Saturday, January 06, 2007

Observing Brain Surgery, or, "I can see it thinking!"

As soon as my classes ended on that specially marked day in my calendar, I headed from school towards the hospital. On the bus, I paged the doctor who had replied affirmatively to my e-mail shadow request, as per his directions. I was lucky to have had case-based learning that morning; our small group tutor was an MD who worked at that hospital and was happy to explain how to page the surgeon, a medical procedure I had not yet been trained in. I paged him, and got no reply, so I called his office and his friendly secretary with the British accent told me that he was in operating room 19, and gave me the extension for the phone in the OR.

After debating in my mind whether or not it was appropriate to actually call the OR, I finally worked up the courage to phone. A very friendly voice answered and after I introduced myself and explained that Dr. Otto had agreed to let me shadow, the voice identified itself as Dr. Otto's resident. "We're in OR 19, come on up." I explained that I had never been to the operating rooms in that hospital before. "Fine, that's no problem, page me when you get here at 35-26104, and we'll get you up here." After I hung up I felt a little embarrassed for being nervous to call, but I was relieved that I had chanced upon a friendly member of the health care profession, and that I had chanced upon him between surgeries.

As per his directions, I paged him from the info desk in the lobby of the hospital, and waited for fifteen minutes. No reply. I knew the OR was on the 4th floor, so I decided to go find it on my own, not bothering to waste my time asking the info desk staff, "How do I get into Operating Room 19?" I assumed that they aren't there to answer such questions for people who seem to be members of the general public, as I probably did.

My decision to search for OR 19 on my own led to what must have been the oddest part of the afternoon for me: one minute I perceived myself looking like a random person off the street wandering through the hospital where I didn't necessarily belong, and the next minute, I was wearing scrubs and a mask, standing in an operating room and looking at a living person's brain.

While I was making my way to the OR, pointed in the right direction once or twice by helpful nurses and hospital staff after explaining who I was and ready to brandish my "this bumbling person is a doctor in training" credentials, I became very appreciative of my extensive experience in operating rooms during my pre-med trip to Nigeria. Had I not learned the rituals and rules of the operating rooms in Nigeria, and had I gone trying to find my way into the OR without this experience, I could very well have busted into the OR after maybe trying to scrub in like I'd seen surgeons do on TV, wearing my street shoes and lacking a hairnet or mask. Fortunately I had been briefed on OR rituals long ago and knew to slip on some shoe covers, put on a surgical cap, and find where they kept the masks, and that observers don't spend five minutes at a sink brushing all surfaces of their hands, fingernails, wrists and forearms. Scrubbing is only for the people lucky enough to be assisting or operating, not observing, and I would not be offered the opportunity to assist my first time watching neurosurgery. This was entirely fine with me, and I assume the patient as well.

When I got into the OR, Dr. Otto, the neurosurgeon was incredibly friendly. He greeted me cheerfully, and after the surgery was well underway he was happy to provide the odd clinical tidbit here and there. "Come look, Vitum, here's the cerebellum... pulsating... as it should." Wow, I thought. I can see it thinking. It wasn't moving rhythmically like a large vessel with blood being pumped through it at regular intervals; instead, it almost looked alive, like a jellyfish or the head of an octopus undulating gently and peacefully within a protective layer of bone that had been chipped away to reveal its hiding place. "What happens to the bone after the surgery? Does it grow back?" I asked. "Nope." I pictured this person recovering with a soft spot in the skin on the back of their head, where they could poke their brain through the skin and muscle using their finger, and presumably affect their balance or other functions associated with the cerebellum.

As interested as I had been in surgery after my time in Nigeria and before observing the brain surgery, I soon became impressed by how bored I was with the procedure. There was a lot of waiting on my part; a lot of meticulous cauterizing (burning) of blood vessels in the process of removing the two tumours, each smaller than a walnut; a lot of slow cutting and bone chipping before that; and a lot of slow sewing after that.

