It isn't rocket science-- it's brain surgery

Clinical was interesting and challenging this week.  I really enjoyed it.  I was even able to take a trip to the operating room with my patient to observe her neurosurgery.  In an effort to maintain patient privacy, I'm leaving out all of the interesting details but here is the gist:

My patient came to the ED where they found an right cerebellar intraparencymal hemorrhage on her head CT.  When I assessed her at 0600, there was a change in her neuro exam.  She was more lethargic and unable to follow commands upon exam.  Mannitol IV was given and then she was taken for a follow up head CT.  The head CT showed worsening edema and obstructive hydrocephalus.  She was then planned for a R cerebellar craniectomy w/evacuation of her hemorrhage.  I asked if I could accompany her to the OR to observe the surgery and my preceptor made it happen.

Ok guys-- brain surgery is crazy. The patient was placed in the prone position (on her belly) and the neurosurgeon got to work.  He reviewed her two previous CT exams prior to starting the procedure.  After the skull was removed and the dura cut away, the cerebellum was easily visible.  It was huge and bulging.  He then opened a hole into cerebellum and then next thing I see is a huge gush of dark, dark red blood.  It was the hemorrhage- it was cool to see it just gush out of the cerebellum.  He cleaned it out nicely and by the end of the procedure, the cerebellum was normal in size.  Instead of replacing the skull, he placed a plate over the cerebellum to protect the brain and then closed her up.  She was taken back to the ICU.

I was thrilled to be able to observe the procedure and hope that when I go back to clinical next week that she will be back to baseline.  Neurosurgery is pretty cool, although I hope that I never have to be the one on the table getting my brain operated on.