Starting up again

Sorry for the blogging hiatus. I was on vacation last week, and spent the time away from the computer and hospital.

There's an interesting phenomenon that occurs when R2s take that week of vacation. Being plucked from the gears of the neurosurgery team for servicing and repairs, we go from the finely tuned, well oiled machine of 3 residents to a piece meal collection of pinch hitters as our seniors cover for us and take call. Suffice it to say there aren't any great disasters, but one does miss the familiar team work that has become as second nature as the beating of our hearts or breaths we unconsciously take.

The most jarring sensation of disconnect is felt, however, when it's time to return from vacation. Rested, revitalized, and ready to take on another stretch of never ending 30hour shifts, you feel like the refurbished part being thrown back into the gears of the service. You're slow at first, the freshly applied oil still cold compared to the racing fever of the neurosurgery machine. You miss scans, have to think about the landmarks on a ventriculostomy, and forget that you can't just sleep when you're tired. But just as only a few days prior you realized all you knew was neurosurgery, that the happenings of daily living were somewhat overwhelming in their lack of structure and intensity, you find you're back at home.

Call yesterday felt like another house of falling cards. I started the day with a red-line, a hemicraniectomy for a stroke patient (procedure where you take off half the patient's skull to give their dying/dead brain room to swell following cell death). I love to operate, but operating when you're on call is painful. Every minute you're in the OR you know the work is piling up around you. The consults still come, attendings still call. It was only a 3 hour case, but by the time I was done I was three hours, 2 consults, and 25 tasks behind. But still, it felt different. Despite the 5 admissions, acute intracranial hemorrhage causing herniation (no bueno), and two bedside procedures, there was never really any moment of panic or helplessness. Tired, yes; overwhelmed, no.

It was when I was placing bilateral subdural hematoma drains at bedside that it really felt like I was making progress. If you recall, my first bedside subdural hematoma drain was a disaster. An hour of futzing around with not much success, and having to call in my senior to help me out with an audience of nursing students watching me flail. Boo. This time, I placed both drains, one on either side of the head, within 30 minutes. The CT showed awesome placement. It almost made up for the 4 CT scans I forgot to show on radiology rounds... gah.