu - each dish paired with a glass of wine. I was a little tipsy, but another advantage of going to a conference is you do not need to worry about driving anywhere! There were some stairs involved leaving hte restaurant, but I managed to keep one hand on the railing and one eye opened!

Other meals included a steakhouse where I believe I had Elk or Bison, a great rib place downtown where for $14 you get shredded pork, bbq ribs and a sausage - or any combination of 3 meats.

The last night we asked the concierge for a good Italian place. We were sent to what looked like a dive from the outside, it was after all next door to a gay biker bar - but inside it was like walking into the living room of your Italian next door neighbors. The food, wine and garlic bread were awesome.

A tradition is to have a Chili's lunch at the airport after a conference, so that is what we did (we have done this 2x in 3 years, sounds like a tradition to me!).

The next conference will be in Chicago in October - always good meals to be had there as well.

My other major trip was actually between St. Louis and Dallas - to Washington DC.
Every year we try to make 3 new operating room nursing videos. In 2005 we shot 6 videos, and as of June 2006 we have 5 of those finished. In March of 2006 we shot 4 more videos over 2 days. The day before the shoot Jim and I realized we had about 20 hours of shooting to do, so we decided to split up the work. Instead of shooting everything with 2 cameras as we normally do, each of us took 2 videos to shoot on our own. We seem to have done it.

Jim's 2 videos were "Cleaning the Operating Room" and "Using Minimally Invasive Surgical Instruments." We need to write scripts for these two videos still.

My 2 videos were "Care of the Elderly Surgical Patient" and "The Perioperative Environment" - both videos about caring for patients before during and after surgery. I had scripts as these were re-makes of old videos, and actors also. I hired one pro actor, a guy who lived near DC and had bit parts in the West Wing, Commander in Chief and Syriana - and a retired 83 year old nurse who played our "elderly" patient.

We are starting to edit these videos now, so it will be interesting to see how they come out.

In May I took a quick 20 hour jaunt to Orlando for a 2 hour project kick-off meeting for a new CD-ROM for Pediatric and Adolescent Gynecology (try to contain your excitement!). Really it is important as there are not that many cases in the average surgical resident's course of studies (luckily) so they need to learn somehow - might as well hire us to help!

Finally I have gone to NY about 6 times since March, primarily for surgery video shoots at New York Presbyterian Hospital.

Nasser Altorki is a renown thoracic surgeon. The two cases I shot with him were first a tumor in the main stem bronchus. Normally you would lose part or all of a lung, but he has figured out how to take out the tumor and sew the bronchus back together.

The other case was that of a young man with a previous surgery to correct a esophageal fistula. At the time of this surgery he was eating via a stoma in his neck, not a nice way to live, and no doubt very difficult to eat an Oreo. So he was opend up from stem to stern, his remaining esophagus removed, a chunk of large intestine removed and used as a new esophagus. Sounds pretty easy but it is quite an ordeal. And the guy neglected to do the bowel prep - you do the math.

The other cases have been with Michel Gagner - he is the Spielberg of Surgeons.
The first case was a combined Sleeve Gastrectomy with Duodenal Switch. Most people are familiar with the Gastric Bypass, a way to lose weight if you are obese and diet and exercise and stopping with the Oreos doesn't work. In a traditional Gastric Bypass, the stomach is cut into a pouch (1/3) and the other 2/3 are left attached to the small intestines. Then the intestine is cut about 100 cm down the line - the far end is attached to the new tiny stomach pouch, the near end is attached 100cm down the line from where it was cut. Thus you have bypassed most of the stomach and about 1/3 of the small intestines - reducing the ability of the body to absorb calories and nutrition from the small quantity of food you are able to eat. However the unused piece of stomach is still attached upstream from the food chute, and also includes attachments to the bile ducts, liver, pancreas etc so you don't die.

Well in the extremely obese, the extraordinarily obese people, those with a BMI over 50 ( http://nhlbisupport.com/bmi/ ) a standard Gastric Bypass ain't enough. In a sleeve gastrectomy, the stomach is cut down the middle, and the unused piece of stomach is completely removed from the body. You do not get a receipt, it's gone. Your remaining stomach becomes a tube, or sleeve, so as opposed to limiting the amount of food you can eat, instead you just can't store any food in your stomach, it goes in your mouth, does not pass go, does not collect $200, and goes directly to jail, or so to speak. It is not conducive to intimate candlelit dinners or long car rides, put it that way.

Once the person loses a hundred pounds or so, they return and have a gastric bypass performed, as described above, only without the extra piece of stomach.

In a duodenal switch(DS), the duodenum, or piece of intestine attached to the stomach, is cut off the stomach, and left in place still attached to the bile ducts and pancreas. Then about 100-150cm down the line, the intestine is cut again. The far end is connected to the stomach tube, and the near end is connected another 100cm down the line approaching the large intestines. Thus you have still bypassed much of the absorptive capability of the intestines, and switched the place of the duodenum so you still have access to bile and important pancreas function, but you don't get to digest any food in the old duodenum.

Another popular technique is the Biliopancreatic Diversion (BPD). This is similar to duodenal switch but a different configuration of stomach pouch is made. The BPD guys don't speak to the DS guys - they have leather jackets, hot rods and the occasional knife fight/dance number in the alley behind the diner once a month - a real rumble!

Well that concludes the anatomy lesson for today. I hope you have not lost your appetite.

Lay off the Oreos.

TTYL