People in healthcare are often interesting humans. Like any number of professions, healthcare often has lots of stereotypes associated with specific roles. Surgeons are often stereotyped as arrogant and crass. Oncologists are often stereotyped as kind and overly optimistic. Psychiatrists are often stereotyped as quirky but good listeners. Nurses are either stereotyped as angles or hateful heathens. Physical Therapists are often stereotyped as sporty and strong. Radiologists and pathologists often are often stereotyped as people who are wildly smart but with poor social skills which is why they are not often interacting with patients. I could go on, but you get the point. Stereotypes aren’t often accurate or even helpful.
Whether we like it or not, stereotypes often influence our biases about people and consequently how we interact with them. I’ve worked with surgeons my whole career in healthcare. Sometimes surgeons fit their stereotypes and sometimes they didn’t. When I was a brand new nurse in the cardiac surgery ICU, I was terrified to interact with most physicians. I was intimidated by physicians – they were smart. I didn’t want to come across stupid, offensive, or waste their time. Some of the physicians I worked with were kind and enjoyed teaching nurses. Some were raging assholes. I quickly learned to spot qualities in people that put people into the kind vs raging asshole categories. Overtime, interacting with physicians became much easier for me because I could quickly tease out who they were as a person.
Neurosurgeons are often stereotyped as cocky, arrogant, and as gods of the OR (operating room). Most of my interactions with surgeons has been trauma surgeons, transplant surgeons, general surgeons, and of course – my bread and butter cardiothoracic surgeons. Prior to Dustin getting sick, I didn’t have a whole lot of experience with neurosurgeons. In fact, I hated neurology so I tried my best to avoid it. As a nurse, sometimes your home base would be overstaffed and they would “float” nurses to other areas that were short staffed. When I’d float to the neuro ICU I felt like a fish out of water. I hated it. I don’t even remember having many interactions with neurosurgeons during times I floated to the neuro ICU. Maybe I just blocked it out. Who knows.
Of course, Dustin couldn’t have a cardiac or transplant related illness. He had to have something wrong with the speciality I disliked the most. Rude, right? I felt like a fish out of water and a little apprehensive about interacting with all these subspecialties in neurology.
I can honestly say that I really enjoyed Dustin’s neurosurgeon. Matt did not fit the stereotype of a neurosurgeon at all. Matt is kind, patient, thoughtful, and calm. Not at all what I expected, although I’m not sure what I expected. I was more anxious and nervous to see him than anything else.
We finally met Dustin’s neurosurgeon Matt in the neuro ICU on July 31st, 2018. He came in the late afternoon, early evening if I recall correctly. I remember him actually sitting down to talk with us which is rare. I’m guessing the neuro oncologist warned him that I requested someone who had interest in brain tumors be it in a clinical sense or research sense. Why? Because he immediately told me who he was, where he did his training, where he did his fellowship, why he chose an second fellowship, what his clinical and research interests were, and why those things interested him as a neurosurgeon. This immediately put me at ease. Matt was exactly the kind of neurosurgeon I wanted for Dustin.
Becoming a brain surgeon takes a long time. You have medical school, internship, residency, and fellowship. But this dude did two fellowships to further sub specialize in neurosurgery. If I recall correctly, Matt did a second fellowship in France that was solely dedicated to awake craniotomies. Brain tumors sometimes occur in regions of the brain that are critical to human functioning. Sure you can go in and remove a tumor, but if it is in a critical area, you risk leaving the patient with permanent deficits that make life much harder or even unbearable.
Matt explained to me what role surgery plays in brain cancer. Research has shown that taking out as much of the tumor as you can gives the patient the best chances of prolonged survival. Unfortunately, gliomas are particularly insidious and removing the entire tumor is impossible. These tumor cells migrate into healthy tissue so stealthily that they aren’t seen. Think of brain cancer like glitter. That shit gets everywhere and always seems to multiply. It’s like getting a birthday card that is covered in glitter. Glitter is insidious and gets everywhere. You can wash your hands to get rid of most of it, but you’ll be finding that damn glitter for days and weeks to come. Hell you can throw away the card but one day you’ll have someone point out a piece of glitter on your face from that card two years ago. It’s fucking obnoxious. Glitter is like brain cancer, it’s fucking obnoxious. If that glitter on your face two years later is cancer, it’s still there doing it’s nefarious business – growing and multiplying.
