Friday, March 04, 2005

Rules of Neurosurgery

Excerpt from When the Air Hits Your Brain by Frank Vertosick:

"Rule number one: You ain't never the same when the air hits your brain. Yes, the good Lord bricked that sucker in pretty good, and for a reason. We're not supposed to play with it. The brain is sorta like a '66 cadillac. You had to drop the engine in that thing just to change all eight spark plugs. It was built for performance, not for easy servicing."

"Rule number two: The only minor operation is one that someone else is doing. If you're doing it, it's major. Never forget that."

"Rule number three applies equally well to the brain patients and to the spinal disc patients: If the patient isn't dead, you can always make him worse if you try hard enough. I've seen guys who have had two discs taken out of their backs and begged us for a third operation, saying that they had nothing to lose since they can't possibly be any worse than they are. So we do a third discectomy and prove them wrong."

"Rule four: One look at the patient is better than a thousand phone calls from a nurse when you're trying to figure out why someone is going to shit. A corollary: When dealing with the staff guy after a patient goes sour, a terrible mistake made at the bedside will be better received than the most expert management rendered from the on-call-room bed or the residents' TV room."

"Rule five: Operating on the wrong patient or doing the wrong side of the body makes for a very bad day...otherwise it's a res ipsa...short for res ipsa loquitur, or 'the thing which speaks for itself'. It means a malpractice case in which the error is so obvious that even a non-expert can see that a fuckup has occurred. A patient falls off the OR table. You cut off the left leg when it's the right one that's gangrenous....A patient bursts into flames during defibrillation....Res ipsa is checkbook time. Just write in a string of zeroes."

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