Friday, April 16, 2010

Amateur Night, or: This Ain't How We Do It

Note to surgeons universally: if you're a general surgeon in some little teeny town in the middle of nowhere, it is not a good idea to experiment with neurosurgery on your locals.

Seriously, dude. Leave it to the experts.

Because what will happen, if you decide to fuck around with somebody's brain, is that you'll screw something up. Even if you're doing what would be (in the hands of our guys) a fairly benign procedure, you'll almost certainly screw it up.

There's a method of embolizing aneurysms that involves shooting dozens of little tiny platinum coils, like itty-bitty Slinkies, into the aneurysm. That causes blood flow to slow down, pressure to drop off, and eventually the thing clots off and collateral circulation forms, solving the problem. Although it's a fairly simple procedure, things can and do occasionally go wrong, even at Sunnydale.

Things go wrong much, much more often outside of Sunnydale.

For one thing, playing around in the vessels of somebody's brain is a high-risk proposition. For another, you have to have a good idea of how blood flow behaves in an aneurysm before you start putting things into it or clipping it off. For a third, you have to know that there are some aneurysms that can be coiled, and others that cannot.

A nine-millimeter-diameter torturous enlargement of the posterior communicating artery probably should not be coiled. If you try, you'll end up shooting coils all over the brain's posterior circulation. And somebody will have to go in--that somebody being one of our boys or girls--and get the damned things out before they cause more problems.

That said, it's interesting to see imaging of your patient's brain and note the little teeny cute coils ALL THE HELL OVER THE PLACE.

Jesus. *rubs eyes*

In other news, I'm going to start wearing safety glasses when I mow the lawn. The nice man who came in this week didn't, and ended up with a piece of yard waste embedded in his eye. Which wouldn't've been a problem, except that that bit of yard waste contained some sort of particularly virulent fungus. And that fungus contaminated his whole eye. And spread. And eventually necessitated the removal--and here I wish I were making this up--of half his face.

Jesus. *rubs forehead*

I have the world's worst neckache. Sadly, I wasn't having any fun when I got it; I was busy wrangling leeches.

Leeches suck, no pun intended. They're fast-moving and aggressive, and they can change shape to an alarming degree. Picking them up with tweezers is an exercise in futility. If you want to preserve the little bastards, pick 'em up with your hands. If you don't care if they live or die, try a pair of ring forceps. (I keep a pair of ring forceps in my bag for just this occasion. Don't tell the OR that I stole 'em, okay?)

Leeches tend to get full fast, then fall off of whatever they're sucking on and start crawling around. This means in practice that if you start with half-a-dozen leeches and end with five, you'll spend forty minutes scouring the damn room for one freakin' leech before you find it attached to your leg just above the ankle.

No kidding. People, I do not lie when I say I had a miniature internal mental breakdown.

Luckily for me, the patient had nothing infectious that I could catch through sharing a leech. But holy Christ on a crutch--finding a peacefully sucking leech about a centimeter above your sock will cause you to freeze, stop your thought processes entirely, then make you think calmly and critically about your situation before you grab the tweezers and alcohol and a little cayenne pepper. (Cayenne pepper stops bleeding; it gives the blood something to grab hold of and clot on.)

Leeches do not hurt, by the way, but their anticoagulant spit is powerful. We use it in drip form for folks who need to be anticoagulated fast but who are allergic to heparin.

Jesus. *rubs ankle*

It's four ack emma and I have four hours before I can go to bed. It's going to be a long, long four hours.


Flea said...

Dude. Leeches freak me right the hell out. I've seen them provide really great results for a patient with complications from facial flap surgery. Awesomely cool. And freaky! FREAKY! I cannot imagine being in that twilight land of partial sedation with leeches on my face. The nightmares, oh the nightmares.

Gretchen said...

Didn't you ever wade through a muddy stream in a cow pasture and end up with a few leeches stuck to your feet? Or is that not the same as medical strength leeches? ;-)

Albinoblackbear said...

Your world is unfathomably more exciting than mine...can we trade??


coulrophobic agnostic said...


Like there weren't enough things to be afraid of in this world. Poor sonofabitch.

Andrea said...

O to tha M to tha G.

me said...


bdaiss said...

Um. Squick. Leaches give me the heebie-jeebies. I'm always fascinated that they're still used in modern medicine...but hope I'm never the one who needs them!

And I have one thing to say about the lawn mower guy. I'm betting he was your typical stubborn git that didn't come in right away, letting the fun-gi spread to a point of no return. Please tell me I'm right. Otherwise I may never mow my lawn again!

Here's hoping you're having sweet dreams!

Loki said...

Steal a leech and put it in a little terrarium to remind you how life can always be worse :D (I hope your day gets better!)

Gossamer1013 said...

It's so cool that these things do what they do, and yet...geeeyahhh! Is the patient sufficiently sedated to keep from being completely skeeved out? I get that they don't hurt, but holy cats. If they ever come up with a treatment involving the application of spiders, Frog help us.

Jo said...

Leeches are one of the things which freak me out - ever since my science teacher calmly put his hand into our local pond on a field trip and it came out covered with them.

But I didn't know that about cayenne pepper - I will have to remember it next time I decide to slice my thumb open when cooking!

Northwoods Baby said...

You can't complain anymore.

But ew and zomg.

messymimi said...

Every time I read your blog, I thank the Almighty again for nurses like you.

Anonymous said...

Holy begeezus, Jo. I'm sticking with cancer nursing. I'll tae tumors over leeches.

TheSchaft said...

Something to read over lunch…

" time you feel something slippery in your nose, is it an oncoming cold? Or something far more creepy?"

Anonymous said...

I find it shocking that you deal with leeches enough that it warrants "borrowing" ring forceps. As ThirdDegreeNurse said, I'm sticking to tumours!

k8 said...

Oh leeches. I got to the point where i just let them suck on my glove until I got them close enough to the blood for them to go "ooh, dinner!"

But none of them ever attached themselves to me. *shudder* Closest i came was somehow managing to not step on The One What Got Away in the dark room. I found him by following the trail of blood. (The patient, for the record, got to the point where he slept through the whole thing, and the ear went from totally blue to a healthy pink in one shift.) Busiest night in my life, though.

Rob said...

geez!! Next time I mow the yard I am wearing a helmet!!