Cracking the Cranial Vault: What It Feels Like to Perform Brain Surgery
October 23, 2016 9:02 PM Subscribe
Dr. Rahul Jandial takes us inside the thoughts of a brain surgeon. After working on flesh and bone for 30 minutes, the real summit presented itself: the human brain, the most delicate, complex, and beautiful thing [in] the universe.
You should definitely not be reading this.
posted by fatbird at 9:37 PM on October 23, 2016 [3 favorites]
posted by fatbird at 9:37 PM on October 23, 2016 [3 favorites]
You should definitely not be reading this.
The surgeons who perform these procedures have done them hundreds of times. They are the most skilled human beings on Earth. They can makes medical miracles look mundane. That's what I took from the article.
posted by Beholder at 9:58 PM on October 23, 2016 [4 favorites]
The surgeons who perform these procedures have done them hundreds of times. They are the most skilled human beings on Earth. They can makes medical miracles look mundane. That's what I took from the article.
posted by Beholder at 9:58 PM on October 23, 2016 [4 favorites]
The first two paragraphs of that article reminded me of an engine rebuild I once did on my old VW van.
The rest of the article, rather less so.
posted by Greg_Ace at 10:13 PM on October 23, 2016 [3 favorites]
The rest of the article, rather less so.
posted by Greg_Ace at 10:13 PM on October 23, 2016 [3 favorites]
This one is a little graphic but will probably at least make you feel hopeful about brain surgery on balance - unlike Henry Marsh's Do No Harm, which I found more compelling but which you almost certainly do not want to read prior to anybody's brain surgery.
posted by atoxyl at 10:26 PM on October 23, 2016 [4 favorites]
posted by atoxyl at 10:26 PM on October 23, 2016 [4 favorites]
That's what I took from the article.
As did I, because I don't have a close relative about to have this exact thing happen to them, and thus I'm immune to personalizing the imagery of drilling through the skull.
I'm just sayin'...
posted by fatbird at 10:27 PM on October 23, 2016
As did I, because I don't have a close relative about to have this exact thing happen to them, and thus I'm immune to personalizing the imagery of drilling through the skull.
I'm just sayin'...
posted by fatbird at 10:27 PM on October 23, 2016
Oh yeah, I stopped reading after the first sentence. No need to alter the discussion on my account or anything.
I just found it very odd timing as I'm about to leave on a road trip to be with my mom for this.
(Taking this thread out of my recent activity for now, so I don't stumble on, I don't know... anything.)
posted by ODiV at 10:37 PM on October 23, 2016
I just found it very odd timing as I'm about to leave on a road trip to be with my mom for this.
(Taking this thread out of my recent activity for now, so I don't stumble on, I don't know... anything.)
posted by ODiV at 10:37 PM on October 23, 2016
-- unlike Henry Marsh's Do No Harm, which I found more compelling but which you almost certainly do not want to read prior to anybody's brain surgery.
posted by atoxyl at 12:26 AM on October 24
Myself, I would be happy to read Henry Marsh's "Do No Harm" prior to a loved ones surgery, because I like to know what exactly is going on. I prefer knowledge over being in the dark, with the doctor as a high priest -- brilliant as these people are, they're not high priests. They are instead highly trained, remarkably competent human beings, with whom I personally would prefer to be able to discuss what's going on.
posted by dancestoblue at 12:32 AM on October 24, 2016 [3 favorites]
posted by atoxyl at 12:26 AM on October 24
Myself, I would be happy to read Henry Marsh's "Do No Harm" prior to a loved ones surgery, because I like to know what exactly is going on. I prefer knowledge over being in the dark, with the doctor as a high priest -- brilliant as these people are, they're not high priests. They are instead highly trained, remarkably competent human beings, with whom I personally would prefer to be able to discuss what's going on.
posted by dancestoblue at 12:32 AM on October 24, 2016 [3 favorites]
Really it's a difference of degree more than kind between the tone of Jandial's writing - which I didn't mean to imply was not good - and Marsh's. They both admit that brain surgery is a very intimidating thing to do. I just found the Marsh book very affecting because - perhaps because he's presumably nearer retirement from the hands-on stuff - he's able to say "yes I've done this thousands of times and some of those times I inevitably failed or fucked up" and talk about what it's like to deal with that.
posted by atoxyl at 12:59 AM on October 24, 2016
posted by atoxyl at 12:59 AM on October 24, 2016
Marsh's book was the best book I read last year - on any topic. Highly recommended.
posted by smoke at 1:03 AM on October 24, 2016
posted by smoke at 1:03 AM on October 24, 2016
A miracle of creation
in this, a simple dome
filled with information
and a love that knows no bounds
posted by phooky at 5:06 AM on October 24, 2016
I was thrilled until I went to his web site and looked at the gallery photo of him exiting a door with a picture of Jesus directing a surgeon's hand during an operation in the background. Made me cringe.
posted by milkwood at 5:14 AM on October 24, 2016 [2 favorites]
posted by milkwood at 5:14 AM on October 24, 2016 [2 favorites]
human brain, the most delicate, complex, and beautiful thing [in] the universe.
