Medical Diary

Nov 27

I am being motivated now. It is very rare. Set a goal and run toward it without remembering bad memories. Nobody cares about how you are feeling now. I rehearsed a presentation with colleagues. I will give it next Saturday. There were no questions. There is still time to improve it.

I performed coil embolization for a cerebral aneurysm in the anterior communicating artery. The patient was very old. He was alert and had no symptoms at the ER. For less-invasiveness, I chose local anesthesia and trans-radial approach (TRA). I like it, though my colleagues have never done, because it has the advantages including less access-site complications, early ambulation, and less post procedural pain.

Waqas M. Interventional Neuroradiology 2022.

Old man
08. Tue

A man in his late eighties developed SAH. Will you perform a surgery for him?

About 3 weeks ago he presented with severe headache.

10/15

There are too many things to do. At first, calm down. Confirm priorities. Do what you have decided to do. Do not waver. The early bird gets the worm. Go as fast as you can. Control the urge to throw your phone against a wall.

Brain hemorrhage due to arteriovenous malformation

A woman in her late twenties, having a one year old child, developed brain hemorrhage. She is comatose.

Vertebral artery injury due to dislocation of cervical spine
10/15

A man in his seventies apparently fell while riding a bicycle. He was transported by ambulance with impaired consciousness. Although his consciousness subsequently improved, he remained in a state of quadriplegia, raising suspicion of cervical spinal cord injury. CT revealed a C3/4 subluxation, and MRI showed T2 hyperintensity in the cervical spinal cord. This led to the development of stenosis in the right vertebral artery. A consultation was requested from neurosurgery to orthopedics due to suspected vertebral artery injury. On the seventh day after admission, the stenosis was resolved, no thrombosis. Heparization was discontinued. It was because good alignment fixation of the neck with harvest. He said he had corrected the alignment and fixed.

2

I had lost my motivation, but watching a skilled surgeon’s operation video revived me. Of course, a whole new world lies ahead. I remembered the feeling of wanting to challenge myself.

1

A woman in her late eighties developed numbness in her right leg due to chronic subdural hematoma. She came to the hospital on Saturday night. Head CT showed large amount of hematoma with midline brain shift. When should I perform evacuation of the hematoma? Now, tomorrow Sunday or Monday after weekend? Last week an old patient with chronic subdural hematoma deteriorated her consciousness and she undertook emergent surgery. I decided to do soon. This morning she was in a good condition. I removed a drainage tube.

5/30

A woman in her fifties

15

A man in his 70s developed subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm a month ago. He has a tracheostomy and a nasogastric tube. When he is in a good condition, he opens his eyes and answers his name. But when in a bad condition, having fever, he doesn’t respond. He had undergone a few surgeries for gastrointestinal cancers.

The treatment for the ruptured aneurysm was difficult. I performed coil embolisation. The shape of aneurysm was multilobar with a wide neck. Coils were deployed in the part of the sac. I attempted to deploy coils into the other side of the sac, but I couldn’t change the direction of microcatheter tip.

14

(1) A man in his 40s developed a stroke a week ago. He has been in the hospital. He has mild hemiparesis in his right leg. He cannot walk on his own. His risk factors are smoking, drinking and hypertension. He is single and live with his parents. It’s not my business whether he cannot or need not or don’t to want to marry. He is very nice. He clearly tells me the problems in the hospital that make patients uneasy. It was tough to listen to his claim. I was silent until he finished.

He came back to the hospital. ‘Living in the hospital is too stressful to do rehabilitation’, he had said. He went home and freshened up.

13

A woman in her 30s was scheduled to undergo endovascular therapy for a cerebral aneurysm. On the day of admission she told a nurse she was pregnant. She wanted to undergo the therapy and have an abortion after that. Three days earlier she had felt nausea and sleepiness, taken a pregnant test. Positive. Do you agree? Do the therapy? No one even knew how many weeks she was pregnant. I decided to postpone it. But was I right? Who suffered her?