Thursday, December 10, 2009

A Day in the Life of a Neurosurgeon – SERIOUSLY?

6:00 am – Out of bed, to the shower
6:35 am – Wake up 11 yo son, remind him to take ADD medicine this morning
6:40 am – Feed 3 hungry cats, out the door to work
7:00 am – Sign and update day’s surgical H&P’s, type an overdue office note into EMR so procedure can be precert’d for Friday
7:10 am – Breakfast, grits and poppyseed muffin, with premed student who’s shadowing this month
7:30 am – See first surgical patient in preop, sign chart, dress in scrubs
7:45 am – Call medical records to assure them I did the overdue discharge summaries last night and I’m back on staff
8:00 am – Do first case, small outpatient procedure
8:40 am – Talk with first pt’s family, see next patient in preop holding, write postop orders, handwrite prescriptions since EMR printer not working AGAIN
9:00 am – Start next case, 2-hour outpatient procedure.  Get page about emergency cerebellar stroke pt en route to ICU from sister hospital, need to consult
9:30 am – Review films of stroke pt during short pause in surgery, obviously needs emergent craniectomy.  Book case, give anesthesia instructions while operating.
10:30 am – Still operating on pt #2; get paged about another consult, not emergent but needs to be seen today.
11:10 am – Finish case, stroke pt not here yet.  Speak with family, write postop orders, decide to proceed with next case (1 hour inpt surgery) while waiting for stroke pt
11:40 am – Start case #3 after difficult awake fiberoptic intubation.  Play Christmas music to improve mood.  Get paged about consult #3 – brain mass.  Start getting irritable, since this was supposed to be a short day (get home at 6:30, actually see family and get dinner made, start decorating tree we brought home on Saturday).  There goes any chance of getting home before 9:30 AGAIN, on a day I’m not on night call.
12:45 pm – Finish case #3, talk to pt family, write postop orders.  Run upstairs to see stroke pt.  Awake but with ominous “pressure” headache.  Discover the internist started him on blood thinners 2 days ago (including Plavix), and he had a dose this am.  Delay emergency OR so platelets can be transfused. 
1:15 pm - Cancel last 2 scheduled elective cases to accommodate emergency.  There goes Dec 18th’s light schedule.  Soothe angry patients who have to be fixed before their deductible starts over Jan 1.
1:30 pm – Field call from our other hospital’s trauma committee chief, chewing me out for taking too long to see a trauma patient in their ER two weekends ago on call.  Explain that when I got their call, I was operating on the day’s second emergency case in the other town and couldn’t leave that patient on the table.  Called partner for help, who wouldn’t come in.  After finishing case, drove straight to ER 30 min away at 11:30 pm after operating since 8:00 am. Got stopped by police for speeding. Took pt straight to OR, operated until 4:00 am.  Pt survived and had great outcome.  “Oh, okay, I guess the circumstances were understandable.”
 
1:45 pm – Drop by doctor’s lounge for a cup of soup while platelets are being prepared.  Watch news about health care reform.  Wonder how many hospitals will have to close with Medicare cuts, and how many physicians will be able to stay out of hospital employment situations.  Realize there’s nothing I can do about it.
2:30 pm – Pt rolls into OR.
3:00 pm – Begin emergency surgery.  More Christmas music, reminding me I haven’t done any shopping or even thought about what to get for which people.
4:58 pm – Still operating.  Get paged about consult #4.  On call partner takes over at 5:00 pm.  Hospital called him first, but he told them to call me.
6:00 pm – Finish emergency.  Speak with family, write postop orders.  Review films on postop pt in rehab with new leg pain.  Can’t tell if his graft has migrated.  Order CT scan.
6:15 pm – Change out of scrubs, see patient with brain mass.  Order additional testing, type consult note.
7:00 pm – Answer text from husband to tell him I won’t be home for dinner AGAIN.  Attach sad emoticon.  Advise him to use olive oil to make couscous for the vegetarian exchange student who lives with us during the week.  Remind him to make sure son takes anxiety meds tonight.  Husband texts back that son only got sent out of one class today for disruptive behavior.  Progress.
7:05 pm – See consult #3, pt with back pain.  MRI films aren’t here, instruct pt’s family to bring tomorrow so we can make decisions.  Type consult note.
7:45 pm – Field question from floor nurses about a postop patient, preventing the need to disturb the on call partner.
7:50 pm – See consult #4, pt with back pain.  Explain to family why I didn’t get here earlier.  Discuss treatment plan, not surgical.  Enter orders and type consult note.
8:30 pm – Check on craniectomy pt in ICU.  BP is 210/130.  Start Cardene drip.  Otherwise doing well.  Hug family member.
8:50 pm – Stop by office to check messages.  Ignore inbox on my desk (known to my staff as “ Mount Surgeon .”)  Review To Do list, realize I can’t mark off a single item.  (There are 18.)
8:55 pm – Glance at call schedule accidentally, reminding myself that I’m on call Christmas (Thurs-Mon) and on backup for New Year’s.
9:00 pm – Rest for 5 minutes to read this blog, am inspired to write this guest post.
 
