Day one

Today was my first day as a ‘pre-resident’ on the neurosurgery unit. Multiple times I imagined us (me and my three colleagues) waiting for the secretary . Would it be awkward? Would we look at each other like dogs sometimes do, nose in the air while sniffling, trying to learn something about the others? And then again real life was much more fluent and less dramatic than in my imagination. We were let in by a enthousiastic young woman. We got a big brown envelope and after the required signatures, we could join the early meeting. I had to introduce myself in the shortest way ever, just a first name was enough. ‘The fastest way will do’ could be the first take-home-lesson.

Trying to put the patients and their details in my head, I got a call from a resident to come down to A&E. If I hurried, he would teach me a first lesson. In the box, an older man, transferred by an ophthalmologist (consulted for ptosis), was sitting on a chair, his shirt too big after recent weight loss and his shoulders hanging down. The ptosis was obvious, his left pupil hidden behind the eyelid. The resident told me to watch the patients chin closely and scratched the thenar eminence with his nail. After he told the patient to stop laughing, the chin twitched very subtly. I would never have seen it, thinking that these frontal release signs, were only described in books. Then he tapped lightly with his index finger on the patients lips and they moved as if he wanted to kiss something. Again a well-known frontal release sign. When his wife and daughter told us that his behaviour had changed since a couple weeks, making him a sleepy, indifferent and without initiative, we knew this fits perfectly with his scan: edema around a big frontal abscess. Perfectly round with a smooth border, controlling a ticking time bomb, that if damaged would lead to a septic shock. And that without any fever and absence of an inflammatory blood image… Then an incomprehensible complex of phone calls and consultations started his treatment plan.