10/26/16
Neurosurgery101Twitter

What’s it all about

Welcome!

It’s About So Much More Than Brain Surgery.

It’s About Life.
We’ve even got videos.

Neurosurgery101Twitter

Neurosurgery 101—TheBlog is about life and some of its harder or more interesting moments. If you have ever wondered how a craniotomy is done, or how hydrocephalus is treated, or what surgeons listen to in the OR (they listen to stuff?!)—you’ll find this blog interesting. It’s for the lay person, the medically-minded person, or anybody with just a little bit of interest in the goings on of the body human, or the human body in disease. It’s about what happens when things go wrong and how we—those of us in medicine—pick up the pieces. When I talk about this stuff, it’s nonfiction. It’s a case of truth is stranger than fiction.

But it’s more than that too. Sometimes I post reviews. These might be about books, like Peter Clines awesome sci fi techno thriller The Fold.  Other times my reviews are about personal experiences, like my unfortunate several days with The Flu in 2012.  Sometimes I answer questions people ask me, like What is a pinched nerve? or Can a person break their neck without becoming paralyzed?

And of course, there’s the fiction. I love fiction and read constantly. You’ll never find me without a book in hand—unless I’ve got a pen for writing. Fiction, both reading and writing, is my #1 passion. You’ll find lots of cool fiction here. 

What you won’t find here is medical advice. I am not practicing medicine online. I also won’t be talking about specific patients. Not even close. Privacy is the law of the land and I believe strongly in it, especially when it comes to one’s health.

Some things I may cover in the not too distant future, or that you might just find cool right now:

What is a pinched nerve and how do you ‘unpinch’ it?

Why does my back hurt so much? Check out this awesome 11 minute video on back pain.

What is sciatica?

When is back pain treated with surgery?

What is a lumbar fusion and how is it done…

How do you open a living skull?

What is hydrocephalus?

What is a concussion?

Can you really operate on the brain with a patient awake?

Can a person break their neck and not be paralyzed?

Is there suppose to be fluid draining out of my back after surgery?

Well, you get the idea. There’s a super amount of information here, some fiction and some nonfiction. I talk a lot about my books and stories too. The interested writer can get a pretty good feel for where I get my ideas and how my stories evolved. For everyone else though, it’s just damn interesting. So come back often and don’t forget to sign-up for updates.

And if you like the writing here, you’re gonna love my many novels, novellas, and short stories. Hop on over to Amazon for a look at my fiction RIGHT NOW. Or read about the stories using the menu at the top of the page. I would suggest you start with THE WRITING.

BooksHeader

CWHeaderNEUROSURGERY101— TheBlog. Life on the edge of a scalpel. For those who have ever wondered what goes on behind the closed doors of the operating room, or the innards of the human body.

NEUROSURGERY 101— TheBlog. Because, outside of a dog, books are a man’s best friend. Inside of a dog…well, that’s what this blog is gonna find out.

NEUROSURGERY101— TheBlog. Because nobody gets out of life alive.

 

03/13/16
Calvin, Jr., standing next to his father 9 days before his death from infection.

A Brave New World of Medicine

A Brave New World
By Edison McDaniels, MD surgeonwriter.com | nonfiction

†††

So, imagine this.

A malignant brain tumor. Fatal? Maybe not in the near future.

You, or a loved one, aren’t feeling well. Maybe it’s a persistent shortness of breath. Or perhaps a nagging ache in your thigh. Or how about a headache that just won’t go away. Or you get up to piss one morning and there’s blood in your urine. How freaky would that be?

Probably you try to ignore these symptoms for awhile. The human mind has an amazing ability to cordon off that which it least wants to deal with. Eventually—days, weeks, even a few months—you decide to see a doctor. You don’t want too, it’s an interruption to your life after all, but you can’t ignore that something is wrong any longer.

“Cancer,” your doctor says.

The word hits like a piece of sky falling upon you. At once, your world is not what it was even a moment before. It’s not just a piece of the sky, it’s a rupture of everything you’ve ever imagined. It’s a near complete erasure of your dreams. What, you wonder, does your future hold? More to the point, do you actually have a future?

That’s a goddamn scary scenario, one that arises for thousands of folks every year.

In the pre-antibiotic era, roughly before WWII, it was infection that elicited that response. In 1924, President Calvin Coolidge’s 16 year-old son died of sepsis from an infected toe (the President later wrote “When he went, the power and the glory of the Presidency went with him…”). Today, such a death is near unthinkable and certainly, in the developed world anyway, rare. Death from infection has not been completely wiped out—and never will be—but the average joe doesn’t live in fear of it and the power and impact of modern antibiotics is immense.

