Quiet Night

I'm happy to report I enjoyed my first quiet night on call. Only one code trauma where neurosurgery was involved, and it turned out to be some drunk that had way too much booze. Only one consult that ended up being non-operative. No one acutely crumping in the ED or the unit (ICU). I thought my pager was broken. I actually got 2ish hours of sleep. Man, if I can get one of these nights every other call or something this year might not be too bad.

Now that I'm operating every other day or so, residency has taken on a whole new level of complexity. Attendings are starting to expect me to position, prep, and drape the patient before they get into the room now. Figuring out how to position the head in relation to the anesthesia peeps, the endotracheal (breathing) tube, whether or not they need a frame to hold their head or if we're just operating with it placed on a foam doughnut... all these considerations aren't things I've actively thought about before, nor took note of how disparate it is between one surgeon from another. I need to start writing these things down...

Today I evacuated an epidural hematoma on a 6 year old kid. Epidural hematomas are blood collections that form between the dura (protective covering of the brain - it's skin essentially) and the skull. I drilled down with a tiny acorn (named for its shape) drill until the blood started gushing out. By this time due to the decomposition of the hemaglobin into hemosiderin, it had taken on a green vomit-like color. As the old blood pulsed out with the kids heartbeat, it appeared something akin to the skull vomiting in tiny spurts through an equally tiny mouth. We enlarged the bony opening by drilling a piece off and washed out the blood until the irrigation was clear. I put the bone flap back on with a titanium plate and screws, stitched up the scalp and called it a day. Nice and simple. Not a bad way to end a not-too bad call.