central artery


On this day in 1954, Boston announced the opening of the Central Artery, the first elevated expressway in the United States. Reporters from the Boston Globe predicted that commutes into Boston would be reduced exponentially.  Unfortunately, these predictions proved to be too optimistic. Less than 30 years later, Governor Michale Dukakis, announced that the Central Artery would be torn down and replaced with an underground expressway. The Big Dig, as the new project was known, was completed in 2007.

The above photos show the Central Artery prior to the construction of the Big Dig. Do any of our followers remember driving on this expressway?

Central Artery, circa 1955-1975  Charlestown Urban Renewal project, Boston Redevelopment Authority photographs, Collection 4010.001

Green Line trolley next to Central Artery, 1976 May,  Peter H. Dreyer slide collection, Collection #9800.007, Boston City Archives, Boston

“It is play, not properness, that is the central artery, the core, the brain stem of creative life. The impulse to play is an instinct. No play, no creative life. Be good, no creative life. Sit still, no creative life. Speak, think, act only demurely, little creative juice. Any group, society, institution, or organization that encourages women to revile the eccentric; to be suspicious of the new and unusual; to avoid the fervent, the vital, the innovative; to impersonalize the personal, is asking for a culture of dead women.”

This is hands down the most important book I have ever read in my life and I highly, highly, highly encourage to get it a try.

journeyintomedicine  asked:

I'm so excited to be following your blog! Please tell me everything about neurosurgery; is it what you expected it to be? What attracted you to that area of surgery? What happens on a day to day basis in your job? 🙌🏻 Thank you so much in advance xx

Hey there!

Neurosurgery actually was not on my radar when I first entered medical school. I knew I wanted to do some type of surgery, but neurosurgery was one of those fields that just seemed unattainable, especially for someone who is coming from my background. I first became interested in it when I found our neuroscience block during first year of Med school to be absolutely fascinating! I loved learning about the diverse pathology that can affect the brain and all the clinical manifestations that can arise as a result of that pathology. I fell in love with the gorgeous anatomy and the complex physiology. To me, neuroscience is like the final frontier of medicine. There’s so much we still don’t know and so much left to be discovered. So…there were many nights that I pondered whether I could bring my love for neuroscience and surgery together, and fortunately, I did. 💗

I built up the courage to shadow a neurosurgeon during my second year of medical school, and that neurosurgeon became someone that I truly admired and strived to be like. He was a really great mentor for me and made me feel like I could actually become a part of this amazing field. I owe everything to him for the life I’m living now.

I matched into neurosurgery at a great program, and I’m really fortunate to be here. I work with an awesome team. I have 11 big brothers who have my back, and I have theirs just as fiercely.

As an intern, “a baby neurosurgeon,” I’m at the bottom of the totem pole right now. I don’t do much operating at this point, but I knew that coming in. You have to earn the privilege to pick up that scalpel by first learning how to care for those patients who are on the other end of that knife. I work long hours and sleep whenever I can. Sometimes, my days are more procedure oriented like the 24 hour period in which I did 3 EVDs (external ventricular drains, also known as ventriculostomies) or throwing in central and arterial lines in our really sick ICU patients). Despite being exhausted, I truly love what I do. I love that I get to play a part in some of the most important scenes of my patients’ lives. Some people tell me secrets that their closest family members don’t even know, and others allow me to witness them in their most vulnerable states. It’s a privilege to take care of these people. I think I have the coolest job in the world.