9:20 pm – Start wiping away tears as I think about what I’ve just written.  I used to love my career, but I am realizing how sick and tired I am of this workload - of not seeing my family, not being ready for holidays, using weekends to catch up on charts… of being dumped on by partners and pushed around by insurance companies.  I can’t remember what I used to do for fun, and I can’t figure out why I’m still getting out of bed for this, day after day.  Why would anybody want to have a day like this, or worse, 5+ days a week?   I know, it’s supposed to be hard, and the culture of neurosurgery is to suck it up and avoid asking for help, because that’s a sign of weakness.  Maybe my fellow residents were right after all, and I’m just lazy.  Maybe I just need to finally reconsider my options and decide whether this has devoured enough of my life.
 
GCS15
 



30 comments:

  1. Thank you for this post!

    I loved my neurosurgery rotation, but the lifestyle seemed completely untenable for me. Your days sound exciting and cool, and I know the surgeries are cool. But I'm the kind of person who needs more control over my life than that.

    Kudos to you for keeping it up!

    ReplyDelete
  2. I cannot imagine what you're going through, and the last paragraph broke my heart. Don't give up on medicine.

    Do you need a vacation? An SSRI?

    I think everybody on the planet needs an SSRI. In my view, God created man to wake, hunt the bear, kill the bear, eat the bear then go back to sleep. I don't think man (or woman) was created to deal with PTA meetings and traffic, let alone what you describe above.

    Welcome to MiM, guest poster, and I hope we hear from you again. Fabulous post!

    ReplyDelete
  3. Thank you so much for this post. I really feel the despiration of your last paragraph.
    That was me almost 30 years ago (not neurosurgery, but intensely "over-everythinged")and every now and then, I feel bad about cutting and running for research. Your post brings back full force all of the reasons for my decision.
    I know that you were writing this at the end of a long, terrible/wonderful day and you were tired and frustrated, but if you really feel like this most days: in my opinion, a career modification is in order before you miss your entire life in the service of others. You can still serve, you just need to do it in a way that allows time for yourself and your family.
    Best of luck and I'm pulling for you. And crying a little for you too.

    ReplyDelete
  4. Wow, thank you for sharing this. It sounds like you're a great doctor and I really admire people like you. I don't know if I could give so much of myself to my work without ending up on the psych ward. I really hope you find a way to strike a balance in your life in a way that makes you happy.

    ReplyDelete
  5. Nothing in your post says "lazy." One thing that I tell med students is, "Do what you love. You'll be able to find a situtation that works for you." I hope I am not misleading them. I do think that's true in many specialities. There are more part-time options, job-sharing...do you have other options/practices in the area that could give you better job/life satisfaction?

    I think of dr.whoo on this blog who was in a practice/job she was miserable in and has now found so much more happiness and balance in her new one.

    Also think it is healthy to look at other jobs and options. Regularly.

    Best of luck, gcs.

    ReplyDelete
  6. I am in awe over all that you do and how well you do it. But, wow, I think it's just too much for anyone...certainly for me...and maybe for you, too. Sounds like you need a different partner, for starters. Seems that you are always the giver and your partner is always the taker. There must be neurosurgery practices with more balance (more partners? better partners?). Best of luck to you and hope you will join us, not just as a guest, on this blog! We can all use the support.

    ReplyDelete
  7. Thanks for the support, everyone - it comes at a much needed time. Anonymous is right, I wrote this at the end of an unexpectedly long, stressful day. December is my worst month, with the holidays added on top of everything else. Maybe I do need a seasonal SSRI during the winter months. I've thought about that before.

