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.

My own personal torture chamber

 

I think I’ve been a little cranky lately.We have been quite busy at the clinic the last few weeks (or months—I mean this year!). This past month I extracted 550 teeth (I usually do about 300 per month plus other procedures). I was up a lot in the middle of the night on call so maybe that is partially why. I’ve talked in the past about the borderline rude comments patients make about dentists (usually based out of fear). Normally I just smile and brush it off but this past week it seemed like everyone had something to say.

Patient #1: “You know, I’ve only had one dentist ever give me shots without hurting me.”

Me: “Oh, I’m guessing you don’t mean me?” (Come on, it’s a shot! And it’s given so I don’t have to hurt you on the next step. Believe me, you want the shot.)

Patient #1: “Oh no! Definitely not!” He laughs.

Me: “Well, I guess we are just a bunch of meanies here!” In a friendly tone.

Patient #1: “No, just you!” Pointing to my assistant,”She hasn’t hurt me yet.”

Me: I just didn’t feel like putting up with it. He was acting like I was purposefully hurting him when he had come to me for relief of his pain and we had nicely worked him into our schedule. He was extra work (and paperwork) for me on a busy day that I had been up since 3 am (which unfortunately is my life this month! ha ha). “It’s probably not a good idea to insult the person who has all of the sharp tools before she starts working on you.” In as friendly a tone as I could muster. Maybe not the best thing to say but I was so frustrated.

And on to patient#2, another add-on patient. She was very anxious. She was crying and wimpering when I walked into the room (before I ever “came at her with my sharp tools.”). I asked her what was wrong, if she was in pain or scared. She said both. She gave me a big spiel about how she hates dentists more than anything/anyone else in the world, how the whole experience is the worst, was I going to shove a needle up in her tooth (because that is the worst)?, etc.  I’m used to this sort of thing but this is was what made me angry:

Patient #2: “I think you are all a bunch of sadists.”

Me: (Thank you! You saying that gives me so much extra pleasure, to know that you really are suffering!) “I’m sorry you feel that way. We are just trying to help you and I think the real sadistic thing to do would be to send you away without helping you feel better.” (Considering how much pain you were having before I even came in here.)

She of course cried throughout the whole thing, but we luckily were able to easily remove the tooth. I hope she feels better.

These experiences are so interesting. My few days of Neurosurgery have reminded me of a new perspective. We are lucky in oral surgery that our patients rarely have serious problems or complications. A hole in the sinus (that heals spontaneously), a broken tooth, a little numbness pales in comparison to the complications that can (and very often do) occur in these brain surgery patients who often can’t talk, move, or be themselves anymore (if they live). Yet, people don’t come in and tell us that Neurosurgeons are the worst and scariest people on Earth. These people have a lot more opportunity to inflict suffering, but they are admired and appreciated. I find it ironic.

The life of a dentist! To be feared and hated (and I think as an oral surgeon, we are THE most feared and hated). I guess I am lucky. Most sadists have to lure their patients in. They either have to find masochists who will enjoy the torture or kidnap or trick people into it. But, I am lucky. People willingly come to me for their torture. And in fact, they pay money. Or their insurance pays. And I have multiple rooms and devices dedicated solely to inflicting pain and misery. I have assistants who help me maximize the torture and fulfill my every bidding to ensure the maximum amount of fear and discomfort. Sometimes I even drug my patients so I can do my best torturing without having to worry about their cooperation!

(In case you aren’t familiar with oral surgery, here are some of my torture devices. Frightening, I know!)

--I hope you can tell I’m only joking. Or am I? (evil laugh)

Good morning!

Tomorrow I start the last month of my "off-service" rotations as a second year. And when I say tomorrow, I mean I will be at the hospital at 4:15 am.

Good thing it is only one month. In the mean time, I am going to try to trick myself tonight into thinking 8:00 is bed time.

The tube

I don’t think of myself as a big TV watcher, but I find I do get sucked into shows very easily. In college I had a few roommates who were hooked on 24. They would sit inches away from the screen, yelling for Jack to get away safely or at his dumb daughter or at the end of the (cliffhanger) episode. They would also stay up all night long watching the entire season. I swore that I would never watch 24. I am sure I would succumb to its wiles and the rest of my waking life (or at least my free time) would be done for. Luckily, most of the shows I am addicted to can be watched later online so I can watch on the weekends or other times when I just need to veg.

