Friday, April 30, 2010

Another head bleed

Last night was my first time taking R2 call for neurosurgery, and incidentally one of the busiest nights for neurosurgery in a while. It's nice to hear the ER attendings muse "I've been here for 17 years, and I don't think I've ever seen neurosurgery get hit this hard."


It starts with morning rounds at 0515. Head CTs and MRIs from the night before, followed by rounding on the service's 35 patients (we're light right now). ICU rounds, battling it out with the neurocritical care team regarding what we think is the best care for the patient. Then a casual breakfast in the otherwise chaotic day at 0700, followed by phone calls to the attending neurosurgeons giving them updates on their patients. This is probably the most stressful part of the day. You never know what they're going to ask you about their patients, making it seemingly impossible to have the right information ready for them. Lots of "uh..." "one second sir...".

And then it starts. A young girl with leukemia who bleeds into her brain. A devastating hemorrhage that's left her unresponsive and intubated. But we can give her a chance. Set up the OR, consult pediatric hematology, hang blood products to correct her platelets of 25 and crit of 12. Oh yea, and who has a white count in the 300s? Honestly. While the blood products are running and hemapharesis going to correct her leucocytosis I steal off to grab a bite to eat. It's lunch at 1400, not too bad. I sit down to a nice piece of salmon and corn bread, yum. Phone rings.

Me: "Yes Dr. xxxx? Products are running and hemapharesis going. Well I don't believe we can do that in the OR. No I'm not completely sure. Yes sir."
Dr. X: "Your patient is dying, go go go!"

I got one bite of my salmon, and in trying to save my soda for the road, watched it explode on the cafeteria floor. It would have been more tragic had I known the next time I'd get a chance to eat would be 0330 the next day.

Push blood products. Deliberate best course of action. Coordinate OR time with hemapharesis. Rush patient to the OR. Pager rings: code trauma. Another CT scan, another head bleed. As the first case finishes up we wheel the next one through. 4 consults pending in the ED. Head bleed, head bleed, head fracture with head bleed, new brain mass... Phone calls from transfer centers asking to send patients with ventriculoperitoneal (VP) shunt malfunctions. Another consult: 90 year old Chinese male with ... head bleed. Hey, does anyone speak Chinese???

32 hours, two back to back red-lines, 11 consults, 0 sleep. I signed up for this? Stupid stupid stupid...

Monday, April 26, 2010

No more Mr. Nice Guy

I'm not sure about other programs, but they say your R2 year (second year of residency) of UCLA neurosurgery changes you. The neurology residents currently have bets going to see if I'll "stay nice" after the next year is over. The junior residents put their money on the persistence of good nature, saying I'll stay the same despite calamity and circumstance... but the senior residents know better. They've seen the lot of residents that come in smiling, charming, joking in common camaraderie, turn sour as the Q3 call (30 hour call every third night) and hail storms of consults (just last week the neurosurgery R2 got 7 consults in one hour) pulverize the softness of human civility and forge, out of necessity, the machine-like unfeeling neurosurgery junior. As if a surgical residency wasn't hard enough, now I have to be cognizant of staying humane while going through it? I don't promise anything, but I hope to write in this blog daily as this experience unfolds, so that if in 400 days the warm, young hearted boyish charm (^^) in my words degrades into the binary outputs of the terminator they expect me to become... somewhere, somehow, the slow transformation from man to machine will be documented and understood, and I'll be vindicated.

I'm getting temporarily promoted to R2 this Thursday and taking in house call. We'll see how it goes.

