Surgery of the Adolescent [antikvár]

It is not possible to provide the best health care to adolescents without understanding adolescence. Such understanding requires not only a familiarity with that process of rapid change that characterizes the journey from childhood to aduit status, but alsó an appreciation of the impact of illness upon maturation, and the impact of maturation upon illness. In less than a decade the child will mature into an aduit. Both the need to grow rapidly and the process of growing rapidly have surgical implications. The management of inflammatory bowel disease, the evaluation of scoliosis, and the timing of cosmetic repairs, all involve an assessment of growth in the decision making process. Beyond issues of physiologic maturation are psychologic considerations. It is during adolescence that we develop our self-image; that concept of self as a unique humán being, healthy or ill, comely or plain, and normál or deficient. At no time in life are cosmetic concerns of greater import. Both demands of the developing self-image and of emerging sexuality place critical importance upon each illness, each scar, each deformity, each impediment to normál activity, and each deviation from the norm. Emancipation from parents must be achieved and illness must therefore be viewed not only as it effects morbidity and mortality but alsó as it may modify educational and vocational goals, the ability to drive a car, live independently, marry, support a family, and parent the next generation. All these issues must be considered and addressed midst the turmoil, liability, and risk-taking behavior that characterize the adolescent years. In addition, that knowledge and those skills that would enable us to care for teenagers are best complemented by a belief in the inherent worth of young people. Too often adolescents are viewed as older children no longer possessing that endearing helplessness that draws us toward the care of the young child, no longer cute, and no longer respectful toward their sage elders. Alternatively, they are viewed as pre-adults not yet possessed of maturity, good sense, and social grace, and hence not yet worthy of treatment as deserving beneficiaries of the health care process. It is far better not to view them as older children or pre-adults, but rather as adolescents, that is, young people now able to actively participate in their own care, not fully förmed, still malleable, and hence, with our assistance, still capable of great strides toward good health and a productive aduit life. Such is the opportunity and excitement of caring for youth. S. Kenneth Schonberg, M. D. Associate Professor of Pediatrics Albert Einstein College of Medicine Director of Division of Adolescent Medicine Montefiore Medical Center Bronx, New York