Neurological black comedy

Author: Frank Furedi (USA) / Country: Mainland China
Publisher:
Publish Date: 2006-05-01
Features: On July 1st, the first day of my neurosurgical resident career. At 5 a.m., staring at the automatic door leading to the neurosurgical observation room—which we call the "atrium"—a wave of nausea, as if déjà vu, suddenly surged over me, completely engulfing me. I wanted to run, hide under the bed until the feeling passed. Right in front of me lay six years of exhausting training. That morning, "six years" weighed heavily on my mind, persistent and oppressive, as if I were being crushed by tons of seawater. I could no longer see the sunlight; normal life, normal work, everything normal, all seemed so far away from me. Before I could press the switch on the wall, the door to the atrium suddenly "whooshed" open. Before me sat two figures long since filed away in my memory: Gary, who smoked constantly, the new neurosurgical resident from back then, now promoted to chief resident; and Eric, who had also transformed from the neurotic intern he once was into the senior resident he is today. Many years ago, when I was just a humble medical student, I had worked with both of them. Over the next six months, we would work under the same supervisor, face patients with pain disorders, trauma patients, and other sudden emergencies. And our boss would be the neurosurgical director—Dr. Abrahamowitz.
"Hey, Eric, look who’s here—the real Mr. Horner with Horner’s syndrome," Gary said, referring to a diagnosis I had made once, the event that led me into this profession. It was a long time ago.
"Hi, Gary, you look like…," I hadn’t finished my sentence.
…"mud piled up. It’s impossible to change. Too much chocolate milk, too much nicotine. But, why haven’t you switched careers yet? Listen, nothing’s scheduled for today because the boss is in court as a witness. Let’s go to the conference room and sit for a bit. I’m going to tell you the rules of neurosurgery—take it in while you’re still fresh, and then I’ll take you to the Pain Museum."
"The rules of neurosurgery? The Pain Museum?"
"Yes, these are rules you won’t find in any of the six volumes of Youmans’ textbooks. We’ll visit the Pain Museum later—you’ll believe it when you see it." Youmans’ textbooks are the Bible of neurosurgery, the source of wisdom for residents.
Back in the small conference room, Gary walked to the blackboard and started writing.
"Rule 1: When your head has a copper-bottomed shell, there’s a reason for it, and we shouldn’t mess with it. Your brain is like a 1966 Cadillac—you have to take the engine out to replace the spark plugs. The designers only cared about performance, never about how easy or convenient it would be to repair."
"Patients usually seem to recover quite well," I protested slightly.
"Yes, generally speaking. But occasionally, strange things happen: patients’ personalities change, or they die suddenly without warning. All this reminds us that we’re walking on mysterious ground and must tread carefully. This brings us to Rule 2: Only surgeries performed by others are considered minor. If you’re the one operating, it’s a major surgery. Never forget that."
He took a sip of coffee and continued:
"Rule 3 is also applicable to patients undergoing brain or disc surgery: as long as the patient is alive, there’s always a way to make things worse. I’ve encountered patients who had two discs removed from their backs and still demanded another operation, only to realize later that they’d made a terrible mistake."
After another sip of coffee, he went on:
"Rule 4: When you suspect a patient is about to run into serious trouble but can’t figure out why, pay close attention to the patient. This is far more useful than a nurse calling you a thousand times to report on their condition. A small rule derived from this is: even if you make a major mistake that causes a problem, the error you make at the operating table is far less severe and easier to be forgiven than the mistakes you make lying in the break room or watching TV. Remember: Look at your patient for real."
"Rule 5: If you misidentify a patient, perform an unnecessary surgery, or operate on the wrong side of their body, you’re in for a world of trouble—always ask the patient which side hurts, which leg is affected, or which hand is numb. Always examine the X-rays yourself, check the names on the films and other charts to ensure they match the patient. And double-check the names on the consent form and the name band on the patient’s wrist. If you don’t, expect the worst—because you’ll be putting yourself in a 'res ipsa loquitur' lawsuit."
"'Res ipsa loquitur'?" I asked. "Medical school never taught me this term?"
"They never will. It’s a legal term, originally Latin for 'the thing speaks for itself.' In our case, it refers to cases of 'negligent treatment,' where the negligence is so obvious that even a non-medical professional can see it was your fault. For example, a patient falling off the operating table; cutting the wrong leg when the patient’s right leg was the problem; treating someone with a broken neck in the emergency room and sending them home with just aspirin; shocking a patient with an electric defibrillator and setting them on fire; or removing a disc from the wrong patient. In such cases, you’d better pull out your checkbook and get ready to write a lot of zeros!"
"Eric, did I miss anything?" Eric thought for a moment.
"Well," he turned to look at me, "just remember the rules all surgical residents must follow: Whenever you have a chance to sit, don’t stand; whenever you have a chance to lie down, don’t sit; whenever there’s an elevator, don’t walk; as long as you can sleep, don’t open your eyes. And eat whenever you get the chance, or go to the bathroom."
After a moment of reflection, he added:
"Always listen to your boss. Remember, the boss represents everything here. Neurosurgery is a sacred and untouchable profession—don’t challenge the boss. When necessary, be humble and beg for favors, and you’ll be fine."
"This is still the resident stage," Gary’s voice echoed again. "You’re no longer just an excellent medical student or the intern you used to be, when people would forgive any mistake you made. Now it’s real—this is your career for life. You no longer have to rotate through pediatric endocrinology or tropical pathology, but as long as you have a breath left, you’ll have to see this through. Are you ready? I ask, are you ready?"
"Ready!" Let the game begin. P2-5