When the Air Hits Your Brain: Tales from Neurosurgery Read Online Free Page B

the skull. Quickly, the chalklike bone dust around the hole turned beet red. Gary reflexively pulled his finger away from the trigger and the drill stopped. The drill that was supposed to stop before it touched the brain had gone deeper than the residents had planned. A lot deeper.
    “Oh SHIT!” cried Carl. “The fucking drill never stopped.Here we are talking about the clutch mechanism, and the thing doesn’t shut off!” He grabbed the drill away from Gary and yanked it out of the patient’s head. A torrent of blood and some stuff that looked like runny strawberry milkshake poured from the small hole in the bone.
    “What’ll we do?!” moaned Gary.
    “WE don’t do anything. YOU just stand there. Give me a Raney punch!” The scrub nurse handed Carl a large biting thing that looked like toe clippers from hell. He frantically tore at the skull bone, widening the small hole.
    “I need to assess the damage, like real fast. Hopefully, we just trashed the cerebellar hemisphere…If we went down to the stem, we’re all screwed.” Carl’s previous scholarly demeanor deteriorated to a nervous pratter. “I mean, God, I never saw a drill plunge so deep back here…Couldn’t you tell you were going through the inner table of the skull?…Lordy, lordy, just so the stem is OK, tell me the stem is OK…”
    The door swung open. The boss again. “Is everything OK?…I SAID IS EVERYTHING OK?”
    “Yeah…ah…fine, sir,” Carl stuttered, “we just put a nick in the cerebellum, I think…We’re fine—.”
    “FIVE MINUTES. A quick cup of coffee and I’ll be in. In FIVE MINUTES.”
    Carl’s gloved fingers twisted and turned instruments in the wound until at last he pronounced the drill’s damage acceptable.
    “It’s just the lateral hemisphere. This guy’s arm will be a little unsteady for a while, but he’ll be OK. Give me a big cottonoid. The boss will never see it.” He took a large white cloth square and covered the injury to the brain like a small boy covering a large scratch in the new coffee table with a newspaper.
    I couldn’t bear to watch any longer. I left, fearing the verbal explosion that might occur if the boss lifted up Carl’s “newspaper.” Given that “shit rolls downhill,” I also realized that the lowest part of the terrain was me. Seeing Gary in the lounge after the case was done, I asked him how things had gone. He sat on a bench, still sweating and tremulous.
    “Fine, I guess. The patient’s fine, but, boy, I nearly killed that guy. I must have been leaning too hard on the drill or something, I don’t know.” He shrugged his shoulders and stuck out his left index finger. “You see this?”
    “Yeah.”
    “That’s about how big your coronary arteries need to be if you want to do brain surgery for a living.”
    Although I brought Gary coffee each morning, I was really Eric’s slave for the remainder of my neurosurgery clerkship. Eric had more work to do, work that even a third-year student could do. The frazzled intern quickly taught me to remove skin sutures and change dressings. He dispatched me to ask patients questions he had neglected: What were their allergies, did they bring their X rays, had they had their morning bowel movements? I became the “scut doggie,” rounding up laboratory reports, photocopying journal articles, fetching lab coats left behind in patients’ rooms.
    My real contribution was my slew of “H & P’s,” short for histories and physicals. The history consists of the patient’s story told in his or her own words, and includes the chief complaint (“My face hurts when I eat”); the present history (“My face pain started three years ago, and has gotten worse since December…”); past history (“I am diabetic and have had my gallbladder removed”); current medications; allergies; occupation; smoking and drinking behavior; and so on. The physical is thephysical examination. Even in an age of increasing technology, a patient’s illness can be