Tuesday, March 14, 2006

Piece of Mind

You know how people say "hey, it's not brain surgery..."? Well today...It was.

After a late night return from a trip to NYC for Purim merrymaking with friends old and new, I was less than thrilled when my alarm went off at 6am this morning, a mere three hours after I'd set it and fallen into bed. Luckily, anesthesiology has brought with its other perks a Return to Pajamas, as in the shapeless, colorless, imminently nonflattering, yet infinitely more comfortable than most other professional attire I've ever worn scrubs that I am obliged to sport while in the hospital. Still operating in slow wave sleep mode, I chugged coffee and downed some vitamins on the way up to meet my fate for the day.
The verdict: neurosurgery operating room! In addition to completing my first successful intubation per anesthesiology requirements, I also had the unique opportunity to observe as a woman quite literally got back her piece of mind--she had had a stroke a while back, and her brain swelled to unhealthy dimensions in response to the insult. So at that time the doctors had done a craniotomy, taking a China-shaped piece of skull out of her all-important globe in order to let the brain swell and heal without choking itself to death inside the otherwise rather tight quarters of the cranium. Now, some time later, she was ready for the docs to give her back a piece of her mind (which, incidentally, had been resting comfortable at a "bone bank" with all the other craniotomy survivors--it seemed rather nonplussed by its unique out of body experience). All went smoothly, and the piece was restored to its rightful resting place.

Brain surgery? Easy as pie, I thought after this first case. That's when the aneurysm walked into the OR. No, no joke here. Just a relatively young middle-aged woman with a bulge in one of the arteries in her brain that had just burst, bled for a bit, and then magically clotted itself, buying her enough time to get to get intubated and rushed to our hospital. We (and by "we" I mean everyone but me--the surgeons, the scrub nurses, the other anesthesiologists) were progressing along fabulously, almost ready to seal the sucker and call it a day when suddenly--like the New Orleans levees--the aneurysm broke open! Instantly, the blood waters rose up, up, up in the cavity of brain, almost spilling right out onto the floor . Each time one of the neurosurgeons suctioned out the excess, the other would fish among the tangles of vessels, trying in vain to stop the leak with a well-placed clip. Each time, the clip would hold for half a minute, the field would stay clear, and then--like a just-flushed toilet--the hole seemed to stop holding its breath, and blood would fill back up in the space. The situation looked pretty grim to me; but luckily, just as I was wondering whether all was lost, the coolhanded surgeon, with a final decisive clip at the offending artery, nipped the problem in the bud for good. Whew. Wouldn't want to have been in their shoes during the last hour. I guess brain surgery really is...brain surgery.


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