If infection was the scourge of the early twentieth century, cancer is the scourge of our time.

A recent development in medical research has the power to change that. Researchers have managed to grow a tiny beating heart in a petri dish on the lab bench: READ THIS

Envision a future where all sorts of human tissues are grown up in the lab. Not just cells, but 3D organs with structure and function. We could imagine all sorts of uses for such tissues—ending the shortage of organs for organ transplantation is the most obvious—but think about this: if researchers can grow normal cells, they can also grow cancer cells.

Which means they can study them. Living, human cancer cells in 3D, acting and behaving just as they might in vivo, inside the human body.

Wow.

Cancer is a disease of the cell’s regulatory machinery, changed in severe ways so that growth is no longer checked. Like water spilling over a cofferdam, cancer cells just keep on dividing and dividing and dividing until they overwhelm the body. Some cancers grow faster than others, but unchecked growth is the hallmark of every cancer.
In order to treat cancer, physicians target these wildly growing cells with toxins of various sorts—and hope the toxins will be less poisonous to the body’s normal cells. Less toxic is relative of course. What these toxins (chemotherapy and radiation both) actually target is the machinery of growth. What this means is that only dividing cells are affected. This includes not just the cancer cells, but any normal dividing cells as well—and the more rapidly dividing a particular group of cells is (we call these like-minded groups of cells tissues, which commingle in turn into organs, like kidneys, liver, the heart, lungs, etc), the more affected they will be by the cancer treatment. This is why cancer patients lose their hair and develop diarrhea—hair grows fast, as does the lining of the intestines, which is constantly sloughing and replenishing.

 

Calvin, Jr., standing next to his father 9 days before his death from infection.

Calvin, Jr., standing next to his father 9 days before his death from infection.

Researchers spend billions of dollars a year looking for drugs that are relatively less toxic to normal cells and tissues and more toxic to cancer. But what if your doctor could take a piece of your cancer, grow it up in a lab, and then rapidly subject it to many and various drugs—toxins—alongside normal cells?

They could then determine not just the most effective drug to treat your cancer, but the least toxic one for the rest of your body. And with that knowledge, they could use the target drugs at the best doses to provide the most effect at the least risk. They would be killing the cancer and saving the person.

And that folks, is how you prop up the sky.

 

 

Read The Crucible today.

A far surpassing tale of surgical suspense. Available on Kindle for just 99¢.

Just 99¢ on Kindle. Click the image.

07/10/14
BrainVeins

Veins of the Brain

BrainVeins

A Neurosurgeon’s Perspective on the Veins of the Brain

The most curious thing about the veins of the brain is how seemingly innocuous they are, until you mess with them. They can get you in trouble in a hurry. Thin walled, they can be very stubborn and persistent in their oozing (and oozing is what they do, this is largely a low pressure system). They don’t hold stitches well, so often if damaged they have to be sacrificed. That may or may not turn out well. In general, if a vein has a name (vein of Labbe, vein of Trolard), it was named for a reason. Probably somebody in the past messed with it, usually with poor consequences.

For instance, the vein of Labbe is the largest vein draining the temporal lobe into the transverse or sigmoid sinus. Sacrificing it often results in a stoke of the temporal lobe—so much so that one rarely violated rule is ‘don’t fuck with Labbe!’ The vein is Trolard is a less constant vein, usually draining the parietal lobe up to the superior sagittal sinus.

Sinuses differ from veins in that they are designed not to collapse. They carry great volumes of blood under low pressure, but they don’t like to be occluded (stopped up). They bleed copiously and when stoppered, even for a few seconds, the brain behind them swells dangerously. Not good.

Click to see JUICING OUT on Amazon.

Click to see JUICING OUT on Amazon.

In my stories, I have written several fictional scenes of a neurosurgeon dealing with venous bleeding. Here’s one, from my novella JUICING OUT, which is just 99¢ for the Amazon Kindle (though the price is going up soon):

He looked pale. Like instead of a bullet to the brain he’d taken a vampire to the neck. His blood pressure was ninety over thirty one moment and sixty over fuck the next. If he had been awake and not anesthetized, he’d have passed out. He would have fainted and never awakened. Yes sir, he looked like a forty percenter to me.

Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I thought Bobby’s days of doing her were just about over.

I stole a glance at the scrub tech. She was frantically trying to get the instruments laid out and ready. I glanced at the table, saw a scalpel and a mess of hemostats, scissors, clamps, and sponges. I thought it probably wouldn’t be enough. I thought it had to be enough. Jesus Mother Mary. You wait any longer, I told myself, you’ll be operating on a cadaver.

