Download Shyanne Miles

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Shyanne Miles
Senior Graduation Project
2010-2011
Research Paper
Neurosurgery is the medical specialty concerned with the prevention, diagnosis,
treatment and rehabilitation of disorders that affect the entire nervous system. As
prospective Neurosurgeon one may need to examine the factors and phenomena
associated with the career. As a future surgeon, an individual may face many issues and
road blocks that could potentially influence one’s perspective throughout his or her
career. Also being a female neurosurgeon, one may need to asses how females are treated
in a dominantly male field. These realizations may arise from experience, mental
maturation, or personal life. No matter the perspective of a potential surgeon, the job
remains more high stress than any other career in the medical field and can become quite
time consuming.
When an individual has a stroke, their brain will be deprived of oxygen causing a
loss of brain cells. Gary K. Steinberg, M.D., Ph.D., chairman of the Stanford University
medical center department of neurosurgery, states that “The brain cells do not die all at
once, they die on a gradual basis, and induced hypothermia can slow the process.”(#)
This induced hypothermia can assist in minimizing damage to the brain as surgeons
correct the problem. During non-emergency surgeries, “Dr. Steinberg will use this
technique so that patients can undergo surgery with out blood flow to the brain for up to
40 minutes without suffering permanent damage.”(#) The process begins with anesthesia
to sedate the patient and prevent shivering which is a natural warming process of the
body that could interrupt the surgery. The surgeon then goes on to inserting a catheter
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into the patient’s femoral vein, this will carry deoxygenated blood back to heart and stop
it below the hearts right atrium. Pumped into the catheter is cold saline, lowering the
patients body temperature to 91.4 degrees Fahrenheit. The doctor clips off a vessel and
does the surgery; normally, brain cells would be lost during this surgery due to lack of
oxygen but hypothermia blocks this process. When the surgery is done the warming
process begins which can take 60 to 90 minutes.
Pediatric Neurosurgeon Mark A. Mittler recounts “his first experience with the
removal of a brain tumor in a 14 teen year old girl”(Mittler1) Mittler describes his
account with the girl and her parents when first telling them about the mass in her brain
and the procedure that needed to be done to get rid of it. Mittler’s emotion is described
during the surgery as being nervous and anxious; he also explains his reasoning with
himself on how to stop the excess bleeding, as he pep talked his way through the surgery.
The wait between the completion of the procedure and the moment the patient wakes up
and the emotion entangled in it is also described, the time lapse is depicted as being an
anxious time period still not sure that the procedure was successful and the patient is
cured. Once the girl was awake and the check up went well the surgeon describes the
moment she was wheeled into the recovery room “as being amazing as well as the fact
that he saved a girl’s life”(Mittler 2). One may see this as an incentive in its self to study
within the neurosurgery field.
In Another Day in the Frontal Lobe a book by neurosurgeon, Katrina Firlik,
mentions a specific surgery that Firlik enjoys, while she states “like any career there has
to be fun in it or it would not be worth working”(Firlik 1). The comparisons of the
surgeon’s real surgeries and future advancements in neurosurgery are made and then it
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goes on to explain Firlik’s technique in writing her book. There is discussion on the rarity
of women in the neurosurgery field and “out of 4,500 in the U.S. there are only 200
women”(Firlik 1) due to the uncommonness of women in this career, females are not
widely accepted. Firlik explains that as a woman in a predominantly male field can cause
employers to not take one seriously. The information is completed when Firlik gives a
statement on being a neurosurgeon saying, “dealing daily with tumors and strokes can be
depressing, she writes, but her familiarity with trauma has ultimately enhanced her
appreciation of ordinary existence”(Firlik 1). Therefore, it is duly noted that one may
grow accustomed to this issues within the field.
The myth that a person only uses ten percent of their brain is challenged when a
girl, AH, from Scotland is discovered to have half a brain. The condition was first noticed
at age three, when the girl began having seizures, there was only half of a hemisphere
present. The seizures, easily treated, were the only side effect of her condition. This girl
has been able to lead a normal life, excelling in school and physical activities, she even
has normal vision. The girl’s brain has rewired itself so that one hemisphere can operate
both eyes. This girl is not the only one with half of a brain; victims of severe epilepsy are
treated by removing the hemisphere in which the issue is present.
Synopsis of a study done on the replacement of nerve cells in the brain analyzes
effects of this process in mice, to examine how it will affect the human brain. Most of the
brain does fine with its original brain cells, but the parts involved in smelling and
remembering sometimes need new recruits. Studies are part of a new wave of research
that shows neurogenesis, once thought to be impossible in the adult brain. Neurogenesis
creates new neurons in the hippocampus, a part of the brain linked to learning and
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memory, and in the olfactory bulb, an organ that detects smells and pheromones. A
mystery about neurogenesis concerns antidepressants known as selective serotonin
reuptake inhibitors or SSRIs the class of drug that includes Prozac. Those drugs were
previously shown to stimulate neurogenesis in the hippocampus, but scientists were not
sure if that was a side effect of the medication or necessary for its action.
Another event occurs when a simulator used to train surgeons, developed “as a
result of the Visual Human Project that creates precise 3-D images of the brain”
(Dowling and Tsiaras 1). Pediatric neurosurgeon John Duncan performed a difficult
removal of a brain-stem tumor using holographic as well as magnetic resonance images.