With brain tumors, the goal is to remove as much of the tumor as possible. The more you get out, the better. In other words, if you have 100 flecks of glitter, it’s best to get rid of 99 and leave only one fleck of glitter behind than it would be to take out 75 flecks of glitter that leaves behind 25 flecks of glitter. The more flecks of glitter you leave behind, those flecks are still there doing its nefarious cancer shit – growing and multiplying. So you want to leave as few flecks of glitter as you possibly can. The more you get out, the fewer cells that left behind doing bad shit. The fewer the cancers glitter cells left behind doing bad shit, the longer it takes for it to build its glitter army back up to full strength. If a lot of cancer glitter cells are left behind, it can build its army back up much more quickly.
The problem arises when glittery cancer cells are in places that control your breathing, your ability to speak, your ability to swallow, your ability to walk or use your hands, your ability to understand, your ability to solve problems. You don’t want to take out the parts of a person that make them who they are or take away the whole reason life is worth living.
Every brain is unique and functions differently. Sure you know the general places of the brain that control memory, speech, vision, motor, tasking, etc. But each brain will have slight variations in where these things are controlled. When doing the surgery whilst the patient is asleep, you’re naturally going to be more conservative in what glittery cancer cells you can safely remove. You don’t want to take away so much that significantly disables or kills a person. Matt explained that by doing the surgery awake, it allows him to be much more aggressive at removing the glittery cancer cells than if he performed the surgery while the patient is asleep.
Dustin’s tumor was in his left frontal lobe which controls executive function, some language, and the secondary motor pathway. In this case, you don’t want to chop out the entire lobe if it leaves him unable to communicate, move, or speak. So the awake craniotomy made sense to us.
Matt went on to explain that there are a lot of components to doing the surgery awake. There would be lots of testing and imaging done before the surgery so he could use that information in real time during the surgery. However, having this baseline information is also useful in assessing his recovery too.
Ultimately, in Matt’s professional opinion, the increase of seizure activity increased the urgency to move the surgery up. It’s the tumor that is causing the seizures and the best way to stop the seizures is to remove the tumor. We could wait to do the surgery, but he did not recommend waiting long. The sooner, the better. Given how he explained the tumor being a glitter bomb in Dustin’s brain, it was pretty clear that we needed to get the glitter bomb out.
Matt wanted us to talk about it together before making any decisions. But we could do all the pre-operative testing and imaging over the next couple of days and the surgery itself on Friday, August 3rd, 2018.
Whoa. Today was Tuesday. July 31st. Friday was so soon. We kind of expected it to be soon, but this put an actual date on it. Yikes. We told him we were on board with getting it out and over with ASAP.
Over the next two days, Matt came in every day to talk with us. Every day he explained what preoperative testing needed to be done and why. He explained what neuropsych testing needed to be done and why. He explained in great detail what that all looked like for Dustin. He also explained what Dustin would be experiencing the day of his surgery too. I’ll share more details of what those things were and what they looked like. But suffice it to say it was so helpful.
Every day, he came in and spent a lot of time discussing all of this with us over and over again. He clearly understood that we were being bombarded with details and that we’d need to hear it multiple times. To him, this was his life and job. He knew what to expect but we didn’t. We aren’t neurosurgeons and this was our first time.
The time Matt took to carefully explain things to us every day was tremendously helpful for both of us. More so for Dustin because his short term memory was awful. Matt’s patience, kindness, and persistence he had with us was a tremendous gift. It allowed us to focus on what was immediately important. It removed a lot of fears and concerns for both of us so we weren’t blindsided. Frankly, it gave me a lot of respect and confidence in him as a physician and surgeon. It provided me confidence that we were in the right place and Dustin was in good, capable, and trustworthy hands.
Glitter bomb would be skillfully and carefully defused in just a few days.
Beside you in time 