The past few months through the retrospectoscope have been like looking through fog frosted glass while backing up an SUV. My research year was coming to a close, and as I said goodbye to the normal 9-5 work day and life without a pager, I began to have little tastes of things to come. Our residency is scheduled in such a way that we start to cover the compatriot ahead of us when he goes on vacation. Not enough to just see the sword of Damocles looming from above, you're allowed to cut your tongue on its cold steel for one week at a time while still but a servant in the king's court.
Many things were vaguely reminiscent of the life I had somewhat forgotten in the eddies of sleep deprived memories. Working long hours, operating without food or water for half days at a time. But the home call was definitely something new. When you're a junior resident, you sign out and leave your work at the hospital. When you're a senior, you're constantly on pager. No more hitting the bars after a long work day with your buddies to recount war stories from the days prior. No more weekend getaways with your significant other to escape the monotony of blood and brain that permeates every part of your life. No sir. Senior resident equals 24 hours each week where they can't touch you, but aside from that all consults seen by the in-house juniors go through you, and you need to be available at all times to operate on a minutes notice. That adds up to 12 days in 90 when sleep was protected and uninterrupted. Or 78 in 90, when there was a good chance you were the neurosurgical undead.
That said, for the first time you were the neurosurgeon. You ran the service. You decided who to operate on. You determined who could be saved, and who was beyond saving. There's a saying in neurosurgery that once God lays his hands on your patient, you take yours away. Well, I was never really the most reverent one.
She just turned 82. A spritely one they said. A bedside drainage procedure had failed, so we counseled the family and decided to evacuate the hematoma in the operating room. The surgery went well, and through a moderately sized craniotomy we were able to evacuate the majority of the blood that had caused her to get weaker and drowsy. I was at my friend's place after work for about 20 minutes when I got a call that she had blown a pupil. CT scan showed a large rebleed into the surgical cavity. She was doing so well, and it had just happened. Most people would have said to let her go at this point, but she wasn't going to die tonight, not on my watch, and sure as hell not on her birthday. I sped down the 405 and made it to the hospital in record time to see the patient being moved onto the OR table. I tore down her head dressing and positioned her accordingly after I had called my senior and attending and got everyone to start the case. Give her mannitol, keep her CO2s low, guys this a real red line, let's move, NOW. I was making skin incision and extending the craniotomy within minutes and was able to visualize the bleeders. My chief joined me shortly to help, the attending much later. He grumbled, annoyed that he had to come in in the middle of the night to what seemed like a futile situation. The size of the hematoma, her age, all strikes against her. But he didn't account for our genuine desire to make sure she would live.
I saw her in clinic 3 months later and she looked fantastic. She had a little bit of a rocky hospital course, but was now walking, talking and laughing like the spritely young thing the family told us she was. It was worth everything. I had been working for 3 days with only 6 hours of sleep (total) and was literally falling asleep while running clinic when I heard she was there for her follow-up. Seeing her like that gave me an energy that coffee could not provide, a sense of joy that achievement could not afford. This is why we do what we do. And why when we do, we do it damn well.