"I wake up every mornin'; I stumble out of bed; Stretchin' and yawnin'; Another day ahead." - Sheena Easton's "Morning Train" (Nine to Five)

Every morning is like that, since I have to be at the hospital by 7 am. The past week though has seen me getting up earlier than usual... and with great difficulty! You see I was in NSS aka Neurosurgery (though I wonder what the extra "S" stands for) and rounds begin at 5:30 am.

Rounds start at the NSS ICU, and then the NSS ward, and through the wards of other departments with co-managed patients--Neuro ICU, PACU, Burn, ENT, Pedia, Neuro ward, Trauma. We end at the ER, usually 9-ish. It's just the rounds that's toxic actually, but the residents teach us and the learning we gain along the way more than makes up for it.

OPD consults are held on Wednesday morning, and Thursday and Friday afternoons. I only got to attend the Wednesday OPD day coz I was at the OR on the other 2 days. Most of the Pts we get at the OPD are babies with hydrocephalus.

On Thursday, I assisted in a VP shunting/aneurysmal clipping procedure of Dr. Lagapa and Dr. Encanto. It was pretty exciting coz they actually *trusted* me to drill a couple of holes through the patient's skull.  The Hudson brace (skull-drilling device) has a locking mechanism that automatically stops the drill once the dura mater has been exposed (so you don't have to worry about drilling through the brain matter!).  I wasn't able to try the Gigli wire though, to saw through the skull. Dr. L proceeded to clip the aneurysm under the microscope , a procedure that especially requires an intact cerebellum, fine finger adroitness and good hand-eye coordination. Cool!  After which, when Dr. E closed the surgical site, he made me cauterize the bleeders and staple the skin.

Friday. We had the Neurosciences department conference in the AM. Drs. Rivera and Valencia gave an interesting talk on Moyamoya disease (it's Japanese, meaning a "puff of smoke", because that is how the abnormal vascular collaterals appear on angiography... like a puff of smoke! ) Assisted in another VPS procedure, this time with Dr. Pioquinto. Took her just 15 minutes to insert the shunt.

Saturday. Missed earlier part of AM rounds for Dr. Consunji's lecture on sepsis (Interesting article here on sepsis management ). He's so galing! He lectured for more than 2 hours, but I was able to absorb it all. Was able to catch up with rounds after the lecture. Dr. E showed a scan of a Pt who had a stroke. The brain could swell and the increased intracranial pressure would cause it to herniate. NSS was on board coz once that happens, they would have to perform a craniectomy (take out a piece of the skull) to allow for the brain to expand outward (and not through the brainstem). The resected piece of skull  can be deposited in the Bone Bank, or a small pocket can be made amongst the abdominal muscles where the bone is kept, until such time that the brain swelling has subsided and bone can be pieced back onto the skull...

Neurosurgery is so interesting! If only I had the manual dexterity, and the physical stamina for surgery training...  And the residents are verrry nice!  They even treated us to lunch at Hacienda Ristorante after the Saturday AM rounds. Lunch convo revolved around NSS topics, including a cow with hydrocephalus!

I chosed NSS for my subspec rotation coz I intend to go into Neurology. And I'm glad I did. I had so much fun and I learned a lot during my 1 week rotation in their division. But I can do without the 5:30 rounds!