James Week 2

6/20/2011 –

This morning I went into the normal room I usually do for rounds but was surprised to see all new faces. It turns out that every two weeks the team gets switched out and a new attending is in charge. I am now shadowing Dr. Jamieson and her team of neurologists, the only familiar face was the one resident Dr. Glass. I asked Dr. Glass about the whole switch and he said it is normal for the attending to be switched out, but usually the neurology team stays. Also, we have two brand new residents that shadowed with me today. Since there was a new attending the morning rounds were long getting her caught up on all the patients. We went through over 15 patients; normally we only go over 6 or 7. I learned that plavix is better to give than coumadin since it does not need to be routinely checked, and is just a lot easier. During morning report there were two cases that interested me. The first was a patient that they diagnosed with thalamic bleeding; on the images there was a massive hemorrhage, unknown origin but hypothesized to be at the thalamus. The next was a 5 year old suffering an intravenous hemorrhage, again it was fairly large. I then preceded to noon meeting which was on clinical trials for targeted therapies for MS. I finished my day in clinical with Dr. Leifer which went through many cases of unknown causes for symptoms (although I did not believe the symptoms were anything other than just getting older).

6/21/2011 –

The neurology team for rounds switched up again although it was still lead by Dr. Jamieson. The day went normal with rounds and morning report. The only case that was interesting was a patient that had self mutilation tendencies and was almost completely unresponsive during. During patient rounds we were told to stay clear of the patient, although a resident and the attending were trying to perform tests, it was kind of scary. The patient hit the resident and when they were strapping the patient back in the nurse said “watch out the patient bites!” This patient discouraged me from working with the mentally ill in general. After rounds I went to a neurology (stroke specific) conference. It was much like morning report, talking about the worst stroke patients of the week and explaining to the audience different ways to deal with each condition. The main thing I learned was the difference in clipping vs coiling an aneurism, overall coiling is better. The day ended with more clinical with Dr. Leifer.

6/22/2011 –

Dr. Leifer is out until Monday so I decided to contact some friends and watch my first neurosurgeries. I was apparently extremely lucky today because they were doing bilateral deep brain stimulation on a patient that was awake and cognitive. This surgery sent electrodes to the hypothalamus. The patient had “violent” tremors perhaps brought on by Parkinson’s. The stimulation is in a specific part of the brain (Can’t remember the exact word, it was SN something). The machine they utilized to judge positioning used auditory signals, which I thought was crude and very insensitive. I believe a Fourier transform on the electrical impulses detected would be a better read out. Once the electrode was in the correct position the next part was remarkable. They sent in small voltages 2-6 Volts and you could see the patient’s tremors completely stop. I spoke with the representative for the bilateral DBS and she said she has never seen such a successful surgery as this one. The next surgery was an endoscopic surgery on a morbidly obese patient who was being considered for a shunt. There was too much fat to find a good placement in the abdominal region so they decided to cancel the shunt.

6/23/2011-

Today I was surprised to find that the normal neurology team was switched, or so I thought. The new attending was Dr. Fink, and some of the team members I knew, so when I asked what happened they said they split the teams into two to handle 6 central and 2 west. I then went down to 2 west and met up with Dr. Jamieson and continued on rounds. I am now a part of the vascular neurology team. Rounds were very confusing, we are working with the vascular PA which likes to run away and we end up waiting. Also, things were just not well organized, it was very annoying.

6/24/2011 –

Rounds went better today, although still very disorganized. After morning report I decided to switch it up a little and followed Dr. Fink’s neurology team for his rounds. After rounds I met up with Dr. White who explained my research project to me. So, now I have a project, though I need to wait on paper work.