Headshot

The request came via email from Editor-in-Chief of the Medical Post, Colin Leslie. At first glance, it was a curious ask, “a new headshot,” a term unfamiliar to me until recently. My initial exposure to “head shots” was at a medical cannabis conference a few years earlier. One of the sponsored perks, besides a pair of weed-logo’d socks, was a booth offering head shots that could be used for personal websites, social media or resumés. Not being a social media aficionado, I intended on bypassing the opportunity until, when leaving the conference, my wife encouraged me to take my best shot, and so I did. The resulting proofs were plentiful and we archived them until I decided to submit one to the Medical Post to replace the old self-portrait. This has even featured with my blog posts ever since. A “major makeover at the CanadianHealthcareNetwork and brand-new website,” to be unveiled in mid-June, prompted Colin’s request for a pictorial upgrade. My wife recently saw a pop-up ad online featuring a new release Tilley hat. The navy, waxed-cotton Outback hat caught her attention. The style suited me, apparently, and would become my go-to hat of choice once travel was deemed a safe pursuit. We have forestalled many a bucket list destination because of COVID-19. Admittedly, I already have two Tilleys in my extensive collection of headwear, the first dating back over 30 years. It remains viable, sound structurally and has withstood the forces of nature, as advertised. The “Outback” was ordered online and arrived at the door one week later. I was thrilled with the purchase, the fit, and the prophylactic benefits of a hat rated at 60 SPF. And so, with the Post’s request for a new headshot and an older image that correlated more with my previous, more formal professional life, my wife took the replacement pic and I sent it on for approval. The new headshot is much more reflective of my life today and the days to follow when we finally consummate our extensive travel backlog. All this talk of headshots was bound to segue into a story or two. Like a brood of ducklings, our clinic group of four trailed in the slipstream of the neurosurgeon as he raced down the sterile corridors. The year was 1968 and we had finally entered the clinical stages of third year medicine after two tedious basic science years which had followed three preparatory years of basic science. The surgical rotations were of two-week duration in order to expose us to as many disciplines as possible, respecting the constraints of time and human endurance. It was something like a clinical tasting menu without the wine pairings. Dr. “Edward Sanderson,” was a stern and formal figure, arrogant, demanding and distanced from his charges. We were all forewarned, reflexively ratcheting up our level of angst and fear. Rounds were sprints, not endurance exercises. We were each assigned inpatient responsibilities while one of us was on call with the residents for the ER. The team was called to the emergency department to assess a 52-year-old male who had sustained a slip-fall head injury, with a brief period of loss of consciousness one week earlier. He had experienced the anticipated headaches but in recent days exhibited behavioural changes and disorientation. I was left to glean a history and conduct the physical, and specifically, neurological assessment and write it up for the service. My assessment and most humble opinion was that Mr. Conn had sustained a closed head injury with subsequent subdural hematoma. I conferred with the senior resident who concurred. Brain imaging du jour was ordered and the patient admitted for observation. I left the “head injury in Room #3” in the capable hands of my senior resident colleague and left the building for the day feeling a newfound sense of bravado. At 9:00 pm that evening the phone rang. I was studying in my apartment, prepping for rounds the following day. Without preamble, the caller began, “Howard, it’s Dr. Sanderson. Your patient has a subdural hematoma and I’m taking him to the OR in two hours. This is your case. Be there.” The call ended abruptly. I drove to the hospital with little respect for the speed limit, found my way to the OR, which I had never had the pleasure of entering and after brief introductions by the nurses, was escorted to the change room to don my first pair of greens. I needed scrubbing instructions, more than once, and ultimately butt-bumped my way through and into the OR suite. “I was going to start without you,” were Dr. Sanderson’s first words, hardly welcoming but intimidating as expected. He drilled the first burr hole with a manual drill. He then handed me the drill. I hesitated. “What are you waiting for, just drill!” He convinced me that I couldn’t possibly drill into