Here are my favorites, in no particular order:

Modern Family – this show is a crack up! An awesome funny quick fix (30 minute episodes).  Wednesday night’s on ABC.

 

Parenthood – Abe and I started watching this last year. It is about a large family and all of the many difficulties families have. Right now I am frustrated that the one daughter wants to have a baby with her boyfriend because “that is the next step when you love someone.” There has been no talk of marriage which in my mind seems like the real no brainer “next step!” Aaaargh!  --see, I’m sucked in for sure. (Tuesday night )NBC?)

The Bachelor

I’m a little embarassed to admit this one, but I accidentally started watching the Bachelorette last season and got hooked. Basically, I think the whole premise of the show is horrible and cruel. Put 25 women against each other, trying to win the love of a single man who within a matter of weeks must choose someone to marry; in the meantime, you must be okay with the fact that your boyfriend you are weeks away from marrying is making out with other girls and may not choose you, anyway. Abe always tells me how awful the show is, that it is the worst show ever. I tend to agree but somehow we both find ourselves watching and discussing it later. I think the 2 hour episodes are a bit much, so I usually tend to catch the last hour. Is anyone else frustrated about Kacie B going home and Courtney staying another week? (Monday night ABC)

 

Criminal Minds –There are episodes for this on all of the time on Ion television network. This is my favorite crime show (after SVU lost Stabler—I’m too sad too keep watching) about the Behavioral Analysis Unit of the FBI who are criminal profilers set to find killers mid-rampage.

 

The Walking Dead—this is my favorite somewhat guilty pleasure. It is a story of the zombie apocalypse and a small group of survivors merely trying to survive. It is gory and pretty scary for TV (almost like watching a mini horror movie every week) and I’m a bit embarrassed for that reason when people sit down to watch with me without seeing more than one episode, but I LOVE this show. My new favorite. You can watch the first season (which is only about 6 episodes) on Netflix. The second season is currently on A&E Sunday nights.

Shows I have enjoyed in the past but don’t follow so closely include Law and Order: SVU, the Office. I also loved Prison Break (although the ending was disappointing).

What are your favorite shows? Do you watch any of these?

Pinterested

Have you found pinterest yet?

I have to admit when I first was invited I was skeptical. I was confused about what I was supposed to be doing. And I felt I was wasting time pretending it was cool when I was clueless.

But the pretending has ended. A friend told me, “Pinterest has changed my life.” That sounds like a bit of a stretch, but here is what pinterest has changed for me:

1. I have a new list of craft ideas for the next time I have an urge for a project or decorating fix

2. I’ve been inspired to remodel my basement. Whether or not it happens, I have a lot of pictures to give me ideas

3. Recipes. I found a new recipe for cauliflower. I think that is hard to do. I have also tried a few new crockpot recipes including hummus and hot fudge cake

4. I’ve been more brave and daring in my make-up now that I have some new ideas. Also, fun ideas for nailpolish. I also found a hairstyle.

5. I’ve been organizing my house. So many tips and ideas when I’m not very good at that sort of thing

 

Basically, its a non-intimidating way to find new projects and ideas to store away so I don’t forget them before I get to it. Things like how to clean the grime from my oven and decorate for the next holiday. And it is fun to see what my friends are interested in, too. I may need to use it to help sort through vacation ideas.

What has pinterest changed for you?

Let me know if you need an invite to get started.

Against Medical Advise and common courtesy

As a health care provider I am very careful to be as kind and compassionate to patient's as I can. I feel a strong part of my responsibility is to deliver good care with compassion. I find I often, very often, do not receive the same treatment back from patients.

I've joked before about the all-too-common comments I get on a daily basis from patients about how much they "hate THE dentist." They are sometimes rude, short, or annoyed with my questioning. I understand that most of my patients are nervous or afraid when they come see me. I understand that most people don't think of their friendly neighborhood oral surgeon as friendly. I know I am the one who is there to "come at them" with sharp tools, "stab their gums to deaden their teeth," or "rip out their teeth from their faces." I'm not talking about this brand of impoliteness.