I'm inclined to think that this only appears to be true because it isn't.
posted by the quidnunc kid at 5:19 AM on October 24, 2016 [3 favorites]
I'm inclined to think that this only appears to be true because it isn't.
posted by the quidnunc kid at 5:19 AM on October 24, 2016 [3 favorites]
Quidnunc kid, why do you hate brains so much? If it weren't for their beautiful complexity, who would ever vote #1?
posted by GenjiandProust at 5:32 AM on October 24, 2016 [1 favorite]
posted by GenjiandProust at 5:32 AM on October 24, 2016 [1 favorite]
Brains?! If "brains" were so great, why do we keep them in vats??? I've doubted a lot of things in my meditations, but I've never doubted the fact that brains never taught us ANYTHING worth knowing. I mean, half the time they're asleep!!! The battery lasts, what - 16 hours max? The memory is small, the software NEVER gets updated and they don't even have a USB port, never mind a headphone jack. Do what I do, get a Galaxy Note 7 - Sure it might blow up in your face, but look at everything our "brains" blow up, on a daily basis. Down with brains!
posted by the quidnunc kid at 5:58 AM on October 24, 2016 [14 favorites]
posted by the quidnunc kid at 5:58 AM on October 24, 2016 [14 favorites]
I had a long talk with a brain surgeon after he'd saved a close friend's life in what had proved to be an heroic operation - sub-arachnoid aneurysm that burst during the op - and it's hard not to go away from such a meeting without a sense of encounter with astronaut-level exceptional. He was a softly-spoken, matter-of-fact man who exuded focus, control and intellect intermingled with a warm humanity, and what I can only describe as a still intensity.
You can see a little of what I mean if you watch any Chris Hadfield video interview; not a physical move is unnecessary or imprecise, there's an almost machine-like economy of movement and speech that is nevertheless entirely human.
(Inevitably, during my friend's illness I over-researched the subject. In the words of an old song, we are so fragile...)
posted by Devonian at 5:59 AM on October 24, 2016 [3 favorites]
You can see a little of what I mean if you watch any Chris Hadfield video interview; not a physical move is unnecessary or imprecise, there's an almost machine-like economy of movement and speech that is nevertheless entirely human.
(Inevitably, during my friend's illness I over-researched the subject. In the words of an old song, we are so fragile...)
posted by Devonian at 5:59 AM on October 24, 2016 [3 favorites]
I was thrilled until I went to his web site and looked at the gallery photo of him exiting a door with a picture of Jesus directing a surgeon's hand during an operation in the background. Made me cringe.
Fits in with my 10 years of working in the medical field, mostly in ER but some in neurosurg, that most neurosurgeons are assholes. Skilled assholes, but the doctors you'd least want to interact with as a member of any other specialty within medicine.
Also the old joke: what's the difference between God and a neurosurgeon?
God doesn't think he's a neurosurgeon.
posted by Silentgoldfish at 7:34 AM on October 24, 2016 [9 favorites]
Fits in with my 10 years of working in the medical field, mostly in ER but some in neurosurg, that most neurosurgeons are assholes. Skilled assholes, but the doctors you'd least want to interact with as a member of any other specialty within medicine.
Also the old joke: what's the difference between God and a neurosurgeon?
God doesn't think he's a neurosurgeon.
posted by Silentgoldfish at 7:34 AM on October 24, 2016 [9 favorites]
My mom had brain surgery to remove a cherry sized, benign cyst in the center of all 4 ventricles in her brain. It was invasive to say the least. She was hospitalized for 3 months, 5 weeks of which were in ICU.
We did have some funny/weird moments during her recovery:
- she insisted dad was locked in a file cabinet in the corner of the ICU. (there was no file cabinet)
- she asked us many times when we would get off the boat;
- I had to explain US currency to her once, as she didn't recognize quarters & nickels, or bills. (I can understand this one since she and dad lived in Germany while he was in the service, and I'm sure all that memory was mixed up while she was trying to put her own brain back together)
- she told me to be careful when I went out to get the afternoon paper and watch for scorpions. (this was in Raleigh NC, where to my knowledge there are no scorpions)
Once she recovered, about 2 years later, she was the same loving, fun mom I'd always had: silly, artistic & intelligent. Fully functional, driving & doing things she'd done all her life. She lived a full 20 years after that surgery, and that was in 1980.
