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Something interesting I learnt in the operating room…brain surgery.

Authors: Rajeevlochan Ravi; Year 5 Medical Student & Peninsula (Plymouth) Medical School; Bristol, United Kingdom; Twitter: @RajeevlochanR; Instagram: @surgeon2be

Ask any six-year-old what they want to grow up to be, and one of three interests invariably is wishing to operate (on the heart in particular). While the passion is well placed, one starts questioning whether it’s sustainable. Fast-forward to medical school, studying about the human body, how it works and keeping that young child’s passion alive, I read a book from Dr Atul Gawande, who said – “Surgery is a craft, an art and a science that requires constant attention to detail and a commitment to excellence”. Not fully understanding the words but repeating them, I walked into an operating room for the first time and witnessed the finest art I had ever imagined – a craniectomy.

The beeping monitors and the smell of ethyl alcohol tickled my senses. The slow wave of awe was briefly interrupted by the scuffling of scrub technicians and nurses asking me to stand aside and choose a wall. Meticulous preparation had been done, from laying the table and arranging instruments to gowning up, preparing and awaiting the arrival of the lead surgeon. It was impossible to tell what he was thinking. It was safe to assume, well within popular belief, that he was confident, perhaps even a tad excited. The lead surgeon, however, performed a beautiful yet simplistic ritual right after confirming the case details and just before he started the surgery – a pause and a nod. A pause that appeared to channel his composure and a nod of encouragement to face what was to come steadfastly.

The surgeon walked us through the procedure step by step, explaining each instrument, their use and how the anatomy, which I had only read about in books, appeared in a shade of red and three-dimensionally. He deftly manipulated what seemed to be a navigation device to locate the tumour he meant to dissect, with finesse, all while continuing to engage me with questions as the sole student in theatre. Grossly, the skull and the brain were structures I could imagine. However, the neuroanatomy and complexity of their arrangement and the requirement for proficient dexterity to manoeuvre through and out of the neuronal labyrinth is astonishing. From that moment forward, surgery felt like a calling to me.

“Surgery is the ultimate expression of the humanistic impulse to heal, alleviate suffering and extend life.” Words that had just been words until that point were now an emotion. The ability to transform a patient’s life, not simply by cutting and stitching, but by demonstrating a unique combination of technical skill and empathy, was a process I resonated with entirely. I felt privileged to have witnessed a skilful craft, a field with such promise and compassionate service. It made me believe that I, too, can one day, contribute my share to this fascinating cornerstone of medicine and be an inspiration to the generations to come.


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