I performed full endoscopic spinal surgery for lumbar hernia. She is not doing well postoperatively. Yesterday, I showed the images to her and her family and explained the course of events. “I performed the surgery as planned. The postoperative MRI shows the herniation in the targeted area was manipulated as planed. However, it appears the nerve root was compressed when the surgical field was opened. It may be the reason for current pain and paralysis of your lower leg. Other factors like discography, surgical positioning, and endoscopic water pressure may also be involved. While there has been improvement compared to immediately after surgery, we will continue rehabilitation.” Did they understand? I know “as planed” is nothing for them. She said, “I don’t regret having the surgery. I just might have underestimated it. It turned out to be a longer road than expected.”
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A few hours
I taught my son his studies. I explained things thoroughly, repeating until they understood, never pushing them too hard, teaching them patiently. What kind of times will lie ahead before them? I cannot predict. What I taught him today may not help him in the future, but a few hours spent with him was precious to me.I never cease to hope for a bright future for them. I don’t ask for much for myself. I want to dedicate the rest of my life to their future. I clean the house everyday since I wish a son who left home will come home someday.
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Slow
It feels like waste of time to sit at a chair and write documents every day like this. I know A.I. will replace such tasks in the near future. I always tell my sons to study, which may make them feel the same way. It’s impossible for me to keep writing past closing time. I get tired and nothing sinks in. My brain just shuts down. Still, I know I need to get serious soon or people will think I am slow. So I will decide in advance what I need to do today and pick just one thing I know I can definitely accomplish. If I can do that, that’s good enough. I will gradually increase the workload. No pushing myself. Today, I’ll read the brain MRI scans. And from now on, if I get a request to read, I’ll finish it the same day. When I finish it, I’ll head home today.
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Chronic subdural hematoma
A 90-year-old woman developed chronic subdural hematoma with impaired consciousness. Due to a history of dementia, she had not recognized her family and had wandered. Since they could not have cared for her at home, they had had her enter a nursing home. The daughter was informed at ER: “The surgery for chronic subdural hematoma is straightforward with minimal risk. We can expect positive outcomes, meaning she could return to her previous state, but her dementia will likely worsen. If you choose conservative therapy, she is unlikely to regain consciousness. However, given her advanced age and severe dementia, non-surgical procedure is also an option.” After consulting with other family members and deliberating, the daughter requested surgery. The procedure concluded as scheduled; it was an extremely simple technique with no complications. Postoperatively, consciousness was restored. The family rejoiced. “She doesn’t recognize me as usual.” she remarked.
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A long day
A patient who underwent surgery for lumbar disc herniation has not recovered. Post-operatively, she developed paralysis and pain in her lower limb. She has also reported weakness in her hand, but which seems unrelated to the surgical site. She is hospitalized for rehabilitation, leaving her elementary school-aged daughter at home. She must resent me. Every time I see her moving down the hallway in her wheelchair, I feel sorry.
I participated as an assistant in a VP shunt procedure, which took two hours. That’s too long. The surgeon was a third-year doctor. It went very well until partway through. After passing the abdominal catheter subcutaneously, he noticed the valve was damaged and replaced the catheter. After connecting the ventricular catheter to the abdominal catheter, the valve position and ventricular catheter length didn’t match. We had to disconnect everything again, shorten the catheter, and reconnect it. Just writing this makes me feel sick. The abdominal incision was small, which was the one positive aspect. The postoperative CT scan showed no abnormalities.
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Stroke on oral contraceptives
A 50-year-old woman suffered a cerebral infarction. She had quit smoking in 10 years. She has a history of scintillating scotoma without migraine. She had been taking oral contraceptives for dysmenorrhea for the past 6 years.
While it is well known that migraine with aura increases the risk of cerebral infarction, does scintillating scotoma alone constitute a risk factor?
The stroke was diagnosed as related to oral contraceptive use. After consulting with the gynecology department, the oral contraceptive was discontinued.
For stroke diagnosis, questioning about medications taken is essential, and for women, it is crucial to ask about menstruation, even though it may be difficult to inquire about.
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What for?
When I showed Ms. Yamamoto my old blog, she just said “What for?”, after scrolling through a bit. It was writing where I honestly poured out what I thought, and it was also writing where I jotted down small truths discovered in daily life.I’d never shown it to anyone before, but I wanted her to read it.
Yet her reaction was unexpectedly cold. True, it was a disjointed collection of writings, probably boring to read. And making her read about my troubles probably felt to her like, “We’re not that close, so what for?” I misjudged the distance between us. She was farther away than I thought, and now she’s drifted even farther.
I agonized over it, but deleted every single post.She is tall, with well-proportioned features. My first impression was that she was sophisticated. She is the type who thinks she is saying something funny, but others don’t see it that way. Even so, she kept saying boring things without faltering. “What for?” might be her catchphrase, but it was the most boring thing she ever said to me.
However, I restarted my blog three days ago. Why? Because I found someone I wanted to read it more than her. -
The final station “HAPPINESS”
Imagine a track laid toward the final station called “HAPPINESS.”
What would parents do to get their child onto the train running along the track? If they want to put their child on the luxury train—getting into a good high school, a good university, a good company—they’d likely push them to study hard since younger.
But the child boards the train only to find they don’t know how to get off. The parents can’t ride with them. If they want to change destinations mid-journey, it would be helpful if someone taught them how to switch trains. But without such an opportunity, they might try to jump off the moving train.
If parents put their child on the train, they must also teach them how to get off. Or they must acknowledge that walking at their own pace is also a valid choice. However, they must warn them that walking on the track is dangerous because the train will run them over without mercy.
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When will ‘always’ end?
A 70-year-old woman has received weekly blood transfusions due to myelodysplastic syndrome. She declined chemotherapy and opted for alternative therapies even though some times her physician had told her the risk of sudden death without chemotherapy.
She has been hospitalized in neurosurgery for the past month since she developed acute subdural hematoma by falling down and striking her head while attempting to feed her cat. Upon admission, she presented with mild impaired consciousness and aphasia. After receiving platelet transfusions, she managed to get through the acute phase without surgery. She is now undergoing rehabilitation while preparing for discharge home.
Recently, after rounds, she tells me, “Thank you, always.” I like her word, “always.” I don’t remember when she started saying “always.” When does “always” begin, and when does it end? I suggest she may say it because she knows when it will end.
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Paralysis after surgery
A patient in her forties underwent spinal surgery. It was endoscopic surgery for a lumbar disc herniation. Postoperatively, she developed paralysis in the left leg, and the back pain worsened. A CT scan revealed no hematoma was related. It appeared the nerve had been damaged during the surgical procedure. I called a supervisor who had performed a main part of the surgery. He gave me good advice but did not come to see her. Six hours post-op, I went to see her. She said she felt her leg might be moving a little better, but as far as I could tell, there was almost no improvement. Who could possibly accept the reality of waking up to find their leg no longer moves?
I don’t want to be thought of as “Dr. Takeda.” Dr. Takeda is the protagonist of a manga based on a Japanese neurosurgeon who repeatedly made medical errors and was sued. However, since I’ve had major complications during spinal surgeries on several occasions, nurses might be calling me “Dr. Takeda” behind my back.
WILLPOWER MELTDOWN SOMETIMES 