“I can’t wait,” I said. “Help me with this, Joe.”

Together we unwrapped the diaper and the crown of his head came into view. He was mostly bald, middle-aged or better I thought. I hadn’t asked his age in the confusion, not that it mattered much now. His age would be on his tombstone after all. No confusion about that.

The skin at the back of his head was torn and bruised. I saw that much. Then Joe pulled the diaper off the hole in Bobby’s skull and the damn burst wide. A sea of dark blue, almost black, blood. For an  instant, it poured out like somebody had diverted Niagara freakin’ Falls into that broken head. Acting with twenty years of experience behind me and without really thinking, I stuffed a wad of cotton into that opening. It might make things worse, might even kill him on the spot if there was a clot inside half as big as the wad of cotton outside. That clot would press the brainstem and then, in the words of Josie’s grammie, he’d go to ground quick. But I didn’t think that would happen. Blood finds it’s own level, and, like water, is always looking for a way out, any way out. I hadn’t seen a clot on the scan (which at twenty minutes old was, admittedly, now ancient history) but the man had looked too good right up until a minute before. So I pressed that wad of cotton against the hole in his skull, against his brain, and bought us a few more precious minutes. “Get that blood, goddammit.” I hadn’t even had time to wash my hands or put on a gown.

“Getting frequent PVC’s over here.” Back flips again. The beeps filled the room, going up and down like a radio signal you couldn’t quite tune in. Bobby’s heart was losing the race. “We need blood for christ’s sake.”

The door opened just then and a pimply faced kid came in carrying a picnic cooler. If he had a clue he was carrying the man’s life in his hands, he didn’t show it. “Hey who do I give this to?”

The blood was hanging within one minute. One of the anesthesia folks (I couldn’t keep straight who was doing what and didn’t try) was squeezing the blood bag between his hands. When the first was finished, he squeezed in a second. He was on his third bag before I pulled away the cotton.

A large piece of lead floated out of Bobby head, followed by dark chunks of what could only be pieces of Bobby’s brain.

The torrent started up again. It flowed steady rather than pulsed with his heart. I knew from that, and from the amount of blood, that it was that mofo vein bleeding. And probably more than a small tear if the amount of blood was telling. I thought there had to be a hole the size of Montana in that thing. “Jesus Mother Mary” I said, then “Stitch!”

The scrub tech slapped a needle holder into my palm, a curved needle and silk stitch clamped into the end of it. I might have closed my eyes—I’ve been told I do that sometimes in surgery when I’m trying to visualize something—though if so I don’t remember doing it. I took that needle and aimed it into the pool of blood. “Suck here Joe, right here,” I said, and when I thought I could see something, something gray and not black red, I plunged the pointy end of the needle through whatever the visible tissue was and looped it out again. I cinched it down and tied it quick, then repeated the maneuver again after adjusting slightly for lighting, sweating, my own bounding heartbeat, and the regret I wasn’t wearing my own diaper. We’re losing.

An image of Josie came to me then. Josie in her Howard Johnson’s maid’s outfit, her weight in the upper limits of the couch potato zone, her unhealthy ruddy complexion. She sucked a cigarette and smelled of pinesol from the toilets she cleaned. The blue beneath her eye had coalesced somehow and now she had a decidedly black eye. Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I know he love me.

I fished out another piece of lead. Either the blood was slowing or whatever was left in his veins was thinning, I couldn’t say which at that moment. But I thought maybe I could see better, that Joe was doing a pretty damn good job moving that sucker here and there, sucking away the blood and oozing brain so I could work. Looking at that broken mess, looking through that thinning blood, I suddenly saw what needed doing, how there was not but one thing to do.

I saw that if I oversewed that mofo vein, it would probably kill him within a few minutes. That’d be like plugging a hose at its business end while water still flowed in from the faucet. In a few seconds that hose would rupture at its weakest point. Bobby’s weakest point was somewhere deep inside his skull, somewhere I hadn’t a prayer of getting to, and when it burst—game freaking over.

But I had no other choice. He was like a pig on a stick otherwise. I could watch him bleed out right now, or I could oversew that mofo vein and wait a few minutes for his head to explode.

He hardly ever do me when I don’t want it. I know he love me.

I thought, So that’s true love then This is for you, Josie. It’s all I got left to save your ain’t no bad guy. And I began to oversew that mother-fucker. When I was nearly done, I looked up to see Bobby’s color was better and, more important, his heart sounded a steady beep throughout the room. More important still, the puddle of blood at my feet had stopped growing and the flow out of his head had thickened and trickled. A few final throws and it stopped altogether.

“Damn fine job, Sam,” Joe said. “You can cut on me anytime.”

