Last Supper

The neurosurgery seniors took the incoming R2s to a really nice steak dinner today at Mastro's. Although the premise was that of indoctrination and forewarning of the responsibilities of the upcoming year, my fellow R2s and I saw it for what it really was - a last supper for those on death row. Listening to my seniors talk about their experiences as the neurosurgery R2 over the past years was simultaneously comforting and disconcerting. Hearing that there's layers of back up, that they'll be there to answer every simple question in the first few months, that we essentially weren't allowed to make any management decision on our own initially... those things were of great comfort. That we'll undoubtedly fall asleep in the OR (which I've already done multiple times), screw up, upset attendings, etc. Fine, whatever. "You will kill people"... almost in jest, but with enough preceding sincerity that you know they're being truthful... that was kind of sickening.

I've heard the stories (none of these from UCLA btw): elective spine cases where one wrong slip leads to quadriplegia in an otherwise healthy gentleman; plunging into the aorta in a lumbar fusion case causing the patient to bleed out on the table; taking too much tissue in a epilepsy case that results in hemiparesis - these are the catastrophes one never thinks will happen to him, but invariably WILL happen if you're in practice long enough. In poker they say you don't always remember all your great wins, but you definitely remember the terrible losses, the bad beats, the hands that leave your pockets empty and hearts cavernous as you get up to leave the table. It's only natural for surgeons, at least the good ones, to remember the tragedies, as they're hopefully few and far between.

After being an intern in the hospital for a year, sure, I've seen people die, often in front of my own eyes. Good people, healthy people, the ones you expected to walk out of the hospital the next day. But no one's died yet because I screwed up. And to be honest I don't think I'd be able to post such a complication if it did happen. I guess that's the problem with medical writing, especially when speaking from a resident's point of view. Next year I'll probably more likely than not violate work hours, be involved in cases where devastating complications occur, and maybe even get to a point where I'm given enough responsibility to cause some of my own. But these are probably the things not written in this blog. How do we report that to the general public and expect them to understand, rather than litigiously hunt our heads? But make no mistake, for the most part in our profession, the patients that come our way would die without our intervention. Brain tumors, intracerebral aneurysms, intracranial bleeds and abscesses... these are dead men walking, their fates already written without neurosurgical intervention. But maybe this line of thinking is to justify my own existence and absolve my mistakes... we'll see.