This thing I refer to as My Life

Radiology has been moving along at a good clip, but most of it is not easily blogged. Since I'm on Neuroradiology, we look at the brain and spinal cord, thus, there has been a parade of slipped discs, intracranial bleeds, tumors, fractures and strokes. I should add that there have been a bunch of anatomically intact people, too. You can't quite say that there is not anything wrong, just nothing structurally deranged when the patient is lying at rest.

I have spent a couple of days in interventional radiology and that does have a little more drama associated with it. In particular, I witnessed a Wada test--apparently named after a Doctor Wada. The study was being performed on a patient that had several tumors in one of the hemispheres of his brain. (I'm a little vague on that point because we had conflicting information as to which hemisphere was affected and no imaging data to resolve the question.) The type of tumors were amenable to resection, however, they wanted to be sure that the patient would not lose his power of speech or memory because of the resection. Seems like a perfectly reasonable thing to know before hand!

To gain this little piece of knowledge, there is a very slick trick that one can do to determine hemispheric dominance: you feed a catheter from the groin into the artery that "feeds" that part of the brain (one of the internal carotids). Then you inject some short acting sedative (Amobarbital) which puts your brain to sleep! Once everything is set up and you verify which artery you're in (that's important because if you hit the vertebral instead, all of the autonomic functions of breathing and heart beating come to an abrupt halt!) the neurologist asks the patient to hold their hands in the air and start counting up. When the patient hits around 40, they inject. On the first try (I think it was the right) the counting stopped and became a monotonic vocalization. (If you have seen the move Total Recall, there is the scene where Arnold is dressed as a woman passing through customs to Mars. The customs agent asks if she has anything to declare but all the electronic mask over Arnolds face can say is "Two weeks." After repeating "two weeks" a couple of times the mask just starts making that strange soundthat's the sound!!!) Next, his left hand started to drop, and the patient started looking to the right. The neurologist asked a series of questions including pointing at objects, repeating sentences and naming. None of which the patient could do. A few moments later the sedative wore off and he was back to normal. No recollection of what happened, no sense of the passage of time, but the patient did remember about where he stopped counting.

We threaded the catheter up the other carotid and tried again. The right arm did drop, but the patient was able to speak, name and point out objects. It was impressive to watch and somewhat chilling as we were basically inducing a massive (but temporary and without lasting complications) stroke in each hemisphere.

The majority of other patients were aneurysm or arterial-venous fistulas in the brain. Interesting to see and watch, but difficult to describe.

Yippy! I have a new way to construct photo galleries and it is a damn site faster than what I had been doing. You'll see the new set to the left! Enjoy.

The first line of the last post should be that ER was over week before last. I've been on my Neuro-radiology rotation starting last week. It's going well so far and I'm trying to stay out of trouble. But there's not a lot to write about. At least nothing as dramatic as before. It is nice to have M4 hours! (That would be 9 till 5 for those of you that don't know.)

ER was over week before last. Although some students were scheduled to work over the switch weekend, I volunteered. Sounds odd (stupid) at first glance, but I had an ulterior motivation: it was a Survival Flight shift! I had the chance to fly in the helicopter during my transplant rotation, but it didn't work out. I thought that was my last chance, but this turned out to be another.

My shift was 7a till noon on Saturday. I hit the door right on time and listened to the daily briefing. The pilot was quizzing the flight nurses on emergency procedures and such. They were talking about what each of them would be doing in the event of an engine loss, where they would land, who they would call and what would they tell them. The pilot said to me that it would be very unlikely that I would even be aware that there was a problem. I responded that if I did figure it out I’d be crying in the corner. We went down the Survival Flight elevator (yes, they have their own elevator with restricted access) and through the corridor to the flight pad. This resolved one of those burning questions I had which was how they transported patients from the helicopter to the hospital. Where I used to work, the landing pad was across the street from the hospital just like the one is here. But there was a little ramp where an ambulance could drive up and then deliver the patient to the ED. There was no such thing here. Instead, there is a tunnel under the street. It makes perfect sense now, I just never appreciated how much lower the landing pad was than the street because I’m usually driving by the pad and I'm too busy trying not to hit anything or anyone to devote much thought to the logistics.

It's a very sharp craft in person and I’m not sure that pictures really do it justice. That, of course, did not stop me from trying. I had my official flight helmet and I was ready to go! There was a "new" pilot who had flown for one of the local news stations and he was going to do some training. The pilots invited me along for the ride, which turned out to be smart. As we were getting ready, a mechanic arrived and the head pilot pointed out a small amount of oil he had noticed leaking after the last flight.

We loaded up; I buckled the four point belt in place and plugged in my headset. After all, it was important for me to know what the pilots were saying to each other. Really, I was so excited that I would have plugged in no matter what. You see, I periodically dream about flight. I have had several dreams about flying a helicopter, although I had never been in one until last weekend. Those dreams were surprisingly accurate with respect to how the flight feels.

Did anyone notice that we took off with the helicopter leaking "a little?" We were flying over to the hanger to perform some field training for the new pilot and for repairs. The training was really fun because they were practicing landing, takeoff and various other maneuvers. The strangest part was landing at an angle. You can apparently land at no more than a 10 degree angle. My favorite line during the training was, "with this craft you fly on torque and angle." When you turn right, your torque drops momentarily and then spikes up. When you turn left, the torque just drops. No, I had no idea why that was important, so I asked. Turns out if you spike the torque too high you'll strain (or break) the connection between the rotor and engine: basically, at the transmission. This would be BAD!

After a little training, we flew over to the hanger. There's an EXTRA helicopter in the hanger! The mechanic took another look at the engine leak and decided it was one of two gaskets and preceded to take the engine apart. I, of course, watched! There was not much I could do to help other than make pleasant conversation mostly about the engine. After a little bit, the pilots decided get the extra helicopter out just in case they needed to take it. The best part is the little battery powered dolly that is used to move the multi-million dollar helicopter around. It doesn't even look as beefy as the forklifts they use in warehouses. But it only took a few moments before the extra helicopter was parked next to the one we road-in on; ready to go. The new pilot, the mechanic and I chatted for the next two hours while the head pilot entertained a stream of families who just stopped by with their children to show them the helicopter. I learned that PR is a substantial part of the Survival Flight pilots' life! A little before noon we received a call that there was a "run" to make and to get back over to the hospital. We loaded up the EXTRA helicopter (which was identical to the one we were using, sans the oil leak) and headed out. When we got back to the U it turned out that we were just making an equipment-run to the Survival Flight fixed wing (airplane) to restock it. To make matters worse, there was a new ER resident who's shift started at noon so I got bumped. Even worse! The picture of me in front of the helicopter did not come out because the camera batteries died. And, to top it all off, I got a parking ticket.

Still, it was worth it!

I'll have to work on getting the pictures posted here....