Sunday, August 30, 2009

Happy Birthday Alexis Belle

Today Miss Lexie is turning one! I'd say she is quite the miracle baby - born 1 lb 6 1/2 oz and 12 inches at less than 26 weeks gestation. She is now thriving beautifully :)

Shortly after her birth:

On our visit in July:

Saturday, August 29, 2009

Happy Birthday Lacey!

Well today is not really her birthday - it was 2 days ago, but being a neglectful dog mom, I forgot. Here's the first picture of her we have:

When we picked her up from Oklahoma City she weighed barely 5 pounds and was shaking like a leaf. I remember the first night I had friends over for dinner, so I put her in her kennel in my bathroom to prevent her from going potty all over the apartment. She whined and wimpered the entire time.

Here are a couple pictures from her first day with her new family:

Over the time we've had her, she's been a source of lots of fun and joy and occasionally frustration. She is the smartest, most annoying and neurotic dog I've ever known. She loves playing with people and other dogs (still not realizing she's not one of the "big" dogs). I still say she is the best Christmas gift I've ever received.

And because she's so cute (not that I'm biased or anything) - here's some more pictures:

  • With Corey's cousin's daughter (Christmas 2007):
  • Her favorite place/position - asleep on the couch:

  • Spending time with her buddy Jake in Hilton Head:
  • Snow! In VA - March 2009
And, I took this just a few nights ago. I went into the bedroom looking for her to take her outside before bed and I find her like this:
She was just hanging out in her kennel - mind you we have not put her in her kennel in several months - usually we just close her in the bedroom. It was too cute not to take a picture.

On a different note: I finished my neurosurgery rotation alive and with my sanity! And, strangely enough, I really started enjoying it toward the end. Enough that I might even consider it as an area to eventually work in. Crazy, I know, but its pretty interesting and a great mix of OR, floor and ICU time. We shall see how things turn out... Monday I start my Behavioral Medicine (aka psych) rotation at Children's National Medical Center. I'll most likely be working on the inpatient adolescent unit so it should be interesting!

Friday, August 21, 2009

This is what greeted me when I got home today - an amazing storm rolling in...I'd say this makes for a great night! Today was one of the best days of my rotation so far. Not that I did anything that exciting, but some great stuff happened. First, I got to scrub in on a great case - it was a cranioplasty with a custom made synthetic bone flap. This company used the patient's CT scan to reconstruct a 3D model of their skull, then made a synthetic bone fragment to fit perfectly over the defect. It was so cool! And the new fragment was see-through so after screwing it on you could still see the brain underneath - kinda like a window! Then this afternoon the chief resident complimented me, tried to convince me to be a neurosurgery PA, and told me to call him when I got closer to graduating to talk about job opportunities...all this in front of 2 med students and another resident. And to top it off we got to leave at 4:30. All in all an excellent day!

I only have 3 shifts left, and am having quite mixed emotions. I'm excited to have more normal hours and to not wake up at 3am everyday. But I also feel like I'm just now getting to know the whole team and getting the hang of things. I'm really starting to have fun and am learning alot! I have a feeling this will be the storyline of the year - get used to and start really enjoying what I'm doing only to finish a week later. I guess I'll get used to it :)

Thursday, August 20, 2009

Well, I didn't get to scrub in on the temporal lobectomy the other day because 2 other students already wanted to. Instead, I scrubbed in with a different MD doing a total corpectomy with cage insertion, which is where they remove an entire vertebral body and replace it with a titanium insert. This was done because the patient had pretty shattered one of their vertebrae. I was the only person assisting so I got to help a decent amount. He even let me put in one of the screws :)

This week has been pretty crazy because we are short a resident and they've had meetings/lectures this week. Also, yesterday it seemed like things just exploded around us. We were in the OR all day with the exception of a 30 minute lunch break. One of my residents was in the OR yesterday from 9pm til 5 this morning. Then she stayed to round with us and get stuff done on the floor. And I thought my hours sucked!

Monday, August 17, 2009

11 days down, 7 to go...

Not that I'm counting or anything :) Today wasn't too bad, but wasn't great either. The best part of the day was leaving just after 4pm - which is completely unheard of around here! My weekend was wonderful - in case you were curious. Saturday treated me with over 14 hours of sleep between going to bed at 8pm on Friday and getting a 4 hour nap Saturday afternoon. It felt great to catch up on some lost sleep. But, of course, I'm already feeling sleep deprived and it's only Monday night. There's a visiting lecturer from Italy here this week giving lectures about stuff I don't understand with a thick makes it really hard to stay awake. But at the same time I know I'm in the presence of a ridiculously smart man, so I'm trying my best to be respectful and attentive. Maybe tomorrow I'll understand a little more of his lecture topic.

Tomorrow should be interesting - I get to be a part of a temporal lobectomy with the head honcho of the neurosurgery dept. There won't be any residents around (at least for the first several hours) so maybe us lowly students will get our hands in the action...we shall see.

Now it's off to bed...