I didn't envy the pressure that neurosurgeon carried on a daily basis. Not just in my mom's case but all his other patients, day in & day out. I was happy that she came through it ok, and well aware that many others do not.
Her surgeon committed suicide 2 years after her discharge. I never found out the story with that, whether he succumbed to the strain of the job, or maybe even became ill himself.
Still, it's amazing that people can do this surgery for others in need of it. Best wishes to you and your mom, ODiV. Do keep us posted, because happy endings do happen.
posted by yoga at 7:38 AM on October 24, 2016 [3 favorites]
We did have some funny/weird moments during her recovery:
- she insisted dad was locked in a file cabinet in the corner of the ICU. (there was no file cabinet)
- she asked us many times when we would get off the boat;
- I had to explain US currency to her once, as she didn't recognize quarters & nickels, or bills. (I can understand this one since she and dad lived in Germany while he was in the service, and I'm sure all that memory was mixed up while she was trying to put her own brain back together)
- she told me to be careful when I went out to get the afternoon paper and watch for scorpions. (this was in Raleigh NC, where to my knowledge there are no scorpions)
Once she recovered, about 2 years later, she was the same loving, fun mom I'd always had: silly, artistic & intelligent. Fully functional, driving & doing things she'd done all her life. She lived a full 20 years after that surgery, and that was in 1980.
I didn't envy the pressure that neurosurgeon carried on a daily basis. Not just in my mom's case but all his other patients, day in & day out. I was happy that she came through it ok, and well aware that many others do not.
Her surgeon committed suicide 2 years after her discharge. I never found out the story with that, whether he succumbed to the strain of the job, or maybe even became ill himself.
Still, it's amazing that people can do this surgery for others in need of it. Best wishes to you and your mom, ODiV. Do keep us posted, because happy endings do happen.
posted by yoga at 7:38 AM on October 24, 2016 [3 favorites]
What an interesting read! Here is a relevant Mitchell & Webb sketch in case, like me, anyone needs to lighten things up a bit after this.
posted by cubby at 8:06 AM on October 24, 2016
posted by cubby at 8:06 AM on October 24, 2016
Fits in with my 10 years of working in the medical field, mostly in ER but some in neurosurg, that most neurosurgeons are assholes.
Kind of have to be, don't you? Well, maybe "have to" is strong, but pretty much the last quality you want in a neurosurgeon is self-doubt. You want someone who's quite intelligent, incredibly skillful, and who has an absolute, rock-solid self-belief in both those qualities, so that they're the kind of person who swifty and without hesitation carves away for hours when being wrong by a fraction of a millimitre can destroy a person.
A lot of doctoring's like that, to a degree, it's why they all run marathons in their spare time. Smart, driven, achievement-oriented, unafraid to take responsibility and act when lives are at stake. You know, cocky bastards.
posted by Diablevert at 8:51 AM on October 24, 2016 [2 favorites]
Kind of have to be, don't you? Well, maybe "have to" is strong, but pretty much the last quality you want in a neurosurgeon is self-doubt. You want someone who's quite intelligent, incredibly skillful, and who has an absolute, rock-solid self-belief in both those qualities, so that they're the kind of person who swifty and without hesitation carves away for hours when being wrong by a fraction of a millimitre can destroy a person.
A lot of doctoring's like that, to a degree, it's why they all run marathons in their spare time. Smart, driven, achievement-oriented, unafraid to take responsibility and act when lives are at stake. You know, cocky bastards.
posted by Diablevert at 8:51 AM on October 24, 2016 [2 favorites]
The best neurological surgeons, are relaxed, affable, confident, excellent physicians, and they assemble good teams. I worked around an excellent team.
Neurological surgeons have to exude confidence, because their work is so high stakes. They have to have credible stance in order to assure both their patients, and their patients' families.
posted by Oyéah at 10:10 AM on October 24, 2016
Neurological surgeons have to exude confidence, because their work is so high stakes. They have to have credible stance in order to assure both their patients, and their patients' families.
posted by Oyéah at 10:10 AM on October 24, 2016
My thoughts to you, ODiV, and ANY others.
posted by BlueHorse at 10:13 AM on October 24, 2016 [1 favorite]
posted by BlueHorse at 10:13 AM on October 24, 2016 [1 favorite]
"The memory is small, the software NEVER gets updated and they don't even have a USB port, never mind a headphone jack."
posted by the quidnunc kid
Well, the memory gets bigger the more it's used unless you're one of the unlucky ones that got a bum harddrive. The software can be updated but it takes SO LONG TO DO omg. You have to study the new paradigm/system like crazy (which is usually in an ALL-ANALOG format called books wtf. See USB comment below), test the system, RE-READ IT because it probably didn't take the first time - would you buy a computer that you had to install a program a few times and hope that it takes? - and then maybe you get that software upgrade. Sure hope you chose the right one, as uninstalling it is as much of a bitch as getting it in there. More so, even.