So, to not spend my time craning my neck around the operating doctor and assisting resident and observing clerk (third-year medical student), I spent a fair bit of time chatting with the other members of the health care education hierarchy who were coming in and out of the room. The clerk on rotation in surgery took me over to the X-ray monitors in the corner of the OR, and spent some time explaining the basics of looking over and presenting an X-ray. "First make sure it's the right patient. Then, check the date. Comment on the other things in the X-ray; ECG wires, or chest tubes and the like. Move on to the quality of the film; if you can see the vertebrae distinctly it's a good exposure." He continued on through the art of presenting an X-ray, using a film from a surgical patient from earlier in the day who had developed acute pulmonary edema. I was excited when this condition was mentioned in lecture a few days later, and I already knew what it was from my time shadowing in the OR.

The neurosurgery resident was very chatty and also friendly, as I had experienced on the phone. He told me that a prerequisite of being accepted into the neurosurgery residency is that you have to have a girlfriend before you start, because you sure as hell won't have time to meet a girl while you're a neurosurgery resident. I actually ran into him in the ER when I was shadowing another ER doc a couple weeks after I shadowed brain surgery; at first I knew that I knew him from somewhere but didn't know exactly who he was until shortly after he started talking to me. Honestly, I would probably have recognized him sooner had he been wearing a surgical mask.

Another resident in the room, an Asian doctor who was in a residency in interventional radiology or something of the sort, and she recounted a story of how difficult it is for female doctors to pick up guys. "A friend and I were at a bar, having a great conversation with a cute guy. He asked us what we do, and I replied, 'I'm in medicine.' He asked what specifically, and I replied, 'I'm a doctor.' At that point, he literally turned around 180 degrees and started a conversation with another girl." I told a friend in second year about this. She told me that "we call that the 'M-bomb', telling someone we're in medicine. I get around that by telling potentials that 'I am in science; I'm interested in becoming a doctor someday.' That seems to intimidate a lot less."

The neurosurgeon and I even had a good chat. I was able to pass on a message from someone else in my class, that he had influenced her to enter medicine when he gave a talk to a group of pre-meds she was in a few years back.

I even cracked a joke that made the whole OR laugh; they were talking about how rich the two creators of YouTube must be now that Google had bought their little website for 2 billion dollars. I piped up, "Yeah, but they have to split it..."

I didn't have a conversation with the anesthesiologist, but he successfully perpetuated my stereotype of what anesthesiologists do during surgeries, as he was busy working on a PowerPoint presentation on his iBook laptop computer. That will be added to my anesthesiology stories of members of that profession who do crossword puzzles, sudoku, nap, or perform yoga on a mat in the corner of the OR during surgery. "It's ok if they fall asleep," my medical student friend told me; "their alarms will wake them up if something goes wrong, and the surgeons wake them up if it's time to close."

After standing around chatting for so long, checking up on the previous surgical patient who ended up with pulmonary edema, and coming back to the OR and chatting some more, I decided to call it quits. I said my farewells, and was welcomed by the surgeon to join him again at any time, but I'm not so sure anymore if surgery is for me.

I was told by an anesthesiologist that one way to categorize medical specialties is into two types: those that have you do one thing, finish it, and move on to the next, versus those that handle you juggling several balls at once. Surgery and anaesthesiology would fall under the former. I think I'm leaning more towards the latter. Fortunately I've got lots of time to decide for sure. But, I don't think that brain surgery will be something I find myself doing as a career.


Jasmine said...

That sound really really exciting... nothing like on tv! I would love to observe a surgery sometime... but I don't think it'll ever happen (given that I'm going into the teaching profession... I hope) Perhaps I'll have to break a bone, in a somewhat serious place, in order to observe a surgery. However, I suppose I'll be unconcious... oh well. You're an excellent writer. Don't kill anyone:) Have fun!

Anonymous said...

Don't draw conclusions about surgery after just one neurosurgery case. I want to do surgery, but I would hate to have to watch a neurosurgeon. They're working on such a small, delicate scale, that there's not much to see, especially when you're not scrubbed in. Even as a clerk, scrubbed in, there are plenty of chances to fall asleep during a case; but that's far diffferent from when you are the one doing it, and you have the patient's life and health actually in your hands.

As far as your breakdown of medicine: I'm not sure if you can really classify any specialty as "only doing one thing at a time;" even surgery: when you're not operating, you can be managing a couple of critically ill patients, and taking consults in the ER, at the same time. Very much juggling.

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