Another Day in the Frontal Lobe 8
I am reading Another Day in the Frontal Lobe by Katrina Firlik. Dr. Firlik is a neurosurgeon. She was the first woman admitted to the neurosurgery residency program at the University of Pittsburg Medical Center; the largest and one the most prestigious neurosurgery programs in the country. She currently teaches at Yale University and lives in Connecticut.
.jpg)
Dr. Firlik’s book, published in 2006, is 20 chapters of her neurosurgical observations offered to non-neurosurgeons. 20 chapters and glimpses into the mundane an d exciting drama of the operating room and brain surgery.
As a neurolawyer, I have a keen interest in the neurosciences. Although neurosurgery is not always present in the cases I handle, I find it very interesting to hear a neurosurgeon’s thoughts on everything from medical school anxiety to the fear doctor’s have of being sued for malpractice. With obligatory forays into operating room procedure, detailed descriptions of what drilling into the skull feels like, and other amazing insider information, I find this book a quick read. Maybe not for everyone, I am enjoying this book.
I want to share some of my thoughts about the chapters here. This will be an ongoing effort and I will post more as I go through the book.
I am at chapter 8 entitled, “Tools.” Here we find that neurosurgeons harbor great affection for the instruments they use in the acts of surgery. And they actually ascribe nicknames to these items. So “Adson forceps” are referred to as “bunnies.” The scrub nurse had better know the particular nomenclature for the particular surgeon or suffer his or her wrath when she fails to place the right instrument into his hand.
One surgeon asked his scrub nurse for “my little nipper,” his particular nickname for a tool properly called a “rongeur.” This tool is used to bite off pieces of bone. Fortunately of all the surgical tools before her, she was able to quickly deduce which one looked like one that nips.
The “sound of surgery,” I learned, is the sound of the neurosurgeons most commonly used tool – the suction device. Similar to the suction device used by dental hygienists, brain and spine surgeons use it throughout surgery to remove fluids that accumulate; namely blood and cerebrospinal fluid. Sometimes suction is interrupted due to pieces of tissue or clotted blood clogging the tube. A similar interruption occurs when an observing medical student unknowingly has her foot on the tubing. A mistake she will make only once.
Every intern’s rite of passage is to claim to have placed the first “bur hole” into a patient’s skull. Neurosurgeons use drills to carve out skull bone to expose the brain. These technologically advanced drills automatically stop once the bone is drilled through preventing further drilling into the brain. This was previously done manually and drills sometimes went too far! Interestingly, one cannot stop drilling half way into the skull and stop. If one does, the drill will not restart. I personally cannot imagine bearing down on a drill as it drives its way through a skull trusting it will stop once the bone is cut.
Finally “bone dust” from what I have gleaned does not smell very good. And you apparently get it on you when doing brain surgery!