Saturday, April 24, 2010

Inspiration Remembered

During one of my neurosurgery away rotations I was honored to have worked with Dr. Alfredo Quinones. This man has the energy of a hamster on speed and the perseverance of a monkey trying to open a plastic banana. Of particular interest, is the tale when he hopped over the United States-Mexican border to illegally escape into the land of honey and opportunity. He was caught the first time and sent back; hardly enough to stop this man. He attempted again, obtained an education, trained in neurosurgery at UCSF, and now is an attending neurosurgeon at the prestigious Johns Hopkins University (I believe he's legalized now, so don't call the INS). One of the few things I'd taken away from the rotation at JHU, aside from a trip to the ER after being plowed by a 2003 Yukon (crazy Baltimorans), was him sitting me down and telling me that in order to succeed in life, one needs to surround himself with brilliant people. Reminiscent of an old Spanish adage 'digame con quien tu andes, y yo te digo quien tu eres' (tell me who you walk with, and i'll tell you who you are), I've found these words to be increasingly more true.

Saving the World:
A good part of the medical community I believe, or would like to believe, for at least a few seconds in their life had dreams of saving the world: eliminating poverty, achieving world peace, delivering chicken nuggets to everyone on Wednesdays. Small people, big aspirations. But the world teaches us that when we grow up, we are no longer children, and we put off our childish thinking and infantile delusions. There is no world they say, only isolated islands of capitalism, communism, and forsaken third world-ers somewhere at the bottom of the ladder. The hooing and hawing of politics and international policy drain the drive of the inspired, entangling them in logistics and law until they hang themselves in their vain efforts to break free of the system. But then there are others that in their Neo-like genius realize that the system can be bent, and even broken. There is no spoon.

I once believed that such people were truly rarities, the ones that you never meet, but only read of in books and epitaphs. But I recently met someone that really gave my matrix a run for its money. She wasn't born into royalty like Princess Diana, or birthed from the fires of political unrest like Gandhi. Nor was she a nun like Mother Teresa or a rock star like Bono. But in her own small ways, she was affecting change in rural countries, improving the lives of others in our own, and dreaming of ways to take these things to bigger scales in the future. As you know, I'm rarely one that gives compliments or openly admires people; but I was was thoroughly stricken with her life attitude, and probably came off as a blathering groupie. Not so much because she could change the world, but that she was doing so now. I always thought I'd have to grow up, be in a position of power to bring such change, but no, she was doing it now, yesterday, before she even graduated college. So yes, she deserved such praise.

Changing the world, one life at a time:
Then there are others who've devoted their lives to the pursuit of saving individual lives. We in the United Sates are in an age of science and technology where we can spend hundreds of thousands of dollars with the most sophisticated methods to save, and maybe not even save but prolong, the life of one person. Meanwhile the people of Malawi are dying by the tens of thousands for want of $1 a day supply of medication. I do not mean to excuse the latter egregious crime of our modern world, but mention the dichotomy to highlight how privileged we really are. We've come so far from the days where the lack of food, clean drinking water, or simple medical remedies would decimate towns in one untoward year. Now we focus on curing the ailments of those who've lived too long - osteoporosis, dementia, cancer, and other conditions where our exhausted topoisomerases give in to the calling graves below. Of these, perhaps one of the most specialized, smallest niche occupying, is the neurosurgeon. One in particular that inspires me is a friend of mine. His tireless pursuit to become the best, to eliminate the world's need for people like himself by curing the disease he treats, and inspiring the generations below to follow his lead - he definitely gives me something to work towards and aspire to be.

So the moments of inspiration are definitely there. They're in the people that happen to walk a path different from the ones laden with the mundane and trite technicalities of the world. They're in the roads that they forge, the roads less traveled as Frost said, and it makes all the difference. As the world saver said, it's about creating value from nothing; these friends are artists of humanity, in their ability to bridge people and create cures that did not exist before. They say the artist fears the blank canvas, and I'll admit to such fear. Fear that the brush strokes of my next 20 years will culminate in the scribblings of a six year old rather than the Monet I had envisioned. But to allow such fear to blind us would only hide the paths of change that my two friends walk. So thus I take the first strokes, and hope that their steps will guide the rest.


About Me

I'm a quixotic idealist that's readjusting to the reality of the world around him. An aesthetic at heart, willing to not shower a week at a time to go camping, exploring, hiking, etc. I love food, poker, and anything that can be turned into a competition.