Funny Stories from Jersey Neurosurgery

I have been up in the tri-state area for about seven weeks and things are radically different from Texas but I truly love everything up here. I am currently sitting at a Starbucks next to Lincoln Square watching the people walk by in their assorted scarves, hats, and coats. The hustle and bustle is not as annoying as I thought it would be, however some days I just want to choke people especially when driving, everyone here drives so slow even when there is no traffic.

Well that was not how I intended to start out this post but rather tell a few funny stories from the hospital. I apologize if you find this too vague or too medical but I will do my best to make it relevant. My first month in New Jersey was spent doing neurosurgery, for some reason this month everyone in New Jersey (or so it seemed) decided to pop and aneurysm in their head. Almost every night we would have a new admission of someone who had a ruptured aneurysm. I learned an enormous amount about the treatment of this disease, which is very complicated to manage. In medical school they just breeze over this stuff but when it comes to the day to day of managing these patients in the ICU it is very complicated. Most of the patients end up needing to be in the hospital for 3 weeks, so I got to know them very well seeing them multiple times a day.

One lady was already in the hospital when I arrived and she had an ACOM aneurysm (don't worry about what that is) but It is near the frontal lobes and as most people know from TV this controls your impulses so she became impulsive and would say anything that came to her mind. Everyday we would go into her room and ask her similar questions to see how she was progressing, things like "What is your name? What is the date? Where are you and Who is the president?" It seemed like every day her name changed a bit as she added a new name to the end of it. The funniest thing happened when she need to have a drain put in to her brain because she was developing hydrocephalus (water on the brain). This procedure can be done at the bedside and is relatively simple. After numbing the scalp an incision is made and the skull is exposed. You then use a twist drill to drill through the skull until the dura (membrane around brain) is exposed, a cut is made in the dura and then you pass a tube into the ventricle (water collecting area). Patients are awake for this or slightly sedated. She was fully awake and as the chief resident drilled through her skull she looked up and said "Heyyyyy now...are you drilling in my head?" we simply told her we weren't and she said ok and continued to watch tv.

A few weeks later another woman was in the unit with the same problem but she had an attitude to put it nicely. Everyday when we woke her up at 6am she would yell at us and tell us we were rude for not letting her sleep. When we asked us to show her two fingers (seeing if she can follow commands) she would always flip us off with both hands. She accused one of the interns of being a lesbian for touching her. She also had a slight crush on one of the other interns.

Woman: "Hey can you do me a favor?"

Intern; "Sure, What do you need?"

Woman in a raspy voice: "Smile"

To appease the woman he smiled

Woman: "You are one sexy bastard"

The intern left the room to her yelling, "You know it, You know it, You know it"

Then there was my favorite patient she came in late one evening cussing up a storm the only words she could say were shit and fuck (we call this an expressive aphasia). She ended up having a left MCA aneurysm this artery supplies the language areas. When the family arrived they told us that sounded like her and weren't surprised. She ended up having the aneurysm coiled and having a drain placed. Slowly as she recovered she would try to talk but all the came out was "ughhhh" and "mugggh" followed by giggling. "Mrs. So and So what is your name?" she would respond "mugggh" and would laugh. She was very frustrated that she couldn't understand or speak, but would try and laugh to play it off. He facial expressions were priceless when I would come in and see her. I actually caught her and her husband flirting one day, which made me really happy.

Then there was the most awkward thing I have ever seen. A 90 year old nun came into the ER after having a massive stroke. We went with the attending to examine her and write our consult even though we knew she wouldn't be a surgical candidate. When examining a patients neurological status we need to know about their strength, pain sensation, vibratory sensation, ability to follow commands and other things. In order to test patients pain sensation we will pinch their skin, stick them with safety pins press on certain nerves etc...however, when a patient is stuporous to try and arouse them we will do a sternal rub or twist their nipple. The attending decided to see how she would react he would twist her nipple. Watching a late 60's man twist a 90 year old nun's nipple was probably the most awkward thing I've ever seen. I couldn't help myself by thinking "that's probably the most action she has ever had"

