Connie Wang ’14, University of Arkansas Medical School

Connie-WangDay 1: Monday, January 28
Though the sun had barely risen in the sky, the surgical floor of UAMS (University of Arkansas for Medical Sciences) Medical Center was already abuzz with activity at 6:45 a.m. when Hope – the other Princetern – and I met with Dr. Erika Petersen ’96, our alum host. After brief introductions, Dr. Petersen entered the pre-op area to explain the surgical procedure to her patient. We then changed into scrubs and went in to the OR.

Dr. Petersen’s first case for the day involved the replacement of a battery pack for a spinal cord stimulator – a device that electrically stimulates the spinal cord to relieve pain from damaged spinal nerves.  Dr. Petersen invited us to watch the procedure up close from a step by the operating table – on the anesthesiologist’s side of the sterile drapes –and explained each step of the procedure as it was performed, pointing out anatomical details such as the different layers of tissue underneath the skin or the fibrous capsule that the patient’s body has formed around the battery. While Dr. Gandhi, a neurosurgery resident, removed the old battery, Dr. Petersen made the incision to insert the new battery, which was considerably smaller compared to the older model.  With Dr. Gandhi and Dr. Petersen working together, the procedure was completed quickly. After taking X-rays to confirm that the electrodes on the spinal cord have not moved during the procedure, Dr. Gandhi and Dr. Petersen closed the incisions, aligning the edges of each layer of tissue so that the wound can properly heal.

Typically, on Mondays, Dr. Petersen performs a procedure called deep brain stimulation (DBS), in which she installs a pacemaker device that provides electrical stimulation to the brain to relieve the tremors caused by conditions such as Parkinson’s disease.  One of the special things about DBS is that, unlike for most other surgeries, the patient is awake for part of the procedure. On this particular Monday, however, Dr. Petersen’s DBS case was cancelled; thus we spent the rest of the day observing two spine surgery cases – one for spinal fusion and one for spinal decompression –  performed by one of Dr. Petersen’s colleagues. Dr. Petersen and Dr. Gandhi explained the procedures to us using a model of a human spine and the X-rays displayed on the monitors. Both patients had suffered spine fractures. The fractured bone had narrowed part of the spinal canal, compressing the spinal cord and causing pain and numbness as a result.

At one point during the second surgery, Dr. Gandhi invited us to come close to the patient and look into the deep wound on the patient’s side. There, underneath the ribs, was the patient’s lung – dark red and glistening with moisture – rhythmically expanding and contracting with each breath, metered by the ventilator.  There is a certain awe and trepidation in being so close to the insides of a living human body.

Day 2: Tuesday, January 30
On Tuesday, we arrived at the hospital even earlier to experience morning rounds with the neurosurgery residents. After presenting updates on the condition of each of their patients, the residents quickly walked down to the hospital cafeteria to snatch a bite to eat before the conference at 7:00 a.m. At the conference for this particular day, the neurosurgeons were discussing candidates for treatment with the gamma knife, a type of radiation therapy that can deliver a dose of radiation to a very specific location within the brain. After the conference, we followed Dr. Petersen to the OR. Both of her cases for this day involved the replacing components of implants with newer technologies. In her first case, Dr. Petersen replaced older wire electrodes on a patient’s spinal cord stimulator with a new paddle electrode that cannot shift out of place as easily. Her second case was a generator replacement for a vagal nerve stimulation (VNS) unit, an implant that can treat epilepsy that does not respond to pharmaceutical approaches, or in some cases, OCD and depression.

In the afternoon, we observed in the clinic of one of Dr. Petersen’s colleagues who specializes in brain surgery. Dr. Ghandi was also in the clinic on this day and took brief pauses in between seeing patients to explain the features that are seen on the MRI and CT scans and the diseases or abnormalities that are observed.  Using a model of the human skull, Dr. Ghandi traced out the grooves and fissures and pits, pointing out the names of these anatomical landmarks and explaining where a surgeon might enter through the skull to reach the disease or injury deep within the brain.

At 5:00 p.m., we joined the residents and Dr. Petersen at the journal club, where they discussed and critiqued recently published articles in the field. Following journal club, we stayed briefly with the resident on call, whose long night shift began with a drive to the children’s hospital – during a rainstorm and a tornado warning – to perform a surgical procedure on an infant.

Day 3: Wednesday, January 31
Wednesdays are Dr. Petersen’s clinic days. On these days, Dr. Petersen evaluates and discusses possible surgical treatments with her patients or follows up on patients after their operations. While Dr. Petersen met with patients in her clinic, we observed in the OR where one of Dr. Petersen’s colleagues was performing brain surgery. The first case of the day was the clipping of an aneurysm, and the second case was the removal of a brain lesion located perilously near the region of the patient’s brain responsible for speech.

After making an incision in the scalp, the surgeons held the muscles with retractors and removed a plate of bone from the skull.  Cutting through the dura, the thin but tough layer of tissue that surrounds and protects the brain, the surgeons revealed the surface of the brain, with its complex network of branching blood vessels that pulsated slightly with each beat of the patient’s heart. From here, the surgeon switched to operating under the surgical microscope to perform the intricate maneuvers required for the operations. In the darkened room, we watched the procedure on the video monitors as the surgeon’s hands delicately dissected through the brain tissue and blood vessels. Only after looking at the actual wound did we realize how minuscule were the blood vessels that appeared so large on the screen – and how rock-steady the surgeon’s hands must have been.

After the functional neurosurgery conference that afternoon, in which the surgeons evaluated candidates for DBS (deep brain stimulation), Dr. Petersen took us out for dinner. In addition to sharing some of the stories during her time as a Princeton undergraduate, Dr. Petersen also shared some of the experiences on her journey to becoming a neurosurgeon and told some of the challenges of balancing personal and professional lives as a neurosurgeon – challenges that do not go away post-residency. Although this Princeternship was only a short three days in length, I have learned a lot from the amazing and diverse experiences of these few days.  As my first time observing in the OR, watching Dr. Petersen and her colleagues’ surgical procedures was an incredibly eye-opening experience. Through conferences and clinic and the other activities in Dr. Petersen’s and her colleagues’ busy schedules, I have experienced a taste of both the diversity of activities in the daily work of a neurosurgeon as well as the rewards and rigorous demands of this profession. I will remember these experiences – and hopefully also the nuggets of clinical knowledge that Dr. Petersen and Dr. Gandhi shared with us – as I continue to pursue a career in medicine, and I would like to thank Dr. Petersen, her colleagues, and the Princeternship program for providing us with such a truly incredible opportunity!