“Once air hits the brain, it ain’t ever the same”

Last week, Dr. Hanel consulted a patient on how to treat the patient’s aneurysms. He could opt for no surgery and monitor his aneurysms (not unreasonable given their size and location), have open surgery to clip the aneurysms, or have a neurointerventional radiology procedure aka coiling (minimally invasive, through the groin procedure). The patient said he definitely didn’t want to do the clipping procedure and Dr. Hanel replied, ‘Yes, I told you that option for full disclosure. You know as they say, once the air hits the brain, it ain’t ever the same.”

In the OR, I had my first experience witnessing a procedure go wrong. The patient already had a stent in her middle cerebral artery. However, over time, the artery continued to narrow within the stent causing her to re-experience symptoms. Images revealed 70% stenosis. Dr. Hanel decided to place a second stent partially overlapping the first stent. At the end of the procedure, the routine CT scan showed bleeding…there was an intraoperative perforation of the vessel. If the bleeding stopped, the patient would be OK, but if she continued to bleed, we would lose her. After the procedure, he spoke with the patient’s family and explained the situation. Some of the patient’s family members began to cry. I felt like crying too. Each time I’ve heard the risks of surgery, I tend to think, “those risks are so low. That wouldn’t happen to the patient.” But it’s surgery. And there are risks. And it really sucks when you might (or do) lose a patient. And how do physicians psychologically prepare themselves to face the family and face the reality of death while a patient was in their care?

Changing gears, I read An Astronaut’s Guide to Life on Earth by Chris Hadfield last week. I really liked his explanation of being a zero:

“Over the years, I’ve realized that in any new situation, whether it involves an elevator or a rocket ship, you will almost certainly be viewed in one of three ways. As a minus one: actively harmful, someone who creates problems. Or as a zero: your impact is neutral and doesn’t tip the balance one way or the other. Or you’ll be seen as a plus one: someone who actively adds value. Everyone wants to be a plus one, of course. But proclaiming your plus-oneness at the outset almost guarantees you’ll be perceived as a minus one, regardless of the skills you bring to the table or how you actually perform…The best way to contribute to a brand-new environment[is] by trying to have a neutral impact, to observe and learn from those who are already there, and to pitch in with the grunt work wherever possible.” (181-182, 186)

Having the goal of being a zero seems like a great way to approach any new situation.

Finally, in personal news: Alba and Francesco are visiting me from Switzerland in two weeks, I’m going diving in three weeks at Key Largo (also interviewing at FIU in Miami), and visiting Ang in four weeks in Atlanta (also interviewing at Emory while I’m up there)! So lots of exciting things in the near future!


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