Lewis and Clark

A few weekends ago I had the opportunity to go and explore the great northwest because of an interview at a residency program in Corvallis, Oregon. Corvallis is home of Oregon State University and has a population of about 55,000. I arrived in Eugene on Friday after a 6hr flight from NYC. I then drove up to Corvallis in my big pimpin' Chrysler 300, it was an absolutely gorgeous drive. Most people describe the northwest as a place where it rains every day, but not this day, the sun was shinning, the air was crisp and fall was in the air. It happened to be OSU's homecoming and the weekend of Halloween so it is needless to say the town was hoping. My hotel was on the Northern end of the main street and after unloading my belongings I got a prank call from a fellow classmate who was rotating at the hospital. After I figured out it was EB, he and took a stroll down the main street and settled into a restaurant to enjoy some pizza. While walking up and down the street it was impossible to notice all the children (and adults) in their costumes trick or treating. All of the local businesses give out free candy each year. Being a Texan I am used to extremely nice people but these people we're even nicer than Texans, which took me off guard after being in the northeast where a bad look gets you in trouble.

Later that night I went to have dinner with the current residents and fellow applicants. My friend TP was there interviewing as well so after the dinner we went to a wine bar next door. The waitress(?) was great and very informative and very eager to tell me about all the awesome things Oregon has to offer. It didn't take too much convincing because thus far everything I had experienced was either gorgeous and/or friendly, including her.

The next day I had my interview in the morning, which went well. I then had lunch at a local brewery with TP. EB met up with us for a bit once he was done at the hospital. TP's flight left that night so we dropped her off and headed on our great adventure to coast. We drove for about an hour through the rain to Newport. First thing on the agenda was to drive over an awesome bridge I saw we did that and then saw a spot to go park near the beach. We walked out on the beach where the wind was blowing at least 30mph. Since we were both from Texas and decided it was cold we left. We heard about a brewery there so we went and walked through it, seeing how I am not a big beer drinker I didn't try any. At this point we were kind of out of things to do, but then we saw a lighthouse. I decided I needed to go in to the lighthouse and once I figured out I could go all the way to the top there wasn't much that could stop me. The stairs were a little scary but when else was I going to be in a lighthouse in Oregon? I then proceeded down to the gift shop to buy a coffee cup since I have decided I collect them. The volunteer informed me that Oregon had six lighthouses, after a few minutes of small talk she discovered I was from Texas and informed me that Texas also had six lighthouses, who knew? I asked her which was a prettier drive up or down the coast she suggest we head north so we did. The girl at the desk of my hotel told me I should check out the Devil's Punchbowl. When driving up the coastal highway we saw a sign for it and made a quick U turn. She was absolutely right it was amazing. There also happened to be a winery at this point with free wine tasting. The Flying Dutchman Winery is the western most winery in the United States according to Dan the man working there. After trying a few wines I bought two and had them shipped back to Fort Worth.





We continued our drive up the coastal highway and then found a random side road that cut back towards Salem. This ended up being very interesting. The one lane side road winded through the mountains and we lost all cell phone reception. Convinced we would die if anything happened to my shaggin wagon 300 we pressed on. Deer roamed through the forest and moss covered every tree. We finally made it back to salem and took the highway back to Corvallis where we enjoyed dinner at a local sports bar where I had the brisket nachos.

Updates Coming

I am promising an update by the end of the week. I have several blog post ideas currently and will try to get some of them up soon.

In the mean time check out my sisters blog http://eatfoodlearnlanguage.tumblr.com/

Whirlwind

Well, I know I promised over a month ago to keep this thing updated. Obviously I am a failure. I was heckled by my good friend KF to update so here I go. First things first congratulations are due to KF and her husband AF on the birth of their first child SF yesterday, as well as congratulations to my cousin SW and his wife MW on their first child CW yesterday.

I finally arrived in Livingston, New Jersey last Monday. I made the drive in two days driving 15 hours the first day to Roanoke and then finishing up the drive in about 6 hours to Livingston. I traveled through Texas, Arkansas, Tennessee, Virginia, West Virginia, Maryland, Pennsylvania and finally New Jersey. I was able to stop in Harrisburg PA to eat lunch with a friend from college who is living in the area which was a pleasant surprise.

The first week of neurosurgery at St. Barnabas Medical Center has gone really well. I have a great time with the residents each day and get along really well with them. I have learned a whole lot about the field in a relatively short time just because of the amount of patients I am rounding on each day. They do a great job of including us in all aspects of medical management which really helps to pick up on things. I had one hick-up when I was driving to work my check engine light came on. Luckily for my my hotel is across the street from the Lexus dealership so I was able to take it over there and get a loaner car in no time and it turned out to be nothing and I was in and out for $100. I took call this past weekend with one of the residents which was really fun but got me really behind on sleep. On Sunday we were able to get most of the work done pretty early and he let the other student and I leave around noon for the day. I took this opportunity to drive to Newark and then take the PATH over to NYC and walk around.

