James Week 6

7/18/2011 –

I joined the neurovascular rounds this morning. There was an interesting case of aphasia which was very hard to determine. At first when talking to the patient he seemed normal, nothing was bothering him and he thought everything he said was normal. He made a few subtle mistakes like where we were, it was hard for him to find the word hospital, but I did not notice anything major. Then we gave him a flashcard with a lot of pictured and had him name them. The first was a glove which he got correct but for the other five pictures he kept saying they were gloves, and it was just repeating glove, he would look for a while and then say “It looks like a glove”, or of the like. It was very interesting; the only other aphasia I have seen was global aphasia which you could tell had a profound effect on the language. After rounds I went with Dr. Leifer to the stroke conference with all the heads of neurology/neurosurgery/radiology/cardiology. The cases were not very interesting to me, most were post surgery patients that the surgeons needed the neurologists help on. I am still awaiting access to the patient charts for my project.

7/19/2011-

I went with the consult team today. There were a lot of new patients, so it took a while to go through everyone. Two patients were labor patients, one having a very depressing and abusive history. Most of the cases were spine related and we were just checking to make sure that the overall neural network was still intact. This was my first time seeing the pin prick technique for numbness. Normally we just ask and see if touching them feels different, but there is a new attending this week and he used a safety pin to tap on the patient’s skin and then asked. I have yet to receive permission to access patient charts for my project.

7/20/2011-

Today I observed cardiovascular surgery, in particular a bypass surgery. The patient walked into the room emotionally unstable, and had to be asked questions about the surgery making sure she knows what is going to happen. Once the patient was under general anesthesia an ultrasound device was placed down her trachea. Her carotid artery was also opened for and life sign indicators were placed through it. After more tubes were placed in her and a urine catheter she was patted down with iodine and ready for surgery. The surgery entailed sawing open the sternum and then dissecting out the mammary artery. Then the pericardium for the heart was breached and the heart lung machine was connected. After the machine was up and running the heart was arrested and the mammary artery was attached. Then the heart was resuscitated and the chest was closed back up. Titanium wire was used to close the ribcage and three sets of sutures were used to close the fat up to the derma.

7/21/2011 –

Nothing of great interest happened today. Mostly I was taking tests for access to Epic. I also discussed a new project idea with Dr. Frayer.