brain tissue and, although reassuring to some extent, I stood paralyzed with drill in hand. He grabbed my hand, forcing the drill onto the cranium and yelled, “Drill, now!” Tentatively I began to rotate the drill. “Wait for the bone to give and you’ll know you’re there.” Easy for him to say. Having successfully and a-traumatically completed the first burr, I was optioned for the third and final drilling. I acquiesced. And then Dr. S. handed me the thread saw. Curt instructions were given and I threaded the saw between the trepanation holes. I was then told to lean back hard and exert torque and begin to oscillate the saw back and forth until the burr holes were connected. It was now midnight and I remembered that I had foregone dinner in lieu of study and was feeling a little peckish. I threaded the saw between the next two holes and as I began to exert more force and get into a new-found rhythm, Dr. S asked if I was feeling OK. I asked why, and he stated that I looked pale and had sweated through my cap. Until that moment I felt well, was actually getting into this surgery stuff and then the wobbles started. Sensing my imminent syncope, Dr. S screamed, “Get him away from my table, get him out of here, he’s going to contaminate the field.” The nurses stood silent for a moment and then he tore a strip off them. Epithets flowed freely, without restraint. Vile, racist and disparaging words. Never forgotten. I was escorted into a corner of the OR, eased down to the terrazzo floor and given orange juice by straw while my brow was wiped. Dr. S, totally oblivious to my circumstances, completed the evacuation of the hematoma, and left the OR. He never looked back. Once resuscitated, I regained my now-embarrassed composure, thanked the nursing staff for their assistance and support and returned home in the darkness of the night. Three days later, on a Saturday evening, the phone rang. The voice on the other end of the line was familiar. “It’s Edward Sanderson,” he said. “How’s it going?” “Maybe, if you’re not doing anything, we could go for a drink.” I was speechless, until I gathered the courage to say I didn’t think that was a very good idea. He hung up the phone. My father was 72 when my mother died of pancreatic cancer after a classic six-month illness. He was a lost soul until he eventually connected with a woman from his adolescent past in the old Palmerston Avenue neighbourhood. Following a weekend in Niagara Falls, I received a call at the office from his “friend.” She expressed concern about my dad’s behaviour on the previous weekend, specifically his loud and inappropriate laughter in the restaurant, disorientation at times and periodic slurred speech. His internist’s office was in my medical building and I arranged for him to be seen that afternoon. Dr. C called on completion of the visit and advised that he was sending my dad for an urgent CT scan at the adjacent hospital. Subdural hematoma was confirmed and my father was transferred to Sunnybrook Hospital for surgery that same day. The procedure went uneventfully. Discharge would be the following day. The neurosurgeon called, apprised me of my dad’s status and asked if I would further reinforce the legislated driving restrictions. The duty to report to the MTO was met with some opposition and had emboldened my father to consider going rogue. I would be the designated “bad cop.” There was one concern, he noted, however. In recovery, when my dad woke up, the anesthetist, checking his neurological status and orientation asked him his name. With a straight face, fully alert, my father answered, “Bill McTavish.” The room went silent, that is, until my dad gave away the ruse with his radiant smile. Got ya! The etiology of the subdural would remain a mystery, that is, until my dad finally recalled an incident several months earlier. While travelling by train to Montreal, he was walking in the aisle when a ventilation grate dropped down from the ceiling above, striking the top of his head. Fortunately, the hat he was wearing cushioned the impact and prevented scalp lacerations or abrasions. There was no loss of consciousness reported. As he characterized it, “just a flesh wound.” Relatively unscathed, he proceeded to enjoy a wonderful weekend in La Belle Province. After this rather heady dissertation on headshots and head injuries from the past, I reach for my new Tilley, adjust the angle just so, and imagine exploring the Outback and all the places we’ll go. There are countless adventures and journeys ahead. All we need is time. Dr. H. Jaye Goldstein is a recently retired Toronto-area family physician.

Piece of Mind

Headshot

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HOWARD GOLDSTEIN

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