Want more? JUICING OUT, a kindle novella for just 99¢ over at Amazon. Give it a read today. Thanks.

05/22/14
RareKindFaith

A Rare Kind of Faith

RareKindFaith

A Rare Kind of Faith
by Edison McDaniels | surgeonwriter.com | fiction

I knew there was nothing I could do as soon as I saw those films. One o’clock in the damn morning and raining, but the cold that came over me as I studied those images had nothing to do with either the night or the rain. It was the dread of knowing she was beyond any help modern medicine could offer.

She was going to die.

Not right there, not even that night. But as I stared at the flat, impersonal images of her wounded brain, my mind reassembled them into something fuller, into three-dimensions that I could work with, could contemplate. It was a useless effort though. All my contemplations told me she was never going to see four years old. I hated myself for knowing that just then.

I flipped the switches on the light boxes, darkening the room. I stood for a long moment, my right hand rubbing a new crease into my forehead. It was damn hard standing in that room, and I grew a headache just thinking about what was coming. It’s a difficult thing to tell somebody they’re dying—it’s another thing entirely to tell someone their future is dying, that all their hopes and aspirations have met a dead end. Literally.

 

I was in no hurry to impart the secret I alone knew. The hospital corridor was dim as I walked the hundred or so feet from radiology to the ER. Half the lights had been turned off, to conserve energy I guess. It leant the place a surrealistic look though, and in the darkness of that moment I sensed the hand of death and its long, cold fingers nearby. But a neurosurgeon, that would be me, comes to know that death is always nearby, never more than a heartbeat or two away in either the day or the night—it just seems closer in the dark. As my footsteps echoed in the empty night, I imagined the grim reaper and those hands—oh God, those hands: big, brutish, calloused, almost a foot from base of palm to fingertips, those tips with their cold, unmerciful touch. I saw the face of death too, obscured not by an executioner’s hood but a mask, the kind we wear in the operating room, where the eyes alone speak for us. As I imagined it, the reaper’s eyes were dark, sunken, lurking things I couldn’t quite look at—some things are better left unseen, even unimagined. Walking down that corridor, death cast a clumsy shadow—the boogeyman, the closet monster from my childhood, the eater of souls. Me.

I wasn’t the grim reaper of course—just the messenger. I would deliver the news, they would fall apart, we would call somebody from the clergy to help out, she would be admitted, and the futile suffering that was the battle to save her young life would begin.

I had seen it all before, had even given it a name. I called it the Sidney scenario.

I stopped by the desk for the medical record. I had gone directly over to radiology upon my arrival and hadn’t needed the girl’s name then, there aren’t many brain tumors lurking about the ER in the middle of the night. The first thing my eyes happened to fall upon was her birthday, which was my birthday as well. An odd coincidence I could have done without at that moment. I’m not a superstitious person, but I’ve always been fascinated by birthdays and the coincidences that stack up around them. Sometimes they’re just interesting, like her having my birthday, May 12th. But this went beyond that. This time it was downright eerie.

This little girl was born on May 12th and her name was Sidney Berry. Sidney, like my little sister, the one who died on my ninth birthday after a long and mostly futile battle…with brain cancer.

Yeah, I’ve seen it all before. And from both sides.

 

The curtain was closed around the cubicle and I stopped a moment, either to draw a last ounce of strength before entering—or to allow them a last moment with their precious future, with all their hopes and dreams still possible. When I did open the curtain, I found a black man of about forty sitting on the single chair beside the gurney. On the gurney itself was the cutest little girl. She had olive brown skin and thick black hair combed back into a single pony tail held together with a wide pink ribbon. She wore pink pajamas to match, a one piece sort that included booties and a long zipper down one leg. She was lying over on her side facing her father and when I entered she popped up immediately and smiled at me in a way no patient before or since ever has. Her lips curled back in a pleasing grin, her cheeks dimpled, and she batted a pair of big, soulful eyes at me. Her smile was comfortably familiar from the first and I had the impression I already knew her—and that she knew me.

There was something else about that smile though, something intensely disturbing, and it was probably the reason I had been called so quickly that night. It was uneven, a subtle asymmetry between the two sides, but glaring to my trained eye. She was still beautiful, but the left side of her mouth lagged and the dimple there was mostly just a suggestion. I suspected it had only been like that a day or two at most, otherwise somebody would have brought it to her parents’ attention. Parents are often the last to notice things like that.