The PATH dropped me off at WTC or now ground zero and I walked from there up broadway to Union Square. I mainly just peopled watched. I noticed that in order to be a true New Yorker you needed a combination of some kind of hat, a fancy coat, skinny jeans, boots, and at least some time of accessory usually a scarf. If you really didn't fit this description I chalk you up to being a tourist. The biggest reason I went to the city was to go to Apostles Church led by JR Vassar. When sitting in a pew by myself a friend from college snuck up and sat next to me I was so surprised she then went on to tell me that another friend from college would be there because she was in town and then I saw another guy who was in BYX with me. Never in a million years would I think I would run in to one person I knew, yet I saw three.

Hopkins and BostonMed

I finished up my second round of boards this week and have been relaxing all week. I heard about a show called BostonMed, that filmed the lives of attendings, residents, and nurses at Mass General, Brigham and Women's, and Boston Children's. I have always had a love-hate relationship with medical shows on tv. They can be very entertaining but also are frustrating because they freak out about stuff that is very common and don't represent what the hospital is actually like. For instance every time they show an operating room the lights are off. Yes many operations that are done laprascopically do have the lights off but I would say the majority of surgeries I have been in on the lights were on. That being said I have always like the show House M.D. and Scrubs but never really gotten in to shows like Grey's Anatomy.

I watched the entire mini-series of BostonMed in two days. It was really good. Granted I have only been working in the hospital as a medical student for one year and have not gone through residency I think the show depicts life at the hospital very well. The interactions between the staff is spot on, after all the show is real and not scripted. So if you really want to see what life is like and not just get caught up in the DRAMA of Grey's then I highly recommend watching these mini-series'.

As soon as I finished BostonMed I started watching episodes of Hopkins which is really good as well. Hopkins actually came out before BostonMed so you can see how they improved the show. Hopkins basically does the same thing as BostonMed except it follows around attendings, residents and nurses at Johns Hopkins. Watching all these episodes has me extremely pumped about being a resident even though they are extremely tired and worn out. The show also has me pumped about being on the East coast for the next few months. There are beautiful shots of Boston and Baltimore throughout the series. The cities are so beautiful and vibrant, I just can't wait to be in that setting doing what I love.

I start my first official neurosurgery rotation on Monday, I'll let you know how it goes.

Code Blue

I have decided that I want to revive my blog after nine months or so of absence. Reviving might not be the correct term since I am not sure how alive the blog was in the first place. Anyways, I decided to do this because I have been trying to read more at night (I canceled my cable and have little else to do). I have read several of the "must read" medical books this past year such as, House of god. I found reading books like these are quite fun for me and encouraging. I just finished the book Better: A surgeon's notes on performance by Atul Gawande. At the end of the book he shares five tips that he previously gave to a group of medical students and one of them was to write, so here we go.

First, a little up date on what I have been doing. I started my fourth year of medical school about two months ago. My first month was spent doing research, the second month has been an academic medicine month. Academic medicine is the month we get to study for our licensing exams. I took one of them (COMLEX) this past Tuesday and take the second one (USMLE) on Monday. If you actually kept up with my blog you would remember a post about how I had a Meltdown last year.

The next few months should be interesting. I have decided that I want to be a neurosurgeon when I grow up. I have told this to several doctors I work with it is usually followed up with questions such as "Are you crazy?", "Are you married?" Neurosurgery is one of the most demanding specialties in the medical field. There really aren't many neurosurgeons, last I checked there were 3,500 in the US. This shortage along with with fact that many of the surgeries take 6+ creates a lot of strain. If you decide to cover trauma for you respective city you might be taking call several times a week for multiple hospitals when you are in your 40-50's. I have been told by some neurosurgeons I shouldn't do it and they wouldn't do it again. I have not been shaken by this so maybe the answer to the first question is yes, I am crazy.

