I'm back at work, so be afraid. But not as afraid as if you'd seen that one doctor.

Just a tip from Auntie Jo to the nameless millions of future hospital patients out there: if you sustain a subdural hematoma in a fall at home, and you need that subdural hematoma evacuated, make sure it's a neurosurgeon doing the evacuating.

Because if you let just any Fred Friendly into your brainbox, it's possible things could go very wrong indeed. This goes double if you're from Teenyville, that tiny town just south of Wherezat and east of Whadyasay.

Grandma took a fall a couple of weeks ago at home and conked herself on the head. It wasn't a very big conk, or a very painful one, but Grandma, being the careful sort (and being on coumadin and aspirin), took herself to the emergency room just to be on the safe side. The folks there checked her over, did a scan, and kept her overnight for observation. This was a very good thing, because Grandma developed a subdural hematoma during the night, and her level of consciousness dropped.

Subdural hematomas are interesting creatures. They're called the "walk, talk, die" injury because of the way they present: you're fine for some amount of time, and then you're very suddenly not at all fine. You become not at all fine because of bleeding below your dura, the covering of your brain, that puts pressure on the brain itself. A brain can stand quite a lot of abuse (that's the "walk, talk" part of the equation) before it finally starts being squished beyond tolerance or repair (that's the "die" part).

Anyway, back to Grandma. She started getting wonky, so the folks at Teenyville Memorial did a series of CT scans that showed an expanding subdural hematoma.

The correct thing to do at this point would've been to ship Grandma to a larger hospital, like Sunnydale or County General or even Our Lady Of Questionable Mercies. Instead, one of the general surgeons at Teenyville Memorial decided to take matters into his own hands and evacuate that subdural hematoma himself.

Evacuations are done with suction. Careful, gentle, less-is-more suction. By qualified neurosurgeons. In a neurosurgical suite, with nurses and assistants and anesthesiologists who know what they're doing. Because, if they're not, you end up with a cowboy with a suction catheter who suctions out part of Grandma's brain.

I'll just let that sit there for a minute while we all look at it in silence.

Yeah. It made me sick to my stomach, too, and I don't quease easily.

So Grandma came to us, because of course we work miracles, including inducing our patients to regrow large portions of their frontal lobes. (Yeah, right.)

Grandma is off the ventilator now, but she'll never write another thank-you note. She doesn't recognize her kids, near as we can tell, or even follow any commands. It's an even bet what did this to her: either it was the jacked-up surgery or the intense high fever she had afterwards (which is usually a sign that something has gone badly wrong in the brain) that wasn't treated correctly.

The general rule of thumb is that, if a patient has a temporal-thermometer temperature of 40 (that's...um...somewhere about 104 or thereabouts), and that patient is an adult, you say the hell with cooling blankets and start packing 'em in ice. You don't put them in a phenobarbital coma in an attempt to calm things down.

Sunnydale Hospital: For those times when even a Dustbuster won't pick up the pieces!

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So, yeah: the first day back at work was a runner of a day. There were more patients than I have fingers on one hand who were on multiple drips (note to self: three four-channel IV pumps on one pole will cause that pole to tip over), there were people with interesting breathing patterns, people with crazy-ass neuro changes, and folks who hovered on the edge of disaster all day long. Add to that the usual postop cases, and we had fun.

But you know what? I loved it. Getting back to work, while it was taxing, was the best thing I could've done. I spent the day as an extra set of hands, helping everybody without carrying any acutely ill patients on my own, and it was *great*. I took two very long breaks to stretch my jaw and rest my face, and ate lunch like a normal person, with conversation and everything.

It was also nice to hear from the most critical people in the world (CCU nurses and intensivist physicians) that I sound mostly normal and look really good.

Tomorrow is another day in the unit. It feels really good to type that, and to end the sentence with the word HOORAY!