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I mentioned on Twitter a little while back that I saw my first real, live, pulsating brain in the OR. I was watching a craniotomy on a woman who had fallen and hit her head the week before. She was bleeding and clotting too much for the space in her skull to handle. Her brain had shifted almost 18mm over the midline. The neurosurgeon cut out a hockey-puck sized piece of skull, carefully sliced and folded back the thick leather-ish brain casing and scraped, sucked and flushed as much blood out as he could. He then inserted a plastic drain tube and fitted the circular skull piece back in place.

The procedure was super cool. The patient recovery was astonishing. Brain surgery is nothing short of miraculous.

The surgery was emergently scheduled at 5pm on a Friday. A most inconvenient time of day for the operating floor that was in the process of cleaning up and shutting down. Also extremely inconvenient for the neurosurgeon who was meant to be on a plane to some convention on the sunny west coast. Bummer.

While we waited for them to prep the OR and patient, the neurosurgeon spoke candidly with us as he flipped through images of luxurious cars online.

“I was young and stupid when I chose neurosurgery,” he said. “If I had it to do all over again, I would marry my family instead of my job.”

This morning, I was reminded of that conversation when I read this post on Mothers in Medicine. It’s one in a series of “A Day In The Life” written by women doctors from a variety of specialties. This neurosurgeon mom finishes reminiscing about her day with the following paragraph:

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.

Back to the neurosurgeon at our hospital: “I tell every single student I see that if there is anything, ANYTHING in the whole wide world that you can be happy doing other than medicine, do it.”

it’s always sad when two of my favourite subjects come together in a negative way.

Two neuropathologists are prominently spotlighted in an article by Malcolm Gladwell in the October 19 issue of The New Yorker. The article explores a provocative question raised by autopsy results on football players: namely, should football be illegal?

Featured are Dr. Ann McKee, neuropathologist at the Veterans Hospital in Bedford, Massachusetts and Dr. Bennet Omalu, forensic neuropathologist and San Joaquin Valley (CA) chief medical examiner. Drs. McKee and Omalu have done some interesting autopsy work which suggests that chronic traumatic brain injury leading to dementia suffered by football players is much more common, even among high school players, than previously realized.

What’s alarming is the presence of abnormal collections of a protein known as tau, one of the proteins one sees in cases of Alzheimer disease, in brains of young ex-football players. As an example, McKee provides photomicrographs from a case of an 18-year-old high school football player and says: “He’s got all this tau. This is frontal and this is insular…. This is completely inappropriate. You don’t see tau like this in an 18-year-old. You don’t see tau like this in a fifty year old.”

You might counter that this is simply the result of a few bad-luck hits on the field, but research involving the University of North Carolina football team suggests otherwise. Players at UNC wear impact sensors in their helmets throughout the season. Results from these investigations suggests that even routine hits during practice can add up to cause concussions and, theoretically, set the stage for chronic traumatic encephalopathy. (On the first day of training camp one UNC lineman was recorded as having been hit in the head thirty-one times!)

Back in 1905, Gladwell reports, the question of whether football should be played in our nation’s schools was raised to the level of the White House, when President Theodore Roosevelt called an emergency summit to discuss the issue. At the time, a professor at the University of Chicago called football a “boy-killing, man-mutilating, money-making, education-prostituting, gladiatorial sport.” And in December of 1905, presidents of twelve prominent colleges met in New York and came within one vote of abolishing the sport at their institutions.

What does this mean for football in America? Nothing. Fans are willing to spend a lot of money to see men slam into each other’s heads on the field. But, as a parent, you can do something.

You can forbid your son from playing football.

~ Brian E. Moore, MD (via KevinMD.com)