Read Online Another Day in the Frontal Lobe by Katrina Firlik - Free Book Online

of hair along the exact path of the proposed incision (a curved “reverse question mark” incision that we often use on the side of the head, just above the ear). I scrubbed her scalp and hair with an antibiotic solution and stapled the sterile drapes along the shaved edges to keep the hair out of the operative field.
    The case went smoothly. In the ICU, after the patient was fully awake, she wanted the full report. She asked about her hair. I surprised her with the news and she was ecstatic. In fact, I have never seen a patient happier after waking up from brain surgery. She couldn’t wait for her well-built boyfriend to see her. (Her delight made me wonder—but only for a moment, before I considered the ethical implications—if we should play a similar trick on other patients, setting up the expectation of a bald patch, but then surprising them with a full head of hair.) Not only that, but her seizures remained under control, too, which was something we all cared about, hair or no hair.
    Neurosurgery requires a delicate balance between fearlessness and caution. As residents, we have to be willing to push ourselves to take the next step, even if our confidence level is not one hundred percent. Otherwise, we won’t go very far. On the other hand, I fear the resident who forges ahead with brazen overconfidence. Some are tempted to do this in an effort to impress the “attending” (attending surgeon) when he walks into the OR, hoping to provoke a comment like “Wow. You’re under the ’scope (microscope) already. I’d better get in there before you finish the case!”
    This leads me to an awkward admission: in the training of a neurosurgeon, the level of supervision can be variable. Keeping a patient safe depends on the judgment of both the attending and the resident: the attending on knowing how much to trust the resident’s skills and the resident on knowing the limits of those skills. Believe it or not, this very human system is much safer than it sounds. Neurosurgeons are generally intelligent individuals who exercise good judgment (in the OR, at least). As a result, the norm is good patient care and the turning out of a steady stream of well-trained neurosurgeons.
    When I was a junior resident, after I had performed a history and physical on a patient scheduled to undergo surgery, the woman turned to me with the sweetest voice she could muster and said: “Oh, and by the way, dear, I don’t want any residents involved in my operation.” Although this may seem like a simple request, akin to asking for a private room, such requests were very rarely heeded at our institution. Our chairman, who was to perform the operation, explained to her that the numbers we quote regarding risk and outcomes are based on our tried-and-true routine perfected over the years at our teaching institution. This routine involved a team, and the team included residents. He did not like to deviate from routine. In general, it is wise to avoid deviating from the routine in surgery. Every surgeon can tell you about a mishap that occurred when a VIP was treated differently from everyone else.
    If avoiding residents is critical to you, a private, nonteaching hospital is always an option. At these hospitals, surgeons usually operate with a variety of non-M.D. surgical assistants rather than residents. In addition, the surgeons in those hospitals are more likely to have surgery as their sole focus. Many academic neurosurgeons have multiple roles: surgeon, teacher, researcher, committee member. They often don’t have time to spend the entirety of each case in the OR, from start to finish. The residents will do a portion of the work while they parallel-process on other tasks. Some neurosurgeons are very hands-on and will stay in the room for nearly the entire case. Others will flit from room to room or between room and office, attending to the case when needed.
    At the extreme of laissez-faire supervision is the government-run VA system (the