WILLPOWER MELTDOWN SOMETIMES

Late last night, I was driving home from the hospital after I admitted an 80 years old man with traumatic subarachnoid hemorrhage. Allegedly he had fallen down on his way to a neighborhood meeting. I saw a cat that had been run over in the median strip. I saw its yellow eyes and something red.

This morning, I was riding my bike to the hospital. I found a fly sitting on my knee. I tapped my thigh lightly, and it flew away.

I saw the patient in an emergency ward. He was alert, and had no headache or nausea. A follow-up CT revealed reduction of the hematoma and contusion in the right frontal lobe. He said “I am a neighborhood leader this term. I want to leave the hospital by next week to attend a handover meeting.” Retired people volunteer as neighborhood leaders. Young people work for themselves, not for the community. I treated a few neighborhood leaders. They had responsibilities for the work and felt very stressed. They loved this town.

I told my son that I had seen the cat hit by car. He said “many cats are living around there. Did you save it?” I said “it was already dead though its eyes were lighting.”

Do you know anyone who has ruined their life by gambling? I don’t know anyone. I haven’t ruined my life though I lost one hundred thousand yen on boat racing last year. The year-end jumbo lottery is advertised on TV, saying “do you want to become a billionaire?” Is spending one hundred thousand yen on it compulsive? I don’t think it is worth it.

The boat racing is organized by local governments. In the boat racing, you just have to pick a trifecta from six boats, so the odds of winning are 1 in 120. The easier the prediction, the smaller the payout. Even if you pour the money you have earned from working into it, the boat racers and the organizers will get rich, but you will just end up poorer.

About 100 boat races are held every day. From those, I select a few races where Boat No. 1 is most likely to finish first, and I choose the second and third-place finishers based on past performance. This usually results in about six different betting combinations. I buy my tickets online at 8:00 a.m. and check the results in the evening. Until then, I work hard and don’t watch the races live online or check the pre-race practice runs. I promise.

I read an article about compulsive gambling on the Mayo Clinic website. It says “gambling can stimulate the brain’s reward system much like drugs or alcohol can, leading to addiction.” I have never felt my brain being stimulated by boat racing. It also says “being highly competitive, a workaholic, impulsive, restless or easily bored may increase your risk of compulsive gambling.” I have such personality characteristics. It may be why I can’t quit.

A 75-year-old woman presented to the hospital with coma. She had been found in her home.

Noncontrast head CT demonstrated extensive subarachnoid hemorrhage, and CTA identified a ruptured aneurysm in the anterior communicating artery. It was 9 p.m.

A neurosurgeon called me. He said, “I decide to perform coil embolization. Can you come for assistance?”

The procedure started at 11 p.m. A 6-Fr Fubuki guide catheter was advanced over the wire and navigated into the left internal carotid artery. Three-dimensional rotational angiography demonstrated a saccular aneurysm measuring 4 mm right to left, 6mm anterior-posterior, and 3 mm craniocaudal. An anterior communicating artery arose from the proximal aspect of the aneurysm wall. A 3.2-Fr Guidepost intermediate catheter was advanced to the cavernous portion of the ICA. An SL 10 microcatheter was placed into the aneurysm doom through the Guidepost. It was not difficult to place, because the A1 and the aneurysm went straight. Of course he had good skills. Three coils were placed through the SL 10. The microcatheter was removed, and subsequent angiographic views demonstrated good embolization of the aneurysm with flow stasis in the aneurysm dome and preserved flow through the anterior communicating artery.

It finished at 1 a.m. I came home and went to bed at 2 a.m.

A fifth-year medical student has been at the hospital for medical clerkship for three weeks. She will stay in a month. She is going to be a doctor after passing the national examination next year. I have to give her a grade on this clerkship. Just before rounds she said, “ do you submit my grade report to the college? I am smart to the extent that I participated in an observership program in the department of hepato-biliary-pancreatic surgery in England for two weeks last year. They spoke very slowly as they knew I didn’t understand English. I would like you to submit a good grade.”

It was very interesting. She has good communication skills. I will give her the best ever score.

A man in his early thirties passed away from a subarachnoid hemorrhage.

Three weeks ago, he presented to the hospital with a severe headache. A head CT revealed such a typical subarachnoid hemorrhage that neurosurgeons suspected there should be a ruptured cerebral aneurysm. An emergent angiography, however, showed no aneurysm. He developed hydrocephalus and underwent lumbar drainage. He had headache and mild cognitive impairment, but he could eat and walk.

Ten days after the initial onset, he developed another subarachnoid hemorrhage. This time an angiography showed very small aneurysm in the superior cerebellar artery. He underwent coil embolization therapy, but he didn’t recover. A postoperative CT showed severe ischemic changes in his brain. He had lived for a week with ventilation and vasopressin infusion. These days were necessary to accept his death. For whom? His family or us?

A fifty-year-old man was hospitalized for a cerebral stroke. He presented with mild hemiparesis in his left hand. I read his chart a nurse had written; he said, “I told an attending doctor that the weakness in my left hand had worsened slightly since yesterday. The doctor just answered ‘I see.’ I suppose he isn’t interested in it.” I was shocked. I didn’t mean it. His condition is stable, but his symptoms are fluctuating. For example, if he works hard for his paralyzed hand, the next day he may feel dull. I suppose I said “I see. Your symptoms are fluctuating. I’ll observe carefully.” I should have paid more attention to how he felt when I explained. Even though the change was too slight to recognize for me, he got nervous very much. He can walk, speak, and eat independently. He can go home. But rehabilitation staffed recommended continuing his hospitalization for further training in order to work again. I don’t think he needs it.

If you don’t enjoy the present, you won’t enjoy the future. If you are living a life where you enjoy the present, you should be grateful for your circumstances. I have read the New York Times ever since a respected man told a webinar audience to read it to understand the world. The events it reports on every day are different from what I see every day. Here are no drones or agents which attack citizens. I think about what I can do, but there are no answers.

A woman in her thirties visited the outpatient clinic three years ago, complaining of left facial pain. It was trigeminal neuralgia caused by compression of the trigeminal nerve with the cerebral artery. I prescribed Tegretol. It was very effective, but she had to quit due to allergic side effects. Then, I prescribed Topamax. It was effective without side effects. Her symptoms resolved. She had not returned to the clinic. A week ago she called the clinic and said she presented with the same symptoms again and wanted to appoint. Last Monday I met her for the first time in three years. I explained the same things as three years ago. She has been living in Japan for five years. I don’t remember where she is from. It is difficult and stressful for her to get appointments because she has to talk on the phone in Japanese. After I explained, she didn’t seem to be satisfied and tell enough what she wanted to say. She wiped away tears.

A seventy-year-old man developed chronic subdural hematoma. He is a clinic doctor in the town. He had fallen down while playing with his grandchild and hit his head. I operated for him. He was in an expensive room of the hospital with so nice carpet that I hesitated to entered the room with my shoes on. When I entered the room to see him today, his daughter and son in-law were talking with him. They are very descent. The way she talked, his hair style and polite words he chose were descent. Just before I saw him, I met his wife in the hallway who was going home. Why did she leave the room alone?