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Typical Day

Dr. Melon wakes at 3:00AM to the sound of his cell phone. His wife rolls over and asks, "Who's calling you so early?"

"The hospital. They have a patient who was in an accident last night, and he needs immediate surgery."

"Why can't they call someone else? You've already performed fifteen surgeries this week and we're supposed to go shopping for a new dresser tomorrow." It's safe to say that Dr. Melon's wife doesn't really "get it" when it comes to what he does for a living.

Brain surgeons typically perform forty to fifty brain surgeries and 160 to 180 spine surgeries per year. It's not unusual for them to perform fifteen brain surgeries in a week, and they often find themselves working sixty-plus hours in a single week. It doesn't leave a lot of time to catch up on all your Thursday shows. Luckily, they can catch up with their family and friends using Twitter or Facebook between surgeries.

Dr. Melon enters the hospital and speaks to the patient's physician about the trauma. Surgeries following a head trauma are rare. Brains aren't like broken legs or skin; they're actually like Jell-O, so they can't exactly be sewn back together. 

Patients need surgeries after head traumas to alleviate brain swelling, remove blood clots, repair blood vessels, or control pressure inside of the skull. Physicians can diagnose problems like intracranial pressure buildup based on the description of the injury, the nature of the symptoms, and CT scans.

Dr. Melon washes up for the surgery. His favorite nurse, Peggy, is on call and they spend a few minutes joking around. When you're cutting up brains all day, you need to keep it light the rest of the time.

"Why's a female brain cheaper than a male brain?" Peggy asks.

"Because it's been used. Ha—I've heard that one a million times."

The patient comes in, and Dr. Melon and Peggy get down to business. To cut open his patient's head, Dr. Melon uses a drill to create a burr hole. Through the burr hole, Dr. Melon inserts an intraventricular catheter, which penetrates the leathery membrane that surrounds the brain to drain excess fluid. 

(We'll pause a moment while you fetch a barf bag.) 

The intraparenchymal catheter relieves pressure caused by excessive cerebrospinal fluid.

"Peggy, do you remember when that hospital lost a bone flap?"

Or, as the pros call it, the Bone Flap Preservation Unit. (Source)

"Yeah, how do you lose a bone flap? Did someone take it home with them?" That actually isn't a joke. Occasionally brain surgeons will remove a section of the skull in an operation called a hemicraniectomy. The surgery gives the brain some room to expand. The bone is later re-implanted in an operation called cranioplasty. To keep the bone fresh, the doc stores it in a refrigerator.

"Yeah, and then the doc's husband threw it out along with the expired mayo." Dr. Melon can't risk laughing during surgery, but he smiles.

The surgery is a success and Dr. Melon washes up. He walks back through the ER and runs into the patient's family. The patient's wife asks Dr. Melon how long her husband will have to stay after surgery.

"Two to eight days," Dr. Melon tells her. It's a ballpark number, but the length of time a patient has to stay in the hospital greatly depends on the exact nature of their surgery. Two to eight days is a safe bet.

Dr. Melon checks his watch. It's 7:20AM. If he hurries, he'll be able to grab a quick breakfast with his wife before furniture shopping. Before he makes it out of the parking lot, though, he gets another emergency call. A senator has been admitted into the hospital for a condition called an arteriovenous malformation, which is a congenital condition that causes an abnormal tangle of blood vessels in the brain. 

Oftentimes, the condition is diagnosed when a patient has high blood pressure and a difficult time being coherent (which describes most senators, actually). Because of the seriousness of the condition, brain surgery is immediately required. Left untreated, the patient's brain could bleed, which can lead to brain damage or death.

Dr. Melon texts his wife and gets ready to scrub up again.

If you see anything other than fruit here, you may have suffered a head injury.

The morning flies by (the operation was a success, by the way) and Dr. Melon still hasn't managed to leave the hospital. He finally manages to get away around noon, but it's only to attend an NFL Head, Neck, and Spine Committee meeting. 

The NFL chose Dr. Melon to serve on the committee because of his expertise in dealing with brain trauma...and his avid dedication to the sport. 

His BMW is covered with so many stickers it's almost a hazard to look out the back windshield. He's also been known to paint his balding head on game days. As part of the committee, he's developed a database that explores the connection between head injuries and cognitive problems experienced by players later in life.

By nine o'clock, Dr. Melon finally makes it home. He sees three different dressers in the entryway. His wife walks over and wraps her arms around him, "I couldn't decide, so I bought three. We can take back the two you don't like. I just wanted to pick your brain first."