This holographic machine matches up with MRI scans which allow Duncan to see
exactly where he is working in the brain. Neurosurgeons can easily get lost in the brain,
all gray matter looks alike, even to the trained eyes, and this revolutionary technology can
allow surgeons to more effectively do their job. A fifth-grader from East Providence
began complaining of headaches and dizziness a pediatric neurologist, suspecting a brain
tumor, sent the boy to Hasbro Children's Hospital in Providence and confirmed the
diagnosis: Michael had a tumor on his brain stem. If it was not removed, it would kill him
within a few years. Duncan also explained to the mother that her son could also die on the
operating table which is exactly why this technology was used in Michael’s case. The
new procedure allowed Duncan to more exactly remove the tumor for a smoother
surgery.
Another study shows Amanda Gefter, who goes into detail describing what
outsiders do not know about what is going on in the surgery room. The biggest
misconception about neurosurgery is that it is a highly intellectual career. Being a
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neurosurgeon does require intelligence and the ability to make quick decisions, but it
largely relies on being practical. Gefter explains that her favorite part of the brain is its
intricate architecture. The activity during surgery is explained as being very light
hearted…talking, joking, music playing, like mechanics working on a car. Women aren’t
really penalized for working in predominantly male field, but can be the butt of friendly
jokes on occasion. Gefter explains, “When dealing with patients most do not except that
as a woman she is actually performing the procedure; it is not sexism but more a
generational issue as the older patients are the doubtful ones”(Gefter 2). Someone
improving is probably the most rewarding part of the job, just saving a life or having their
life changed by a procedure. The brain is both a fragile and resilient organ, in many cases
kids bounce back from what appears to be a serious head injury. On the other hand, if
someone has a tiny injury in the brain stem, that can put them in a locked-in state where
they can only communicate by blinking. Implanted electrical stimulators, a device for
stroke survivors is under development that has been effective in early studies may be a
really important part in the future of brain surgery. Enhancing cognition will be a wideopen field that neurosurgeons will participate in.
Last, according to recent research from Barcelona, Spain, reversible changes in
brain Magnetic Resonance Imaging, MRI, weighted in Diffusion-Weighted Images,
DWI, and Apparent water Diffusion Coefficient, ADC, maps have been reported in acute
stroke, epilepsy, eclampsia, and hypoglycemia, but they are contradictory regarding to
migraine aura. It is noted that “a 41-year-old woman with known basilar migraine for
five years consulted about a persistent visual aura plus bilateral paresthesias in the
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extremities for four days”(Belvis 1). An MRI showed no apparent lesions but abnormal
signal appeared in the left occipital lobe.
While shadowing local surgeon, Dr. Lowe, at the Outer Banks Hospital one’s self
acquired knowledge on reality within the job. Dr. Lowe preformed five surgeries for one
to observe as wells as answered many relevant questions, such as the cost of medical
school, years of school it takes to become a surgeon, and the risks one takes on when
pursuing this career. Dr. Lowe warned the prospective surgeons may have difficulty
finding jobs due to the current Health Care Reform and also when taking on this career
one may face the effects of limited family time due to constant on call time.
Due to one’s shadowing experience, one has made the decision to not pursue a
career within the surgical field, or any medical field for that matter. Many aspects of this
project have led one to believe that one may not enjoy this as a career including the
inability to stomach the procedures during a surgery observation. Another reason for
deciding against this career is extreme cost of medical school, in that one may not be able
to afford it. Shadowing allowed one to peer into the life of a surgeon and this gave one
the knowledge to make the educated choice that this is not the correct career choice.
There is no anecdote for the time missed with one’s family, and although women
have made their way within the field of neurosurgery have established successful stories,
that will benefit future prospective female surgeons, one has decided against this career.
Despite realizations within the filed, this job still remains more high stress than any other
career in the medical field and is time consuming, making it difficult to make
commitments in one personal life to family and friends.
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Works Cited
Dowling, Claudia Glenn, and Alexander Tsiaras. "Real patients, virtual surgery." Life Feb.
1997: 72+. Student Edition. Web. 26 Oct. 2010.
"Girl has half a brain." Current Science, a Weekly Reader publication 30 Oct. 2009: 15.
Student Edition. Web. 25 Oct. 2010.
Gefter, Amanda. "Confessions of a brain surgeon." New Scientist 190.2552 (2006): 50+.
Student Edition. Web. 26 Oct. 2010.
Maltby, Anna. "The Miracle on Ice : How it works Induced hypothermia." Men's Health
Mar. 2007: 116. Student Edition. Web. 21 Oct. 2010.
"New findings from R. Belvis and co-authors in the area of headache published." Women's
Health Weekly 22 July 2010: 49. Student Edition. Web. 26 Oct. 2010.
“Removing a Brain Tumor; Mark A. Mittler, Co-chief of Pediatric Neurosurgery, Schneider
Children's Hospital." New York 15 June 2009. Student Edition. Web. 25 Oct. 2010.
Ross, Greg. "Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside."
American Scientist 94.6 (2006): 571. Student Edition. Web. 25 Oct. 2010.
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Saey, Tina Hesman. "Creating new nerve cells makes sense for the brain: neurogenesis
seems to aid memory, depression drugs." Science News 27 Sept. 2008: 5+. Student
Edition. Web. 26 Oct. 2010.