With deciding to do this I have applied to several residencies and part of getting in to them is doing audition rotations (AKA away rotations or Sub-I's) at the places you apply. Unfortunately for me there are no programs in Texas that I am going to apply to so I will be doing this rotations in other states. Next month I will still be in Fort Worth doing a neurosurgery rotation with a local doctor so he can get me prepared to go "show off" to these other places. I am really excited about starting to do rotations in what I actually want to do. I have spent the first part of the year in thing like OBGYN, Pediatrics, and Psychiatry, all which I had fun because I love medicine but I really like operating and operating on the brain is just so exhilarating. After my last day of my rotation here I will make the trek up to New Jersey for a month, followed by a month in Long Island, then a final month in Philadelphia. Once I finish in Philly it will be Christmas and I will be on my way back home.

Given that I will be in the North East all by my lonesome I hope I can read even more books at night and hopefully blog about the experience.

SHARE Kenya

I know it has been a really long time since my last post but I have no finished up half of my third year of medical school wow time flies. I was lucky enough to participate in a trip to Kisumu Kenya during my family medicine rotation this past month below is an email i sent home while i was there. Here is a link to my photos, and a link to a website of our group's updates.

Hey guys,

I am writing this email as we journey on our hour and fifteen min bus ride from kisumu to masara. We take a two lane highway that is pretty scary; bicyclists ride on the edge of the road without a bike lane and tour buses pass us nearly having a head on collision each time while running cyclist off the road. Children play in the trash and bathe in the streams naked as we pass. Most ecstatically jump up and wave with both hands as they see us shouting mzungu (white person). Their smiles are absolutely gorgeous as you can see they joy within them. Once we get to ahero we take a left off the pavement on to a dirt road. We stop and pick up some of the translators who crawl on top of the bus and hold on for dear life as we travel the bumpy road for about five miles. The road is very much domed so we spend a good deal of the trek driving at what feels like 30 degrees. The scenery is gorgeous women walking from market with baskets on their heads. Other women out in the rice fields working with their children in the far distance you can see the mountain ranges. The best part is when gazing upon the horizon there are no power lines to interrupt the beauty. I usually take this time each morning to listen to my iPod and treat it as a one of worship and can't help but look out and think how great god is and bow He created this for our pleasure so that we may subdue it.

We finally pull up to the clinic each day with several hundred people waiting for our arrival. There are probably 20 children running from their perspective huts to follow the bus. We usually have morning clinic for about 3 hours until we take a lunch break. The women of the village cook. Chapiti for us which is a piece of flat bread that is fried Almost like a pita. To drink we get a cup of hot tea with sugar in the raw. Yes it is 90 degrees outside and we drink hot tea. We will then finish clinic leave some pharmacy students behind to finish up filling some scripts as we make the journey home.

We are averaging about 300 pts a day at clinic, yesterday was our biggest day at 400. The cases consist of malaria with fevers of 105, diarrhea from parasites, asthma, allergies, arthritis, trauma, abscess etc. We have a wound clinic that we rotate through. My first day in wound clinic I injected countless knees for arthritis drained many abscess and even pulled some teeth.

I have yet to have any patients that aren't happy and content. Everyone seems so happy about everything. The children run around and play with anything they can find. One of my favorite toys is a metal ring they spin and run alongside with a stick that pushes it. Might not be the best description but that is essentially what they do. We pass out stickers to them every day and they absolutely love them. I get asked daily for my water bottle and my pens something they get to experience and play with once a year.

Sunday Bonyo's dad had a party for us at the village. We had live entertainment that consisted of a keyboard 5 cow skin drums a shaker and a man singing. Each song lasted about 20 mins it seemed. I made a complete fool of myself but the children loved it. We had the kids in a Congo line at one point. After watching the villagers dance they sat down and said it was the white peoples turn to dance so we stood up and tried to dance some more. I have never been laughed at that much but I believe they enjoyed it. We finished the party with a meal provided by the women. I went into their huts and watched them prepare the meal and will show you pics later. The huts made of mud with a tin roof had two rooms one for sleeping and the other for cooking. The cooking room had a wood fire in the corner with a pot of water on it. The women sat around a table and prepared the meal. Chickens roamed throughout the hut along with cats and dogs. So who knows what the meat was. It is custom that guest eat first and then they eat the leftovers. Makes you think twice before getting seconds or a lot off food and never will you not finish a meal.

I have many more stories that I hope to get into an email but I am now tired of typing on my phone. I hope you all are doing well and can't wait to get back and share stories and pics.

-Parker