clinic

I just started work last week in the Interventional Neurovascular Unit at the hospital, a subgroup within Radiology & Diagnostic Imaging, and I have to say that being in the clinic is a completely different experience from learning in the book. Reading papers is fantastic when you're just studying the theory behind it, but when it comes to actual intervention, knowing how to roll a patient properly holds much more weight than knowing the physiology of why heparin works.

Irregardless of my lack of clinical prowress, I've seen some really interesting things the last few days. We do a lot of angiograms where I work, which allows for visualization of the vessels in the brain. Our unit takes X-ray pictures of the vasculature using a contrast agent to show the vessels, and then using this data, we can recreate a 3D image that can be manipulated, spun, and measured to plan surgical treatment.

I got to see a patient with a MASSIVE berry aneurysm coupled by two smaller aneurysms. An aneurysm is essentially a bubble in a blood vessel due to wall weakening, which is extremely dangerous. It's basically a time bomb - the overly dilated vessel itself does nothing on its own, but can rupture at any point in time, causing inter-brain hemorrhage that quickly can result in death. I've seen some textbook photos of aneurysms, but nothing so big as what I saw on that screen.



I also got to witness an ateriovenous malformation (AVM). Blood vessels typically grow in a regularly spaced fashion, but individuals with AVMs have abnormally growing vessels that become almost neoplastic in nature. These people have massive clumps of vessels that provide inadequate blood circulation to the areas of the brain that require perfusion.



Today, I also got to see another aneurysm, but what was more interesting was that the patient just had a craniotomy (they open up the skull to expose the brain), and her forehead was stapled shut. She had this hairband of staples to close the surgical wound, and on the scans you could see this snowflake-shaped material clearly in contrast to the rest of the image. I asked one of the nurses what it was, and she told me that they were surgical clamps, permanent pieces of metal embedded in the skulls to hold the bone in place after craniotomies.



What I find most fascinating is that these patients who have severe brain abnormalities are completely intact cognitively - they can converse and laugh and grumble about how it takes so long for procedures to start. They are absolutely able to function normally, albeit with minor seizures or headaches, even though they have this time bomb in their head that might kill them or utterly incapacitate them at any point in time. It's almost a sad story, but I suppose the best kind of disease, apart from having no disease, is one that doesn't affect you until the moment before you die.