Week 3 - Babies and Brainsurgery

Week 3

Dr. Frayer arranged for me to go on rounds in NICU (Neonatal and Intensive Care unit) with his colleague, Dr. Schulman, and Team 1. The team of nurses, residents, and a fellow all stop at each baby in the NICU with the doctor for a run down, assessment, and discussion of how much the baby ate, what came out of the baby, the baby’s heart rate, and a number of other things that are being monitored. They even check the baby’s tummy for firmness. Some of the babies are wrapped in blankets in normal cribs , but the itty-bitty babies are kept in plastic incubators that have holes in the sides for hands reach in. They look a lot like glove boxes except for the cheerful blankets draped over them (and the baby inside of course). I have never seen babies so tiny (one was 15 weeks premature), and they almost sound like kittens when they cry. Tubes and wires that might seem small on an adult look huge on a baby (especially if the baby’s head appears to be the size of a navel orange). One of the babies heard everybody come up to his incubator, woke up and started to fuss. One of the nurses quickly sterilized her hands and then reached into the incubator to hold the baby – and he calmed down and went to sleep. One baby had apparently suffered a collapsed lung but it was able to reinflate. When the doctor came by his incubator he was really red faced, squalling mad -- the baby not the doctor -- but the doctor said the fact that the baby was able to express his anger so loudly was a very good sign.

One of the big jobs in the NICU seems to be getting the babies to handle eating - getting them used to a nipple, starting them on formula, and moving them up to breast milk. I saw several mothers who had come in to hold and feed their babies, even though they couldn’t yet take them home. The doctors will talk to the parents and the family’s normal pediatrician to make sure that once the baby is ready to go home, the parents are equipped to take care of the baby. Sometimes more than one baby -- as many of the babies in the NICU are part of a set of twins or triplets.

After I left the NICU I ran into David who invited me to see a neurosurgery. This was the first time I got to be in the operating room (OR). David got me scrubs from a scrubs vending machine (I’m sure there’s a more technical name for this) where he put in an account number and then the size of the scrubs needed. After changing into the scrubs, we put on hairnets and booties. In the operating room we stood off to the side where we could watch, but would not touch any blue things. The person undergoing the surgery that day was already asleep with her head clamped into some sort of vise when we got there. She had apparently had at least one craniotomy before. The doctors shaved off all of the hair on the area where they were planning to cut and swabbed her scalp with disinfectant several time. David said that this was the largest tumor resection he’s seen yet. I only started blacking out during the surgery once, and that was when the surgeon started cutting underneath the scalp to peal it back and started clipping blue clamps on the edges (after cauterizing) and all the blood is caught in a bag. The blue clips looked remarkably similar to office paper clips. I had to go outside and get a drink of water but after that I was okay to go back in. The surgery was needed to remove a very large menengioma. After the surgeon cut through the scalp and then the bone (there was lots of irrigation during all of this), the surgeon pealed back the dura to reach the brain. While I was present two fairly large pieces of the tumor were cut out (squishy and white- distinctly different from the rest of the brain) and part of the sample was sent off to be evaluated by pathology). It was very interesting to get to see the OR. There were lots of people present. Two neurosurgeons, one commanding nurse, an anesthesiologist, another nurse, and 3 students (David, me, and a nursing student) were there. The only part of the patient during the surgery that you see is the part of the head that is being worked on, because she was essentially entirely covered by sterile sheets with everything taped down. Neurosurgery is quite distinct from the cardiology imaging I’ve seen thus far, mostly by the nature of the work. In imaging the doctor is trying to figure out what is wrong so that the best approach to fixing the problem can be determined (planning and assessing), but surgery is the action part of the story (cut out and destroy the enemy).