Friday, August 14, 2009


Oh goodness - it was a long week, but a good week. Despite a couple rough moments, the last couple days have been pretty good. I got to see an encephalocele repair yesterday. It wasn't that cool to watch because it was all endoscopic (through the nose with a little camera) but it is an interesting condition. Basically it is when a piece of brain herniates through a broken or dessicated bone in the skull. The herniated part becomes necrotic (dies) and sometimes the layers surrounding the brain can have a tear and leak cerebrospinal fluid into the nose or mouth. This patient had a tear in one of her sinuses, so she was have symptoms of chronic sinusitis for months until an ENT thought to check the type of fluid coming from her nose.

Today I watched a cranioplasty, which is when they place a bone flap or mesh matrix to cover the brain where a piece of the skull has been removed. When patients have brain bleeds pressure builds up quickly within the skull compressing the brain which can lead to permanent neurological damage and even death. To treat it the neurosurgeons will often remove a flap of bone in a procedure called a craniectomy. If the bleeding is not localized to one area where it can be easily removed, the flap is left off and the scalp is closed. They do this to allow the pressure to remain low. Eventually (months to years later) they will replace the bone flap, which has been stored in a sterile freezer for the patient. So this patient had a craniectomy decades ago and had a defect in her skull where the bone flap was never replaced. Since she had no protection over a portion of her brain, she was at a high risk for traumatic brain injury from even the slightest head injury. The surgeon cut down to the brain, exposing the edges of the bone that was still present, placed the mesh and screwed it into the skull, then closed her head up. One of the coolest things about this case was that you could see her scalp pulsating where the bone was missing.

This week was better than last because I actually feel like I know a little more about what's going on and what is expected of me. Also I've been getting to know the residents a little more and they seem to be warming up to us. Two of the med students I've been working with are moving on to a 2 week neurology rotation and me and a 3rd year are continuing. I've been pretty lucky to work with some great med students. The four of us got along really well which made the long days more bearable. We should be getting a new med student Monday which will be cool.

And to top everything off, I got off before 5 today and made it home at a reasonable hour :) Now I'm going to spend some time with my favorite person in the world this weekend and try to get some things done around the house. Perhaps I'll finally make this banana bread I've been planning to make for a couple weeks...

Tuesday, August 11, 2009

Rough day

Today seemed to be all about God reminding of the not so pretty side of medicine. Our team had to tell a man that his wife of over 50 years was essentially brain dead and surgery would be futile. He never questioned a single thing the resident said, and at the end of the discussion told us that he trusted our opinion. A few hours later his wife was taken off the vent and she passed away.

Then we diagnosed an extremely fit man in his low fifties with a serious brain tumor that usually carries a prognosis of 1 year or less. But he doesn't know his prognosis yet because the official pathology report isn't back, so no one wants to give him the news. It's amazing that this man was feeling just fine a week ago until he started having a few relatively minor symptoms which have since resolved. Now he will be receiving the news that he has one year to live.

Then a man who we'd just released one week after surgery came back to the ER for worsening symptoms and his poor family was just exasperated and exhausted.

I guess all this is just a reminder that medicine can cure a lot of ailments, but we can't fix it all. It's easy to celebrate the victories, but it's not so easy to accept the losses. Perhaps it's all part of the education process. As much as I hope to be able to take the negative aspects in stride, I pray that I never become immune to the feelings involved. If it ever becomes easy for me to tell a man his wife is dead or another man that he has less than one year to live, then it's time for me to leave medicine. I won't practice medicine if I can't do it with care and compassion.

Sunday, August 9, 2009

Neurosurgery for Dummies

Right now I'm on my elective rotation and for some unknown reason I "elected" to do neurosugery. Last week was my first of 4 weeks there. My days consist of waking up at 3am to leave the house by 3:45. I see my patients before rounding with the residents at 5:30. Then the team of 10 rounds with the attending before heading off to see pre-op patients. The rest of the morning is usually spent in the OR watching various kinds of surgeries. So far I've seen an aneurysm repair, 2 brain tumor resections, 2 herniated disc excisions, a cervical spine fusion, and the insertion of an intrathecal (inside the sac surrounding the spinal cord) pump for medications. The afternoons are either spent in the OR or on the floor tending to patients and preparing them for discharge if possible. We then round one more time, finish up what's left to be ordered/done for patients and then go home around 6pm. Needless to say, the days are long and extremely tiring. My feet, knees, and back usually ache and my mind is numb. I get a couple hours to have dinner and spend time with Corey and Lacey before its off to bed (hopefully by 9 or 9:30).

Things I've learned so far: it's FREEZING in the OR (especially on the microscopic surgeries where the overhead lights are off), I can function before the sun comes up with enough caffiene, my 10 hour shifts as a scribe were a piece of cake, brain surgery is kinda violent, I'll never get used to the smell of burning flesh, the brain bleeds a lot when being cut into, and I know nothing about neuroanatomy. I've also learned how to remove central lines, staples, and JP drains (so now I can properly do the scut work for the residents).

It's exhausting and frustrating at times, but I'm already 1/4th of the way through and I'm determined to make the most of it. Now I must go finish reading the 70 page manual they gave us chock-full on everything a student needs to know about neurosurgery...


While at the hospital earlier this week, I thought it would be fun to blog about my experiences on rotations. Since we are so busy and will continue to be busy, I thought it would be a great way to allow our friends and family to keep up with our life (if they care to do so). So, here it is - I hope you enjoy!