    I also do need a vacation - haven't had one for 5 months (when I had my carpal tunnel repaired). Not every day is quite this bad, although some are worse. I do love neurosurgery, and the patients are very rewarding. My 3 partners can be vexing, but as neurosurgeons go, 2 of them are very good to work with. The third I could do without. Certainly there are no better options in the area. It's impossible to do neurosurgery part time - I've seen it tried.

    Thank God for an amazing husband who is totally understanding and Type B!

    KC, I've said the same thing to my students. I still believe that's true, even in surgical specialties. I'd love to see more women go into neurosurgery despite my post - maybe we could soften the "I can't believe you're asking for help, you lazy slacker" mentality if there were more of us.

    Eight years of days like this, fighting the system, have made me get tired and whiny sometimes. Thanks for bearing with me.

    ReplyDelete
  8. I'm just a resident and maybe partner politics precludes this, but it seems to me that you could really benefit from a PA or two (I really hope this schedule isn't with a PA -- if it is, for starters, get him/her doing discharge summaries and H&Ps!) I understand that a lot of the mentality/culture of neurosurgery is control, but if there is one thing that I've learned from being a mom in medicine--help is vital and good, reliable help is often the key to survival.

    ReplyDelete
  9. gcs15 ~ Great, great post. I so totally "feel" you. You strike me as very hard working and responsible and not a lazy slacker at all. It is just the way we are conditioned in medical/surgical training. "Call me if you need help...but don't call me." Sounds like one of your partners is a gem. I have had recent experience with that. As KC mentioned, I recently underwent a major move and job change. We even moved to a place I swore never to live, and life is so. much. better. At the very least, get thee a vacation!! No break in over 5 months (and no, recovery from surgery does not count!) :)

    ReplyDelete
  10. God, I am hurting for you. And feeling every bit of your agony, remembering my residency. Not nearly as bad as a neurosurgoen, but still. I agree - love medicine. And find time for your family. Create something new. For yourself and everyone around you.

    ReplyDelete
  11. Thanks for sharing, especially your honesty about how hard it can be (holidays or not, the day you described would take it out of anyone). My thoughts will remain with you.

    A

    ReplyDelete
  12. Thank you for sharing GCS15. Neurosurgery, especially caring for acute stroke/ trauma patients is a calling. What you do is amazing. I am struggling too. It is a fight to preserve time away from the hospital. You are not alone my friend.

    ReplyDelete
  13. Just curious, how much do you make for this kind of day, Maybe 700K+ every year. That maybe you can call it quits in 15 years

    ReplyDelete
  14. Your last paragraph is heartbreaking. I cried a lot during residency but soldiered on because of the promised light at the end of the tunnel. It sounds like you are sacrificing a lot for your job. I feel for you and hope it gets better. Hugs....

    ReplyDelete
  15. I just wanted to say thank you. I know you wrote this back at Christmas, but I got on here searching for any moms in surgery. I'm a 3rd year med student and I want to go into a surgical career and I want to have a family. It is important for me to see that it can be done. How are you this spring? Did you get a PA, or a low dose SSRI, or maybe get rid of that one partner, lol? I hope this finds you well. Thank you again for your post, for being a female in Neurosurgery, and for all you do for people!

    ReplyDelete
  16. Do you ever wonder why your child needs all this medication to cope? You seem to be a great mother to your patients. No doubt about that. But who is mothering your son? At the end of the day, it doesn't matter how many patients you save. What matters the most is that your son gets the love and attention he needs. And he isn't getting that. You are clearly an excellent doctor. But pay attention to your guilt. It is telling you something true.

    ReplyDelete
  17. To GCS15:
    What are the pros and cons of being a neurosurgeon?

    ReplyDelete
  18. I had two brain surgeries and wonder how much concentration a surgeon puts into one patient during the op with so much stuff going through their minds.

    I discovered that I'm not a good multitasker. All the medical research indicates that the human brain unlike a computer cannot multi-task so why are all the companies requiring it?

    ReplyDelete
  19. Thanks for this really honest post. I need as much informaton as I can get before starting medical school. I feel motivated to become a neurosurgeon, but keep looking for reasons to not do it. I know it's hard. I had a practical question: When you operate until 4 AM, do you still have to wake up at 6 AM the next day and have a full day?