So what’s a typical day like for me?
It depends on the rotation. We spend 3 months on Neuro ICU, 3 months on Neuro electives, and 6 months on the neurosurgery floor. So the majority of our intern year is focused on managing the floor patients, which are mostly post-op patients who I’m trying to get stable enough to go home, to physical rehabilitation facilities, or to skilled nursing facilities. My first two months as a doctor, I had 15-25 patients that I would carry by myself. It was pretty overwhelming at first, but I learned a lot very quickly. I had to. I really didn’t have a choice. Sink or swim. Most days, I feel like I’m barely keeping my head above water, but I’m still alive. Fortunately, we have some help from a hospitalist that works for our service. I like to ask them to help with management of people who have poorly controlled diabetes, hypertension, and other general medical issues. I can manage the average medical issues on my own, but some of our patients in the south are not so healthy and have lots of comorbidities that would otherwise keep me from dealing with a lot of their neurosurgical issues. I arrive every morning around 4AM to pre-round on the floor and our step down unit (patients who are a little too sick for the floor but not sick enough to be in the ICU). I gather all the pertinent info I need and do Neuro exams on everyone. I always think, if someone woke me up out of a dead sleep between 4:30 and 5:30 in the morning, I would never answer orientation questions appropriately. LOL. Afterward, I join the rest of my team for film rounds, in which the on call resident goes through all the consults they had in the past 24 hours and their imaging in addition to any new imaging we obtained on patients who are already on our service. Then, we round on the ICU as a team. I have to pay close attention so that when these patients are stable enough for the floor, I know how to care for them. After ICU rounds, I present all the floor and step down patients to the entire team with my plans, and my team adds their input in and other things to add to the daily plans. Then, I leave everyone and go to the floor to start putting in orders, calling consults, writing notes, answering pages (which sometimes are relentless), pulling surgical drains, attending meetings with the nursing staff, consoling sad families, calming down angry families, etc. My worth as an intern is measured in the number of discharges I successfully accomplish everyday, which can sometimes be very frustrating. You have to make sure you discharge patients safely on a timely basis, otherwise, you become the barrier of the wheel that needs to keep turning, the rate limiting step in a chemical reaction that must occur to sustain order in the world. If patients don’t leave, new ones can’t get beds, and the surgeries stop. When the surgeries slow down, your Chiefs are not pleased. When the Chiefs aren’t happy, no one is happy. So bottom line, I work my a** off to get people discharged from the hospital safely and on time so more people can get the care they need. I don’t pee. I don’t eat. I don’t drink. I don’t stop until all the work is done, which depends on how many patients you have that day and how stable they are. Most days I try to sign out my patients to the on call resident by 4:30PM, but I tend to work on things hours past that to make sure it all gets done everyday. Sometimes I work 14 days straight. I’ve even worked 19 straight at one point. It’s physically, emotionally, and mentally exhausting, but I know I have to put in my time and learn how to care for neurosurgical patients before earning the privilege to pick up a knife and cut them open. What’s the point in performing a beautiful operation if you can’t manage their health and complications afterward? So I get it. It sucks. It’s tough. It’s really hard, but it’s worth it. And how do I know that right now? Because every now and then, my big brothers know when I need that reminder, and they ask me to join them in the OR. I’ve put in lateral mass screws on a man who needed an emergent posterior cervical decompression and fusion when he developed central cord syndrome after a fall. I’ve performed two subdural hematoma evacuations, and I’ve even assisted in a shunt exploration on a little kiddo. I’ve performed 8 external ventricular drain placements and dropped quite a few central and arterial lines. I am 3 months into my intern year, 3 months into being a doctor, 3 months into being a neurosurgeon in training, and it’s incredible how much I’ve learned in just 3 months. I can’t wait to see how much I’ll learn over the course of these 7 years. I am incredibly fortunate to do what I do everyday. Sometimes, I need little reminders to keep me going, but when I stop for a few seconds to think about how much my life has changed in the last decade, especially in the last three months, I thank God for allowing me to live my dream. I thank God for giving me such a supportive family that helped me get this far. I thank God for the strength he gave me when I didn’t think I could keep going. I’m a neurosurgeon, and I love my life.

Subject appears to have fallen from a great height. Spatter pattern shows elongated droplets with numerous satellites and tails. Victim was dead or immobilized on impact based on lack of swipes on the floor, with clearly centralized pooling. Possible arterial spatter. Radius indicates sole point of blunt trauma impact.