It's like pulling teeth...I mean, like brain surgery

First, isn't it funny when you hear these cliche phrases in their literal context. When people tell me "it's like pulling teeth" I can't help but laugh. Shouldn't be a problem then, I think to myself. Unless your 65 and want me to pull out an impacted wisdom tooth. Another story...

People keep asking me how my Neurosurgery rotation is going. Well, for one, at just after 9 pm it is way past my bed time. My mornings start nice and early. Even living within just a few minutes of the hospital I find myself waking up in the 3 am-4 am block. Even when I am well rested, it just feels strange. I am starting work "in the middle of the night" to be there in time to pre-round on my patients about 4 am. We round as a team at 5am. We eat breakfast and then I take care of patients "on the floor." Luckily so far this part has been manageable. We have a small amount of patients (about 30 compared to the usual 60) and a large team this month.We focus a lot on "the neuro exam," which includes the ability to move body parts, respond to commands, feel sensation, and answer basic questions appropriately (some of the math questions are hard for me that early, "What is 100 - 7?"). We are responsible for surgery work ups during the day. We round at least one day per weekend. The earliest I can leave is 5pm.

I've had very little exposure in the past to neurosurgery in the past. During my anesthesia rotation I saw many different surgeries but only a few neurosurgery cases.

The only memorable neurosurgery moment I've had was with a well known surgeon at our hospital. I was rushed in to take over an emergency brain surgery within the first few days of my rotation on anesthesia.
During the procedure I heard the surgeon yelling, "Valsalva. Valsalva!" It took me a few seconds to realize he was speaking to me.
"Oh, are you speaking to me sir?"
"Valsalva!" As if saying it more loudly and more often would help me register the meaning.
I was puzzled. I know what a valsalva is (essentially the "bearing down" action like when you cough), but had no idea how to perform it on someone else. He continued to yell this impatiently.
"I'm sorry sir, but I don't know how to do that."
He was angry about this. He was muttering to the resident working with him. "Can you believe she doesn't know how to valsalva? Who doesn't know how to do that? etc etc." I waited for him to assist me by giving me some instruction (I wish I would have asked, "Do YOU know how to valsalva?) but finally he yelled at me to bring in my staff.
I frantically called the staff doctor who talked me through the procedure (basically a long breath hold). At the end of the case he told her, "She didn't even know how to do the valsalva! Can you believe it? How could this be?" He was obviously trying to get me in trouble.
She was wonderful and told him to back off, that it was my first week, and did he know everything his first week?
"Yes, in fact I was born a neurosurgeon and have been doing these procedures since I was 2!"

When we round I laugh about this story knowing this doctor has no idea who I am or how scared he made me early on.

Today was my first real exposure to a real neurosurgery case, a cranioplasty. Essentially they replaced the missing portion of a woman's skull that had to be removed due to a trauma. It was very cool to see them reshape her sunk-in skull with a metal piece that simulated the missing skull (ala the bionic woman or the tin woodsman). But, unlike our procedures that are quite safe, even this cosmetic surgery caries a large risk. These doctors carry a lot of responsibility with them every day!



I hope to see some more procedures and my first live brain in the near future.