I am talking inappropriate, rude behavior that I would hope you wouldn't use with anyone, let alone the person who rolled out of their warm, comfy bed after a long day at 3 am to help fix your face (and your pain).  A sadly high proportion of patients are belligerent, yell, cuss, or refuse to cooperate (--not to mention sexual harassment or innuendo, which luckily is usually reserved to the geriatric male population). Sometimes they even threaten physical harm. I usually laugh or ignore the inappropriate behavior. I want to be understanding. I would be angry too if I was "sucker punched." I may even swear if I was told my jaw would be wired shut for 8 weeks. Maybe I've been afraid of being seen as rude, uncaring, or even of being sued. But I am getting tired of being treated horribly for trying to deliver medical care.

Today I was asked to speak to a patient who wanted to leave the hospital "AMA" (against medical advice). When I arrived he was yelling and cussing at everyone in the room and a family member on the phone. I tried to listen to his problem, give him some time to process, and figure out what the plan was. We were trying to get him to his surgery which was scheduled to happen at that time. He continued to yell and cuss until I finally, sternly, told him his behavior was inappropriate. Not only was it unfair to his nurses and to me, but to all of the children on the pediatric floor he was staying on. He continued to yell and tell me I was the one who was disrespectful, some "nurse who just comes in here" and disrespects him. At some point he even did some threatening body posturing in my direction--behind my back which I didn't see.

He calmed down, stopped yelling, and agreed to have the surgery after a male resident talked to him (of course, he had no qualms about yelling at the 7 women there before, but a man shows up and he is perfectly reasonable). Things ended up okay but it made me think about how to act in these situations. I have started telling patient's when their behaviors are inappropriate. I have asked them to stop swearing. To treat my staff with more respect. But it is still hard. I wonder what I would do if I were physically threatened by a patient. Would I be allowed to protect myself without worrying about some kind of negative consequences? Would I be brave enough to fight back? I have heard stories of nurses being attacked (or groped), why not me? Today was the first time the thought has even crossed my mind.

Ultimately, I am trying to help. I am trying to do my job. And a lot of the time anger, fear, annoyance, prejudice, etc gets in the way. In a big way. I don't see this happening in many other industries. Can you imagine cussing out your baker because they gave you a free sample but didn't pay for your parking? Or berating your barber for asking you to hold still after you came in (with your own free will) to get a haircut? Or tell your waiter you don't know if you can control yourself and not hit him if the coffee isn't hot enough? I didn't think so. But I didn't make up these scenarios (just changed the context).

(This isn't even mentioning the guy who called and hung up on me Saturday night for asking him questions about his problem. He called me! And he hung up on me! But according to him, I was the rude one.)

Happy Birthday Abe

A few months ago Abe did a load of laundry which consisted mainly of our dress clothes, including a bunch of new pants we bought him for work. Unfortunately some bleach went renegade and ruined a bunch of our stuff. Oh man!

Today I was shopping for Abe's birthday at Ann Taylor Loft (Ok ok I got a little sidetracked) and found these dress pants on sale.

 

Not a great picture but you get the idea.

I quickly snatched up almost as many as I could find in my size. I felt a little guilty, " Come on Erin, it is Abe's birthday and you can't just buy one, you have to choose four?!" But at the checkout I realized they were originally about $70 each. In the end I saved $200 on something I needed to replace the old ones anyway. Yay. I’m good at rationalizing, huh?

I also decided to embrace the skinny jean trend. A few months ago I toyed with the idea, but afraid to commit because I felt they made me look ridiculously un-proportioned, I went with the $14.99 special. I’ve been enjoying them so decided to try another pair today from American Eagle for a decent price (about $30). This may be the first time I ever tried on one, and only one, pair of jeans and walked out with them just minutes later. I find that their jeans tend to fit me pretty well. I’ve tried more expensive brands only to be frustrated after trying on about 15 pairs. What a dream when they fit after the first one! And they don’t drag on the floor, either, which is a perk since I have relatively stubby legs.

Here I am trying them on for Abe. And surprisingly they are super comfy and don’t feel like “SKINNY” make-you-lose-your-breath jeans.

I am curious what brands you like? Does anyone have a particular jean company they recommend? Do you feel it is worth it to spend a lot?

 

Oh, and Happy Birthday to Abe. (

PS I did buy him a few things but I can’t spoil it for him by talking about that.