I sat down at 6:30AM in Neurosurgery Grand Rounds expecting some kind of small presentation, coffee, bagels, and discussion over cranial scans. People filed in slowly, hitting the coffee station first before settling in around a massive conference table. What did I notice first, with all of those brilliant minds around me? Neurosurgeons are beyond tired–absolutely exhausted. During the hour long meeting, I noticed my eyes getting tired (which could have had something to do with the fact that I had no input into how to determine encephalopathy in patients with no direct warning signs). To keep myself alert, I studied faces. One resident was about fourteen degrees away from tipping off of the cabinet she was sitting on, her head flopped down on her chest. Another resident was watching her, making sure she didn’t fall, but allowing her the precious unconsciousness. Many of the neurosurgeons bickered about packing fat into cavities in the brain. What was the best method? Several drank more than one cup of coffee.
Though I knew from outside descriptions that the doctor I was going to be shadowing that day had the emotional capacity of a piece of popcorn, I was positive that he would note my obvious dedication and pull me under his nearly invisible wing. I had met Dr. A once before and he had been very cordial. After the doctors has run through several cases (during which they fluffed and preened their peacock feathers thoroughly), the meeting adjourned. I was shuttled off by Dr. A and Dr. B, who was a colleague of Dr. A’s and also more amenable to having someone young and inexperienced trailing after him like a puppy eager to please. They shuttled me off to meet the scrub machine, a giant clothing dispenser that looks like the transformer’s version of a chest of drawers. After changing into scrubs (which were much too big) and waddling up to the OR floor, I started to realize that I was going to have to shove myself into every opportunity I wanted without fear of being rejected. Neurosurgery is a competitive environment. Dr. B actually wondered aloud what I thought I was doing wasting my childhood away before medical school stole my soul, sleep, and happiness.
Then there were brains–lots of brains. There were four surgeries that day. The first was a deep stimulation in the Vim region of the Thalamus to treat a central tremor. Two electrodes are placed into the thalamus and, in a subsequent surgery, are attached to a generator that provides electric stimulation to the region of the brain that controls the tremor. What I learned from the first part of the surgery? The head bleeds…a lot. I sat a good distance away from the patient while his head was opened, shooting questions at the equipment representative about what the procedure entailed to distract myself from the blood pooling at the surgeon’s feet. I’ve never been afraid of blood and it has never made me queasy, but watching the blood pool made me feel dizzy. The internal me was irrational– thinking: DEAR GOD IF THAT PERSON IS BLEEDING SO MUCH THERE MUST BE SOME KIND OF BRAIN VIRUS FLYING UP MY NOSTRILS RIGHT THIS SECOND TO SCRAMBLE MY BRAINS!… It wasn’t until a towel was thrown under the patient’s head that I was able to worm my way behind the surgeons and watch them insert the electrodes. That part was pure awesome. Dr. A came up to me after the surgery and presented me with a clean fiducial (a tiny screw used to position a halo of stabilizing metal to the patient’s head) that had been dropped on the floor. He said, “some of the girls in the department collect things like this that have dropped on the floor and they make jewelry out of them”. I grinned. I knew it! He had to like me if he made a joke about me putting a fiducial through my belly button! Then he left. And then the patient was woken up and she left. I didn’t know where to go, but the Chief told me to go eat if I could because it was easy to forget about food. I ran to the locker room, texted everyone I knew that surgery was SO COOL, and then waited around for Dr. A to show up again.
I waited around in the OR lobby feeling impossibly awkward for about ten minutes before recognizing the Fellow and a visiting doctor from China. I attached to them like a leech so that I would end up in the right OR room. The Fellow was quite a character. His large smile and impressive level of social ease paired with his incredible vocabulary made him seem like some curious mixture of a genius and pimp. He asked me questions, gave me advice, and told me to come closer to see “how real neurosurgeons operate”. He and the Chief resident bounced jokes and slander off of one another during the entire surgery day. The Chief, once a tall dark and handsome athlete, kept his proverbial cheeks and tail inflamed and impressive as much as physically possible. He winked at me several times, told me to “watch this”, and nicknamed me the “almost medical student”. Of course, he’s been battling his way to the top for years, and around his eyes, the exhaustion has begun to show. Though he plays the big-boy game, I’m sure he could konk out like a two year old, leaning over some coveted, toy after a box of mac n’ cheese.
The second surgery was a deep brain stimulation for tremors. The patient was awake. He had a cochlear implant, so the surgeon had to raise his voice to speak to him. To an outsider, it looked like a rather abusive encounter filled with repetitive statements and demands. After 30 minutes of probing and stimulating, his right hand was completely steadied. A tear fell from his eye. “Isn’t that wonderful.” He was wheeled off, still impressed with his still hand, with only one stitch in his head.
Then I was left to wander around again. The last two surgeries were removals. The Chief, with Dr. A, pulled two cysts off of the lower spine of an elderly woman. Dr. A pulled me along with him to another OR room where the Fellow was closing up after a brain tumor. Fellow de-gloved and gave me a high five. He felt rather “baller” after that particular operation. Super slick.
Then Dr.A disappeared into a random closet and nobody could tell me where he was. Without the knowledge of how the pager system worked, I was left to stalk Dr. A’s colleagues in an attempt to locate him. After several unsuccessful tries, I decided that my first day of shadowing was over. Maybe Dr. A isn’t all warm and fuzzy butterflies, but the man gave me a fiducial. That has to count for something, right?