2nd Week

This week I have mostly shadowed Dr. Clements as Dr. Wilson had a surgery almost every morning and then proceeded to quickly escape the confines of the hospital shortly after. But I still have to tell you, St. Joseph's Neurological ICU (Dr. Clements is also an intensivist [intensive care physician]) is a pretty impressive place. It is enough to look at just at one of the twelve patient rooms to get jealous; every single bed has at least 50 different settings and a huge wide screen tv on the wall( although most patients are in comatose state, or in the "la-la land"- on Propafol, the "Michael Jackson killer drug, " Dr Clements once joked). In addition to the redundant tv and awesome bed, your attention is pulled to the countless appliances situated around the bed , the annoying sounds( the most annoying one is similar to the start up of windows 7 that the breathing machine produces when a patient takes a breath on his/her own without the help of the machine), all the illustrations of vital signs on the monitors, and a chaos of tubes wires and electronically programmed pumps with at least seven different medication bags ( 3 of them are almost always Sodium Chloride).

Even though, the most common condition that the patients are suffering from is Subarachnoid Hemorrhage (the bleeding between the brain and one of the layers surrounding the brain -mostly caused by head trauma or ruptured cerebral aneurism[pockets of blood that form due to weakening of the walls of cerebral artery or vein]), there are always a couple of unusual interesting cases. One in particular was striking-- a patient with T-cell lymphoma(I am getting tired of explaining) who has zero percent chance of getting out of the hospital for more than 4 month or let alone surviving for more than 9 months; his wife is also suffering from a lobular cancer that reappeared 8 years after it was supposedly cured. Apart from the obvious reasons, I find this particular case intriguing because his family has also asked Dr. Clements to follow the DNR( do not resuscitate) guidelines; they later explained that "he would not have wanted to exist that way" referring to his current comatose state. What struck me is their practicality and decisiveness -it is as if he has already died for them( which is true in many respects).Usually, the reverse happens and people hold on the person that they love beyond the point of necessity (keeping them alive in a vegetative state for years). Because almost all the patients in the Neuro ICU are walking the line between life and death and only a third actually survive ,I was able to witness numerous other cases similar to this. On Thursday I even asked whether Dr.Clements "dissociates the patients from their body." He went on to explain that that is the first thing that all doctors do, joking that instead of "b00bs" he saw cancer. Poor fella! I also found out most doctors' opinions concerning lawyers and malpractice insurance companies as an average doctor gets sued at least one during their career and has to pay HUMONGOUS sums for this reason. Neurosurgeons have an even more sour relationship with lawyers as they get sued twice more often. "This is not a profession that makes money," said Dr. Wilson. Dr. Clement's "I am just covering my @ss" remark when asked why he documents everything also reinforces the point.

Random interesting procedure that I saw yesterday -"ventriculostomy." This was one of the most brutal things I saw done to a patient outside of the surgery room and it made Hannibal look like a kind grandfather. Vetriculostomy is done to relieve the pressure from too much cerebrospinal fluid build and it is done by putting a "small catheter" through about 5-6 cm of brain to reach the ventricles. The whole process is started with the use of "small manual drill," skull and blood fragments that are catapulted around the room by that drill, and the smell of ethanol(sanitizer). The process is finished with an odd looking stick coming out of the patients head and about 10 extra years of live.