Helpless Human

There's an old joke that goes: What's the difference between a neurosurgeon and God? ... God doesn't think he's a neurosurgeon.

There are definitely the fair share of ego-maniacs within the field of neurosurgery. Many self-entitled based on the hardships in training and countless hours spent to reach their goal. There are the rare few however that are deserving of praise such as "hands of God" capable of performing exquisitely challenging surgeries that are both life saving and function preserving. What people oftentimes don't understand is that some lesions that are deemed "inoperable" by one neurosurgeon, may just be a matter of inexperience or lack of technical ability that cannot be admitted. But sometimes, some situations are beyond even the most gifted surgeons, and we are reminded of the adage that once God lays his hands on your patient, you should take yours away.

My last night on call was terribly draining, not on a physical level per se, but more on an emotional one as I watched multiple patients slip away into the night, far removed from the grasp of the medical care we could offer them.

We red-lined a patient with a multiple year history of end stage liver disease to evacuate a spontaneous brain hemorrhage he experienced for want of clotting products that his liver could no longer produce. His emergent surgery was striking to me for two reasons. One, it was an epic uphill battle after we removed a good part of the blood clot from his bulging blood clot swollen brain. Trying to get him to stop bleeding despite all the clotting factors we were dumping into his blood stream felt akin to trying to stop a dripping sponge with a box of matches. Two, his brain was yellow. It was probably one of the weirdest things I've seen this year. During certain stages of liver failure the body fails to breakdown and reabsorb bilirubin, so it floods the bloodstream and stains everything yellow. First it's the conjunctivae of your eyes, the underside of your tongue, your skin... and I guess your brain as well. The brain is usually a glistening grey mass (hence grey matter) with a beautiful architecture of blood vessels overlaying the surface. This appeared like a big golden egg, and in the setting of swelling from the underlying hematoma, seemed like it was a golden chicken about to hatch from a less yellow, but equally aberrantly tinted skull. After the initial amusement and childlike curiosity ensued a feeling of helplessness that pervaded through the morning, the night, and into the next day. Given his disease he would not stop bleeding. We did the best we could, and saved him from immediate death from herniation (when parts of your brain go and compress other critical areas given an intracranial mass). But he continued to bleed. I watched as his scans worsened, as his exams worsened, and with each radiographic or clinical deterioration presented the case to the team and attending. There was nothing we could do. Surgery would only make things worse. Even if he survived this incident he would likely end up a vegetable, and if he woke up, would not be able to talk or use the right side of his body. He was beyond what we as neurosurgeons, what we as human beings, could do. We were in the operating suite of a higher power, and we had no place there.

On a less religious and more uplifting level... I operated on a 9 day old baby today! She had a congenital condition that required her to have a permanent CSF shunt from her ventricles to elsewhere in her body. I had done enough of these on other patients by now that the attending let me do the case as he assisted and guided me through the parts I was still rusty on. It went perfectly, and the baby woke up smiling without crying (maybe she was still high on anesthesia). She'll be able to grow up to be a fully functional person later on because of what we did.

So for today, I guess we're even.