USB. They're called eyes. The data transfer rate is super kickass, unless they're old, but then it's still pretty ok. The bottleneck is the the brain (I know: big shock there.) which will reject incoming data "just because". Some reasons for data rejection include "that can't be true, so it's not" and "oh gross".
Headphone jack - we got 'em! TWO! EARS! And they're in Ultra-RealSoundTM, or Mega-SurroundSoundTM something. All I know is Dolby would probably slaughter innocents for the patent, it's that good. I know, I know, they're not the kind of headphone jack you're thinking of, but what would you have? A 3.5mm jack? Good luck using your iPhone with THAT, buddy.
posted by Zack_Replica at 11:51 AM on October 24, 2016 [2 favorites]
posted by the quidnunc kid
Well, the memory gets bigger the more it's used unless you're one of the unlucky ones that got a bum harddrive. The software can be updated but it takes SO LONG TO DO omg. You have to study the new paradigm/system like crazy (which is usually in an ALL-ANALOG format called books wtf. See USB comment below), test the system, RE-READ IT because it probably didn't take the first time - would you buy a computer that you had to install a program a few times and hope that it takes? - and then maybe you get that software upgrade. Sure hope you chose the right one, as uninstalling it is as much of a bitch as getting it in there. More so, even.
USB. They're called eyes. The data transfer rate is super kickass, unless they're old, but then it's still pretty ok. The bottleneck is the the brain (I know: big shock there.) which will reject incoming data "just because". Some reasons for data rejection include "that can't be true, so it's not" and "oh gross".
Headphone jack - we got 'em! TWO! EARS! And they're in Ultra-RealSoundTM, or Mega-SurroundSoundTM something. All I know is Dolby would probably slaughter innocents for the patent, it's that good. I know, I know, they're not the kind of headphone jack you're thinking of, but what would you have? A 3.5mm jack? Good luck using your iPhone with THAT, buddy.
posted by Zack_Replica at 11:51 AM on October 24, 2016 [2 favorites]
But.. on-topic... It's pretty amazing that we've come from trepanning with sharpened rocks to surgery as complex as symphonies. It actually might be an idea to read this ODiV - it's written by a surgeon and displays the premeditation and care that someone would achieve with that level of skill and experience.
posted by Zack_Replica at 12:03 PM on October 24, 2016
posted by Zack_Replica at 12:03 PM on October 24, 2016
It's pretty amazing that we've come from trepanning with sharpened rocks to ...
...using titanium drill bits and saw blades instead!
posted by Greg_Ace at 12:36 PM on October 24, 2016
...using titanium drill bits and saw blades instead!
posted by Greg_Ace at 12:36 PM on October 24, 2016
As someone who's had brain surgery, I booed out pretty quickly. Something about the tone and details sent off warning bells for me, so I stopped. Not saying that it's not a good, accurate, or true article, but it was not the right thing for me, not right now.
posted by GenjiandProust at 12:42 PM on October 24, 2016 [1 favorite]
posted by GenjiandProust at 12:42 PM on October 24, 2016 [1 favorite]
I watched a brain surgery documentary where they were lesioning an epileptic person's brain. It was fascinating to me for a lot of reasons but the most notable one was how they talked once the patient was knocked out to pop part of the skull off - they went from crisp serious professionals to carpenters in less than 10 seconds counted backwards. Then when they brought the patient back out from under they were back to serious professionals. It was probably the clearest example of the sociologist Erving Goffman's front-stage & back-stage behavior changes that I have ever seen.
posted by srboisvert at 2:20 PM on October 24, 2016 [3 favorites]
posted by srboisvert at 2:20 PM on October 24, 2016 [3 favorites]
As someone who's had brain surgery, I booed out pretty quickly.
Dear Genji: I'm glad your brain (and you) are OK, and still with us. Vote #1 GenjiandProust!
posted by the quidnunc kid at 12:35 AM on October 25, 2016 [6 favorites]
Dear Genji: I'm glad your brain (and you) are OK, and still with us. Vote #1 GenjiandProust!
posted by the quidnunc kid at 12:35 AM on October 25, 2016 [6 favorites]
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Not sure I should be reading this.
posted by ODiV at 9:15 PM on October 23, 2016 [1 favorite]