Sunday, May 30, 2010

Not so lazy Sundays...

Days off during residency are bittersweet at best. It's nice being able to sleep through till morning, awaking to the sun rather than the leftovers of the passing night. On my days off it usually takes me an additional 3 hours to get out of bed. Not because I'm fatigued to the point where 8 hours of sleep isn't enough, but more because upon awaking I remember that the only thing that awaits me is more neurosurgery reading or paper writing. We're always instructed that our days off should be the time we catch up on our anatomy, write papers for journal publication, and continue our research projects. Exercise is a good idea, not for overall general health, but more so we can develop the stamina to get us through the long operative cases.

Yesterday I woke up at 10AM, all rested from the night before, ready to take on the new day. I got up, turned on my computer, saw the list of things to do for the day, turned off my computer, threw myself back into bed and went back to sleep. I woke at 1PM. OK fine, that's enough. I was still in a post-post call daze/depression, as I personally take on a rather dampened affect when I'm fatigued, so the rest of the day wasn't too productive.

I awake today (9AM mind you, not at the time of this post) reinvigorated, ready to take on the cruel peer reviewer comments of this paper I'm revising. Seven different sets of comments, each asking different things and expecting different degrees of crazy. What happened to the good old Sundays when we could lounge and read the comics after a nice family meal? There's no rest for the weary... careers in radiology are looking pretty good right now...

Monday, May 24, 2010

Egoism makes you bleed...

GAH, what a frustrating day.

At some time during your residency you start to get more comfortable with your everyday tasks and procedures. First it's the little things such as presenting vitals and physical exams on rounds (no, medical school really doesn't prepare you for everything). Then it's smaller procedures such as drawing CSF, starting arterial lines... then before you know it you're throwing in central venous catheters and ventricular catheters (that yes, go into the brain), like it was tying your shoes. Well, admittedly I don't believe I'm quite at the point where I can do an EVD (external ventricular drain - entails drilling a hole into a patient's skull at bedside and placing a catheter, more or less blindly using anatomic landmarks, into his brain, aiming for the ventricles, in order to drain cerebrospinal fluid [CSF] in the setting of increased intracranial pressure from bleeding, tumors, etc) like I tie my shoes, but I've gotten fairly adept at it. But this isn't about the advanced techniques, but rather the simpler ones we become overconfident in.

I was setting up to place an arterial line today, and as my last few had gone swimmingly, so I told the family I'd be done in 20 minutes. "Twenty minutes?" the nurse asked. "Yes," I responded, "no problem." It wasn't really due to arrogance, but maybe there was some underlying overconfidence there. Well in any case you can probably see where this is going. The line placement was a disaster. The patient kept flexing his wrists and arm like he was arm wrestling me despite the local anesthetic, boluses of propofol, and IV morphine and versed we gave him. I even achieved arterial flow, but his clonic movements made it impossible to thread the guide wire. At this point I should have stopped, but my claim that I could do it in 20 minutes (and the goading of the timer on the wall... cursed competitiveness) drove me on. His arm started looking like a pin cushion. Just as I was about to call it quits, my patient got his vengeance and curiously the needle turned in my hand and stabbed my other hand as I was trying to put it away. Did it break skin? No I don't think so... but then there it was, the faint tint of blood with the wrong color... the color of it being on the inside of the powdered latex. GAH.

I broke scrub (got out of sterile attire) and washed my hands. You win sir, this time. We sent the routine labs for HIV, Hep C, Hep B... I'm not too anxious as his family denied him having any history of these diseases, but I'm still somewhat apprehensive. It was a hollow needle, with a large bore: the kind of needle that has a greater chance of ruining your life.

Moral of the story: don't get cocky. Arrogance leads to bloodshed... and not infrequently your own.

Friday, May 07, 2010

Another manic holiday

You have to be a little manic to be a neurosurgeon. Occasionally, we must eat delusions of grandeur for dessert and use flight of ideas as our condiments to be able to deal with the sleep deprivation and high expectations. Cinco de Mayo this year was definitely one of those times. Crazy partying down in Hermosa Beach, driving home at 3:30 in the morning and waking up in an hour and change to get to work by 5:30. Then operating all day. Man. What a rush though. I was doing out patient procedures with just the attending and he let me do most of the cases as they were pretty simple. Changing batteries on deep brain stimulator generators, localizing nerve roots using fluoroscopy for radiofrequency ablations. Awesome times. The best part of working with an attending surgeon is that if you earn their trust during the earlier parts of the operation, they'll just leave the room and let you finish up once the "critical parts" of the operation are done. It's fun being "the surgeon" in the room, sewing things up, making sure the patient wakes up, and taking him to recovery. Suffice it to say I was in dire need of some operative cases. When you're cutting and slicing up the insides of someone's skull or body, sleep is definitely a distant thought... at least for now. I'm sure one day it'll become commonplace and I'll pass out on the operating table just like I do everywhere else (I swear I have narcolepsy).


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.