during intermediates we were required to rotate through all the surgical disciplines. one of our rotations was therefore neurosurgery. those guys really work hard. i think it's fair to say they almost work as hard as us general surgeons. without a doubt, besides us, there was no other surgical discipline that came even close as far as hours and hard work were concerned. and yet they were very different to us.
certain conditions are considered surgical but it does not necessarily mean all surgical conditions are for operation. we will happily accept for example a bleeding peptic ulcer and treat it medically, only operating if it becomes absolutely necessary. the neurosurgeons, however, tended not to do this. if they weren't actually going to operate the patient they simply didn't accept him. so a peripheral hospital would send a scan through for their opinion. if they saw that either no operation was necessary or that the patient was in such a bad way that even an operation wouldn't save him, then they simply didn't accept the patient. cases from casualties with fractures and also some degree of suppression of consciousness who were not destined to fall under their knives they would also not accept. the poor orthopod would get stuck with a semi conscious patient that he wouldn't really know what to do with long after the bones had set.
so when we were getting tutorials from the neurosurgeons i thought it funny when they gave a long talk about the management of a patient with mild neurological suppression. i was even surprised that the consultant giving the tutorial seemed to know how to handle such a patient. being in the department i had seen no evidence whatsoever that they actually ever did handle such patients. fortunately i kept my thoughts to myself (i achieved this by biting my bottom lip every time i was tempted to say something. other than the slight taste of blood i suffered no ill effects like failing my neurosurgery rotation which is a lot worse than the taste of blood).
when the intermediate exams were around the corner i once again enjoyed the humour in the rumours that the management of mild head injuries was supposed to be a spot from the neurosurgeons. i couldn't help wondering who would mark that question. maybe they could ask the orthopaedic department to help them.
finally the exam day arrived. when i saw the question actually turn up in the exam as so many of us had guessed it would i found myself chuckling at the thought of some burly orthopod trying to read my handwriting. i also wondered if the neurosurgeon was honestly asking because he didn't know.
in the end, after considering simply writing:-
'break the patient's leg and turf him to the orthopods,' i buckled down and answered the question.
certain conditions are considered surgical but it does not necessarily mean all surgical conditions are for operation. we will happily accept for example a bleeding peptic ulcer and treat it medically, only operating if it becomes absolutely necessary. the neurosurgeons, however, tended not to do this. if they weren't actually going to operate the patient they simply didn't accept him. so a peripheral hospital would send a scan through for their opinion. if they saw that either no operation was necessary or that the patient was in such a bad way that even an operation wouldn't save him, then they simply didn't accept the patient. cases from casualties with fractures and also some degree of suppression of consciousness who were not destined to fall under their knives they would also not accept. the poor orthopod would get stuck with a semi conscious patient that he wouldn't really know what to do with long after the bones had set.
so when we were getting tutorials from the neurosurgeons i thought it funny when they gave a long talk about the management of a patient with mild neurological suppression. i was even surprised that the consultant giving the tutorial seemed to know how to handle such a patient. being in the department i had seen no evidence whatsoever that they actually ever did handle such patients. fortunately i kept my thoughts to myself (i achieved this by biting my bottom lip every time i was tempted to say something. other than the slight taste of blood i suffered no ill effects like failing my neurosurgery rotation which is a lot worse than the taste of blood).
when the intermediate exams were around the corner i once again enjoyed the humour in the rumours that the management of mild head injuries was supposed to be a spot from the neurosurgeons. i couldn't help wondering who would mark that question. maybe they could ask the orthopaedic department to help them.
finally the exam day arrived. when i saw the question actually turn up in the exam as so many of us had guessed it would i found myself chuckling at the thought of some burly orthopod trying to read my handwriting. i also wondered if the neurosurgeon was honestly asking because he didn't know.
in the end, after considering simply writing:-
'break the patient's leg and turf him to the orthopods,' i buckled down and answered the question.
I laughed at this one. It's funny because it's so true. The only case where the neurosurgeons around here will take a case is when they can get a diagnostic procedure charge out of it (like a cerebral perfusion study) and then all of the credit for the resultant organ donation (the surgery for which they are not, of course, involved in.)
ReplyDeleteHi Bongi!
ReplyDeleteThanx for your excellent blogging...been through it all in 2 weeks and still cant wait to get home and 'revise' it all after a busy ER shift in the UK,on my balcony with a cold Carlsberg in hand!...(keeping me distracted from studying for primaries :)/and sane over here..
so keep it coming!
Hierdie post bring great herinneringe terug van al die Hoofbeserings onder my hand in Themba en Robs 2003/4 en lang gesprekke met Neuro-Chir Pretoria...nie vir die lem,maar wel vir my sorg,in Algemene Chir saal 4 met hul T-tubes in situ, geen Vent en Staf meer geinteresserd in die lunchpryse van Chicken Licken vs Spar se specials op Runners en Pap,...Goed Prof,maar hoe dan verder aan die kant?,en vir hoe lank....
Seker maar 'Die Boss' se grinding op Tuks vir Vasbyt en Genade van Bo,maar kan wel se dit was amazing om n handvol GCS'se van 3 'n paar maande later te kon sien arriveer op hul fietse vir opvolgkliniek,'Supra en Infratentorially Perfectly Intact' :)...what a reward in The Lowveld!
Anyway,...kon nog nooit verstaan hoekom Ortho die Hoofbeserings oorneem nie,as we speak,selfs in die UK?
Sterkte daaikant Tjomma!..hoop self om 'Die Boss' se span binnekort te join...sal maar n paar Lang Wit Jasse en Goeie Skeermes moet aanskaf :)
Groete,
Heini Palmer
Tuks 2002.