The God Complex: Truth or Myth

This past week has been very enlightening. From my perspective before this experience, it seemed that surgeons were mavericks blazing a trail into a new horizon. TV made surgeons out to be egotistical maniacs that had the “God Complex.” As my time has progressed here, I have slowly learned of the teamwork needed between all of the people in healthcare to effectively treat a patient. Many patients have multiples issues and it is only with good teamwork by way of great communication that these patients have their best chance of successful treatment. In my experience here at Weill, I have not found a surgeon that could be accused of having a “God Complex.” It is easy to understand why they need so much confidence. As a resident and or fellow, they are constantly torn down by the attending physicians. Yes, it is deliberate but the intentions are not malicious in nature. One of the goals is to create people of strong character who will stand up for what they feel is the best treatment for a patient. Surgery has proven to be a field where aspirants should have a “thick” skin. The surgeons that I have met have been very confident. I am sure that I only want surgeons operating on me that have confidence. I think that there is a fine line between overconfidence and confidence; the surgeons here tread carefully.

Last week proved to be very challenging. There was more of the same but some cases draw a person in more than others. I asked a Neurological Surgery fellow,”How do you not get emotionally attached?” He began telling me a story about his third year in medical school. As he entered an examination room to see a patient, the patient took a deep breath and died before his very eyes. He explained that becoming emotionally vested in the patients that he cared for would be too taxing. Before coming for this Summer Immersion program, I probably would have thought that to be harsh and the easy way out. Now I understand how true his statements are. Each week there has been at least one case in which I felt some attachment. Sometimes your heart can not help caring for patients with compelling circumstances. In my position, shadowing a clinician, I began feeling the weight of this burden. It seems an almost impossible task to carry all of that baggage around. I began thinking about the patients too often. I was vested in their successful recovery. Being vested in their recovery alone would probably be ok, but that’s not life. Recovery is not always the path chosen. Death occurs often and sometimes without warning. I can’t begin to imagine the bag of bricks that I would have to drag around if I became attached the patients that we have seen thus far. Well, enough of that, we are moving on to the fun stuff!

A 36 year old woman was brought to the ER after suffering from numbness on her left side. We were told by her husband that her chief complaint before loosing consciousness was severe headache and splitting pains. For whatever reasons, she thought this would pass but it obviously ended up being more than she bargained for. While in the ER, she had a seizure involving her torso and left leg. This seizing began spontaneously. A CT scan showed an area of hypodensity measuring 3.3 cm with associated hemorrhage. At this stage, it was thought that the patient could be suffering from an AVM. On day 2, a second seizure was observed and treated. The patient’s movement was severely retarded. The patient was transferred to the NYH NSICU. After angiography, it was determined that this patient was suffering from sinus thrombosis. In this condition, a clot, thrombosis, has migrated the vasculature of the head and become trapped in one of the sinuses, venous system for the head. In short, blood was collecting in the patient’s head causing damage to surrounding tissues which resulted in paralysis on the left side.

After review angiography footage, a team of physicians were called in to consult on this case. It was determined that the best course of action would be to wait on TPA (tissue-plasminogen activator) treatment as the patient’s movement on her right side had become better. TPA involved certain risks and it seemed that the IV medications were helping. One of the risks was bleeding around the clot that had formed in the sinus. If this bleeding was unable to be controlled, a vegetative state could be the result. On the other hand, TPA could dissolve some or the entire clot and restore drainage. After no improvement over 12 hours, a couple of rounds of TPA were administered in the NSICU. The patient has improved at his point but is still undergoing treatment. She is a soldier with much to fight for as she is a wife and the mother of 4.

More on TPA http://www.americanheart.org/presenter.jhtml?identifier=4751