Neurosurgery – First Day
II.II.I
FIRST DAY
As much as I dreaded leaving Gozo and going back to Malta’s chaos and commotion, I was still quite psyched about my upcoming rotation. Next up was neurosurgery – my all-time favourite specialty and the gateway to my lifelong career aspirations.
Together with Jacqueline, another house officer in her first year, and Christa, our senior doubling as Wonder Woman, I’d be in charge of looking after around twenty-five patients. These, we were told, were under the care of three consultants, Mr Sullen, Mr President, and Dr Queen. Each of them had their own surgical lists and outpatient clinics, meaning we’d have our fair share of work. Having just left Gozo’s slow and idyllic life, this was certainly gonna be a change of pace – one I was quite anxious about.
On our first day, we had to re-evaluate and rethink everything we had gotten used to by then. I, for one, had to give up my handwritten census of five patients (at most) for a two-page printed one – trying to cram all the patient information and bloodwork into the little space that remained.
Given that we had three consultants working on different rosters, our ward rounds would be complex to say the least. We’d start off by going around the neuro ward together with Christa. Then, when each consultant would show up, we’d round on their respective patients a second time – making sure their management plan agrees with ours. As time-consuming and redundant as this was, it did at least ensure optimal patient care.
With neurosurgical patients being riddled with all kinds of ailments, not to mention being more vulnerable than most, the ward round was more akin to a marathon. Our list of tasks grew exponentially with every patient we saw. Luckily, after rotating through various specialties for over a year, I knew my way around the hospital and could teach Jacqueline a few tips and tricks that would make both our lives easier – like who to page and who not to page, how to get certain investigations expedited, and so on. Plus, my medical knowledge could now spare us a consult or two when facing things I’d already dealt with before. I wanted to be that which Emily was to me for Jacqueline – reliable and dependable.
As busy as the ward work would keep us, we had more stuff going on. Here, we wouldn’t have a pre-op day – instead, patients would just show up to the ward and have their assessments done when possible. Whilst I tried to get as many things sorted as quickly as possible, Jacqueline agreed to handle those on her own. Of course, by that point, we were getting flooded with requests from the nurses and from each consultant alike. I swear I had never been that busy in my entire life. In fact, up until then, I’d always said that my job teaching English to foreign students was far more hectic.
The worst part, it seemed, was just how disorganised the department was. From day one, I set myself the goal of coming up with a spreadsheet-based system to keep track of everything we had to deal with on a daily basis: inpatients, outpatients, pre-ops, and surgical lists. Given the sheer size of our workload, it would’ve been easy for things to slip through the cracks, and I wasn’t gonna let that happen. First, I didn’t wanna deliver substandard care. Second, this was the department I wanted to work in. I couldn’t afford to make a bad impression.
Just as I was about to put my tongue back in my mouth and head home, Christa called to ask whether I wanted to scrub in on an urgent surgery, having just heard me say I wanted to assist at every possible chance.
We’d be operating on Ms Holy, a sixty-year-old nun admitted under our care following a change in behaviour. She’d become obtunded overnight, and a CT scan showed ventriculomegaly – enlargement of her cerebral ventricles. To relieve the pressure, we’d have to insert an external ventricular drain (EVD). And so, we rushed her down to theatre and scrubbed in. Suddenly, I was standing in front of an open skull. Well, not quite open, save for a small burr hole through which the drain was inserted – but even so, it was one of the coolest things I’d ever seen.
I had seen an open skull before. Back in my third year as a med student, I had been to Pécs in Hungary for a neurosurgery elective. While I had squandered most of my time there hanging out, drinking, smoking and having random one-night stands, I still got to observe a few surgeries. But this? This was in own homeland. This is where I’d get to learn and eventually go on to perform these procedures myself. Right there and then, as I stood in front of that skull, I knew this was it for me.
Throughout the procedure, Christa made a point of explaining everything she was doing, firing questions at me and challenging my knowledge at every step. Despite never having worked in this specialty before, I could keep up. Guess passion does count for something. It was truly surreal realising that after so long, there was someone who genuinely cared about my education. I had goosebumps – my eyes tearing up the entire time.
It took just one day for me to realise that I had my work cut out for me in the neurosurgical department. But I wouldn’t have had it any other way. I was up for the challenge.