Though it was only my first day at UAMS, my schedule was jam-packed. I met Dr. Erika Petersen ’96 in the lobby at 6:45 am, and as soon as I changed into scrubs, we met the patients she was scheduled to operate on. She talked to each of the patients and their family members as they were being prepared for the operation, providing reassurance and reminding them of the operative procedures that would take place.
The first operation I observed was a laminectomy, used to treat spinal stenosis. Stenosis involves a thickening of ligaments and bone tissue that surround the spinal nerve sac, which often causes pain, stiffness and weakness. In our case, the patient was suffering from pain in his legs, and was unable to stand straight for even the six minutes needed to brew a cup of tea. A laminectomy removes the ligaments and bone tissues to widen the area around spinal nerves and give them more “breathing room,” relieving pressure. The operation took about two hours, and when we went to visit him later in the afternoon, he reported that his leg already felt a lot better. I myself gained a lot of respect for doctors by the end of this first operation; it was hard just to remain standing up for two hours—imagine how hard it would be to stand for two hours straight while operating on a patient under high-stress conditions! The stakes were even higher for Dr. Petersen because the patient was her colleague’s father.
The second operation was the first of a two-part operation for deep-brain stimulation, Dr. Petersen’s specialty. During this procedure, electrodes are surgically implanted into the brain and are later wired to a generator, which is implanted into the patient’s chest. Stimulation of these electrodes via the generator is said to relieve tremors and treat symptoms of Parkinson’s disease; according to Dr. Petersen, some doctors have also used it to treat anorexia and depression. That day, DBS was used to treat a patient with dystonia, which causes tremors, twisting and abnormal postures. Although Dr. Petersen didn’t expect to see any immediate effects of DBS on his condition, the patient said his muscles felt less tight. Dr. Petersen and her staff will have to run more tests and observe him throughout the next couple of months, but things do look quite promising!
The last operation didn’t take place in the operating room, but in the patient’s ward. The patient had suffered major brain trauma from a motorcycle accident, and the resident doctor was planting an intracranial pressure sensor so that he would be able to monitor pressure changes in the patient’s brain. The operation was relatively quick, and implanting the ICP itself took only ten minutes. According to the doctor, it is impossible to tell how bad the effects of trauma will be on the patient, but hopefully long-term care and therapy will bring as much of him back as possible.
Day 2 started even earlier at six in the morning, which began with Dr. Petersen’s lecture to the anesthesiology department about Spinal Cord Stimulation—which, surprisingly enough, I understood! As its name may suggest, SCS stimulates nerves in the spinal cord, which blocks them from sending pain signals to the brain. Although DBS is Dr. Petersen’s specialty, she performs SCS operations more frequently.
After checking in on Dr. Petersen’s patients, Dr. Petersen and I entered the OR with a busy schedule ahead of us. I was able to observe five “day” operations, which means that patients both come in and leave on the same day without having to stay overnight in the hospital. The first two operations were Stage 2 DBS operations, in which Dr. Petersen and a resident physician implanted the generator used to stimulate DBS electrodes that had already been inserted in a previous operation. To connect the electrodes to the generator, the wires were literally tunneled through the head, neck and upper chest area using brute force, which was interesting to watch. The third operation involved a decompression of the ulnar nerve, which is the nerve that runs through the “funny bone” in the elbow. The area around the nerve was very tight, and by removing the tissue around the nerve, Dr. Petersen gave it more “breathing room.” Next, Dr. Petersen implanted a generator for Vagus Nerve Stimulation, which stimulates the vagus nerve originating from the medulla of the brain. The procedure was very similar to that of DBS. Finally, Dr. Petersen changed a SCS generator that had run out of battery. The last patient kept waking and yelping out in pain from time to time, but all five surgeries ended successfully, and we delivered good news to all of Dr. Petersen’s patients and family members.
At the end of the day, Dr. Petersen treated me to dinner again; this time, we had Mexican food! The bean and cheese dip was delicious; make sure to get it if you happen to visit Senor Tequila in Little Rock any time soon.
My final day at UAMS started the earliest, at 5:50 am. I met the neurosurgery residents at the Intensive Care Unit (where patients in the most critical conditions are) and listened in on their meeting, where they went over the current conditions of the patients they were taking care of. After the meeting, I joined Dr. Day (the chair of the UAMS neurosurgery department) and his residents in an aneurysm removal surgery. An aneurysm is a bulge in a blood vessel—not only did this patient have three aneurisms, but these bulges extended from carotid arteries (arteries that supply the head and neck with oxygenated blood) located deep in the brain. A doctor from Japan who was visiting Dr. Day was very helpful and walked me through all of the steps Dr. Day and the residents took to remove the aneurysms. The surgery was intense, which is probably why the entire procedure took six hours from start to finish. Residents had to rotate from one to another, and even Dr. Day had to take a small break!
I then joined Dr. Petersen in her clinic sessions, during which she consulted patients with a variety of conditions, from brain tumors to chronic back pain to face pain. The way in which Dr. Petersen seemed genuinely devoted to her patients’ wellbeing was very admirable, and I hope to become the same kind of caring, committed doctor in the future. She was also very accessible, which is a must for any good doctor. Dr. Petersen’s patients are certainly lucky to have her.
Overall, the past three days at UAMS gave me a more than worthwhile experience. Not only did I get to observe many intense, interesting surgeries (some of which I had never even heard of before, like DBS!), but I also was able to get a good feel for what it means to be a doctor. Medicine (especially surgery) involves long hours, patients, little sleep and a lot of fatigue, but it really is worthwhile, especially when both you and your patients know that you’ve completely turned their lives around 180 degrees for the better. That one smile or token of appreciation—that feeling of knowing you’ve made a huge difference in someone else’s life—is priceless, and it keeps you going.