    ReplyDelete
  20. Hi, im a 14 year old high school student, and to be a neurosurgeon has been my dream since i was very young, and reading your post has been such an insipiration, but it all seems soo confusing and i know i have a long way to go,all your abbrevations are very confusing..but thank you..now i ahve much of an idea of what im going to be doing so i can get mentally prepared for it..

    ReplyDelete
  21. Thank you for your post. I am a vascular surgeon who was expecting the "light at the end of the tunnel" and isn't findng it. I feel that I have given up so much and there is no end in sight. My days all seem to be like the one you described.

    How did you get past this? I am hopeful it can be done given your "balance" post

    ReplyDelete
  22. Bless you for trying so hard with your life.

    I hope you will find a way to count yourself amongst those who need your love, and find more balance in your life.

    True heart

    ReplyDelete
  23. Be thankful. You have incredible job stability. You will never have difficulty paying your mortgage or putting food on the table. You are very well respected in the community for your profession and you are rewarded handsomely for the hours you put in. Contrast that with scores of people who struggle to do all of the above and you may see things in a different perspective.

    ReplyDelete
  24. Looks just like the schedule--in terms of time management and attending to critical life and death situations and vital communications--of a life support specialist (RT). Of course, because nobody knows what RTs do, they get little exposure (or the appropriate compensation.) The doctor leaves before 6:30 which leaves RTs to deal with the families, calling doctors, weaning patients off life support,making sure patients don't die on the life support,etc.

    ReplyDelete
  25. Totally overrated. I watched a neurosurgery in person. The doctor has a screen to see exactly where he/she is going with the instruments. About 30% of neurosurgery patients will die. The fascination with neurosurgery is the belief that some people have the power of life and death. Only God can save lives. We are all tools to accomplish this. Nurses,doctors, life support specialists, speech language pathologists, physical therapy and occupational therapy make it all possible. I am tire of the idolatrous blasphemy of people who think one medical profession is "the best". It is just the messiah complex as far as I am concerned. It is good to see a woman as a surgeon. Too many go into OBGyn and pediatrics. Besides, given the fact that most surgeons are arrogant,elitist,pompous,despotic, contemptible gits, I have serious reservations about their motivations. If their heart is in the right place, I am happy for them. It is usually just for money, power and prestige--all ego manifestations. To those who are genuinely humble, kind and caring, my hat goes off to them. They are the people who make medicine worthwhile.

    ReplyDelete
  26. I, for one, really appreciate that you shared this. I'm a pre-med student and I've been thinking about neurosurgery for about a year and really looking into it (what I thought was) really in-depth. But nothing quite has summed up the actual work in reality like this post has. All that being said, we'll see how far I make it since I live for a good challenge ;)

    ReplyDelete
  27. Great post but think about the feeling after helping someone in need. Think about the lives that you have saved. I would imagine being able to do all these thinks will help you realize that you missed being with your family for a great cause(helping people and saving their lives) That is why I want to be a Neurosurgeon!!!

    ReplyDelete
  28. This is an amazing post. You are saving lives, and you're job is what i aspire to be. You're a loving mother, have children and working in such an amazing and rewarding field! It breaks my heart that you are feeling overwhelmed, but you are an amazing person and are doing so much. I just hope one day I could be were you are..

    ReplyDelete
  29. Thank you very much for your wonderful and encouraging post !! Your truly a strong and wonderful person , women like you give us women such great hopes and encouragements . I really want to become trauma surgeon in future :) , I would really love to become a surgeon and a mother at the same time . Your all really helpful for us women who wants to become surgeons in near future . Please post more articles about managing both career and family life , we all support every women in this medical career and also never give up your dreams .Thank you and have a nice day ahead :) .

    ReplyDelete
  30. Thank you so much for this post. I am a first year medical student who is interested in neurosurgery. You just gave me a glimpse of what my day would/will be like. Your schedule should scare me but for some odd reason it doesn't. In the past, I have dedicated 12+ hours a day performing job duties that I did not enjoy so I figured maybe, just maybe, I would be happy dedicating such hours to a field that I love. I am currently looking for opportunities to experience the daily activities of a neurosurgeon in order to finalize my future career path and I am grateful because you helped paved the way for women such as myself. Please do not give up. Others appreciate your hard work and dedication. Your patients appreciate you even if they do not verbalize or show it.

    ReplyDelete

Comments on posts older than 14 days are moderated as a spam precaution. There may be a delay between submitting your comment and its publishing. Thanks for commenting!