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Typical Day

Dr. Melon wakes at 3am to the sound of his cell phone. His wife rolls over and asks, "Who is 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 15 surgeries this week and we were supposed to go shopping for a new dresser tomorrow." It would be safe to say that Dr. Melon's wife never really "got" what he does.

Brain surgeons typically perform 40 to 50 brain surgeries and 160 to 180 spine surgeries a year. It is not unusual for them to perform 15 brain surgeries in a week. Oftentimes, they find themselves working 60-plus hours in a single 7-day span. 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 in between surgeries.

Many surgeons working in hospitals go from operating room to operating room during their day. Not all neurosurgeons work at hospitals. Many have their own private practices that specialize in specific problems such as tumors, cerebrovascular disorders, pediatric disorders, and epilepsy. Others work for universities or teach at medical schools.

Dr. Melon enters the hospital and speaks to the patient's physician about the trauma. Surgeries following a head trauma are rare. Brains are not like broken legs or skin. They are 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 brain all day, you need to keep it light the rest of the time.

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

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

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?"

"Yeah, how do you lose a bone flap? Did someone take it home with them?"

Occasionally, brain surgeons will remove a section of the skull in an operation called hemicraniectomy. The surgery gives the brain some room to expand. The bone is later reimplanted in an operation called cranioplasty. To keep the bone fresh, they store it in a refrigerator (next to the Gatorade).

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. The length of time a patient has to stay in the hospital greatly depends on the exact nature of their surgery. Many times patients stay between two to eight days. If the surgery was minimally invasive, they may have to stay for only a day. In fact, tumors that are removed using the Endoscopic Endonasal Approach only require that patients stay up to two days. To predict that you're gonna need to have one of those performed, you may have to be a regular Nostrildamus.

Dr. Melon checks his watch. There will be some time to grab a quick breakfast with his wife before furniture shopping. Before he makes it out of the parking lot, 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). 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.

The afternoon flies by (the operation was a success, by the way) and Dr. Melon still hasn't managed to leave the hospital. He breaks away from the hospital 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, as well as 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 has also been known to paint his balding head on game days. As part of the committee, he has developed a database that explores the connection between head injuries and cognitive problems experienced by players later in life.

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

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."

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