Mr. Berry was a big man, not fat but big boned. He too smiled and immediately rose from his chair, putting his hand out to shake mine. I introduced myself and asked if Mrs. Berry was about. He said yes, that she had gone to the bathroom and would be back presently. Okay, I replied, then asked a few questions to gather a history. It wasn’t terribly important that history, but I wanted and needed to establish a rapport. You can’t just blurt out I’ve seen the images of your daughter’s brain and you might as well start looking for a coffin now. Truth be told though, I’ve seen physicians do just that.

When Sidney’s mother returned I introduced myself to her, leaving out—for the moment—that I was a neurosurgeon, just as I had done in introducing myself to her husband. Nobody’s ever happy to see a neurosurgeon, especially when their child—their future—is concerned. I wanted to work the field on my terms just then, bring them up to speed slowly and compassionately.

We talked awhile. Small talk in the wee hours of the ER I suppose. Often this is awkward, but there was no awkwardness in that cubicle that night. The Berrys were beautiful people, gifted with the most genuine and soft manner. They made me feel at ease. They both were obviously well educated—he was a Navy Captain and she was a college professor I found out later—but there was nothing pretentious about them at all. 

Sidney had been diagnosed with an ear infection and I asked about that. “That’s right,” Mrs. Berry said. “She’s been pulling at her ear a lot lately, keeps rubbing the side of her head as well.”

“I see,” I said. She’s probably had a headache I thought. Kids will do odd things with headaches, just about everything except say they have a headache.

I had been leaning against the gurney all this time and now, as Mrs. Berry spoke, Sidney stood up and put her arms around me from behind. She laid her head on my shoulder as naturally as my own daughter would. She too was just three and the similarity between the two spooked me as I felt Sidney’s small embrace. For just a moment I found it hard to concentrate on what her mom was saying. “Any vomiting or problems eating?” I finally asked, knowing the answer.

“Hasn’t been eating well, just picking at her food. I thought it was the flu at first.” She looked at me and I saw the concern in her eyes.

“And vomiting?”

“No vomiting, but, and this is the reason we came in tonight, she’s been gagging a bit,” Mrs. Berry said.

“Can you tell me about that?”

We talked some more and I tried not to appear overly concerned, but I was never very good at hiding a thing like that.

“Do you know what the problem is?” Mrs. Berry finally asked.

“Well, let me examine Sid and then we’ll talk, okay?”

Sidney still had her arms around me from behind. Her father picked her up and she immediately kissed him and offered an enormous though lopsided smile. Pound for pound, I’ve not seen a bigger smile since and it made my heart glad. He gently set her back on the gurney.

“Sidney, can you close your eyes tight sweetie?”

She did and I saw immediately how her left eyeball rolled upward until only the white was visible. Called a Bell’s phenomenon, it always looks a little eerie, especially in a three year old. It’s not abnormal though, the eye is suppose to roll up like that. But Sidney’s eyelid, which was suppose to cover it, stayed put. That was the abnormality.

Next I had her stick her tongue out and instead of jutting straight out, it veered to the left. Damn, I thought, ticking off a list in my head. Each abnormality served only to confirm the diagnosis and offered small comfort.

When I finished the exam, Sidney laid down and closed her eyes. Looking at her, I couldn’t help but think of my Sidney, my precious little sister, and of the Sidney scenario: the lingering torment her death became. It always seemed to me she had spent her last few weeks and months dying when she should have been living. I put the image of Sidney—both of them—out of my head and turned to her parents. I couldn’t put off what I knew any longer.

They looked at me and I at them. I can’t say that I fumbled for words. I had been a neurosurgeon a half dozen years by then and finding the words wasn’t the problem. It was the sentiment that I struggled with, trying to keep my voice from breaking. In less than an hour, this little girl had turned me inside out. She had that kind of force of personality. Some people live seventy years and never make an impact on another person. Sidney Berry was three and had an impact on every person she met.

“I’m sorry,” I said, “there’s a tumor.” And just like that, they knew. We spent some time, quite awhile really, discussing it. I told them it was inoperable, suggested they get another opinion. When we finished, I said I’d make arrangements to have her admitted.

“Why?” Mrs. Berry asked. “What can you do for her tonight that we can’t do for her at home in her own bed?”

The answer, of course, was nothing. What better place could there be for a little girl with an inoperable brain tumor than home in her own bed, surrounded by all her familiars, by her loving family? And just that quick, I knew.

The Berrys got those other opinions, but so far as I know she never spent a night in a hospital. She died in her own bed just shy of three months later, after a trip to Disneyworld and with her family at her side. She might have lingered a bit longer with chemotherapy, but that wouldn’t have been living her parents said. They had faith she was going to a better place and what they wanted to remember was the way she lived, not the way she died.

A rare kind of selfless faith that was—letting a child live in the midst of dying. It made my heart glad.