I applied to this Princeternship at Swedish Neuroscience Institute expecting to see how research and medical practice intersected. It ended up being a face-to-face encounter with life and death – a story of the struggle for hope and a battle for survival all in a short three days of a neurosurgeon.
Monday
It started off with a tumor board where doctors in scrubs congregate at 7:30 a.m. around Starbucks cups and fMRI projections. A brain image would go up and after giving a short description of the patient, the group of surgeons and radiologists would proceed to comment and dialogue about potential treatment. It was hard to believe that every single blotchy black and white blob on the screen belonged to an actual person – with a story, a family – a life. Sometimes, it was very easy to forget that in the jargon of ‘necrotic tissue’ and ‘intertemporal medial lobe’. Dr. Charles Cobbs ‘85 started to speak of a woman in a comatose state; and in that moment, it was no longer tissue, the case had a face and a name. She had 3 kids, was divorced, addicted to narcotics and still young – only 34 years old. The gentleness and compassion with which he spoke moved me. This is where medicine touched real lives. They were going to have to pull the plug on her pretty soon, it seemed was the verdict. A procedure to implant a shunt was scheduled later that afternoon as a last-ditch measure to keep her alive.
Without taking off the doctor-cap, we immediately switched gears to talking about research at his lab meeting. By applying his experience with brain cancer patients to his time beside the lab bench, Dr. Cobbs is able to generate the most cutting-edge research as it pertains to brain cancer. He discovered, for example, that cytomegalovirus is behind glioblastoma, the most deadly form of malignant brain tumors and this has led him to design vaccines to cure brain cancer which currently has no cure. This was groundbreaking.
As the newly recruited director of the Ivy Institute, Dr. Cobbs’ job also takes on an administrative role. An advisor counselled him on how to make Swedish the most competitive in the space, so that those with brain tumors will see it as a place that has ‘got it right’. We also talked about how to cut down on extraneous costs.
Back in the office, Dr. Cobbs receives a call from the comatose woman’s mother requesting they cancel the surgery and remove life-support.
I step outside the hospital doors. One more person has just crossed the line from life to death. I can’t imagine every day being like this. Seeing lives pass through your fingers, but like gripping sand you can’t do anything to stop it. I ponder about eternity as I board the bus back home.
Tuesday
After a rather somber end to the first day, I was ready to meet the hopeful cases – the patients who had gone through surgery and were coming to see Dr. Cobbs for a post-op follow up visit, and also those who were contemplating a potential surgery. He had eight patients lined up back to back without a lunch break and with persevering dedication, he powered through all of them – going into a room, meeting patients, going back to his office and dictating notes, then back to another room again.
If I could use one word to describe Dr. Cobbs as he met his patients, it would be humble. As a very accomplished neurosurgeon, he probably knows all there is to know about the brain. Yet, with each patient, he broke the concepts down to a very basic level and patiently walked them through enigmatic grey-and-white brain scans.
A couple of scenes stick out in my mind: Dr. Cobbs holding an elderly man as he got out of a wheelchair, his arms reassuring the man as he stood wobbling; Dr. Cobbs gingerly pulling back a woman’s hair to clean up the scar tissue beside her ear and apologizing when he hit some raw tissue; him very gently breaking the news to a visibly distressed elderly lady of the need for surgery as soon as possible to remove a malignant tumor. Even though he has only been at Swedish for a couple of months, he is much respected by his patients and it was such an honor seeing such a display of genuine caring. This world needs more doctors like that.
I was also amazed at the hopefulness Dr. Cobbs carried in the face of such a menacing disease. I can’t even imagine the frustration of months of hard work only to have the patient pass away. How do you stay sufficiently emotionally detached so that each inevitable loss is not devastating, yet continue fighting this amorphous monster to the last breath? Perhaps it is the way Dr. Cobbs doesn’t take himself too seriously that gives him the grace to carry on this kind of environment.
“Thanks for answering all of my questions doctor,” a patient pipes up after an intense interrogation.
“Oh, it was tough,” Dr. Cobbs responds with a twinkle in his eye.
Wednesday
The first day I saw death, the second, life and now I was to stand at the brink of life and death. It was surgery day.
After sending my parents a quick email to please pray for me so I don’t faint, I donned my scrubs and entered the already-buzzing operating room at 7 in the morning. Today’s was a “cranie,” in other words the removal of a cancerous tumor in the brain.
It was my first surgery so I had to look away
as the anesthesiologist stuck an IV into the patient’s neck. I never was a big fan of needles. Unfortunately, I didn’t look away fast enough to miss the other surgeon nonchalantly screwing a U-shaped fixture with long sharp needles on either end into the man’s head.
Dr. Cobbs took me and another observing student into the back room to show us where the tumor was located using an fMRI. This man’s tumor was huge and he would probably have to remove about a quarter of the brain to get it all out.
Being careful to stay 3 feet away from all the blue sterile stuff lest I get kicked out of the OR, I made my way to the front of the bed where the surgery was proceeding like clockwork. The skin was cut through, holes were drilled in the bone, dura peeled back and finally brain revealed. I gasped quietly in awe at the first sight of the brain.
However, the recognizable folds of the brain were quickly dismembered under the skillful scalpel of Dr. Cobbs. Soon, he was burrowing deep into the brain, sucking out pieces of brain to the tune of Adele in the background.
All of a sudden, Dr. Cobbs’ voice turned terse, “He is showing a lot of swelling, also hyperventilating. I need an ultrasound.” It is an emergency situation. The lights turn down and I pray under my breath for a man I do not even know. “Shut the music,” he orders. No one moves as they stare intently at the screens displaying the man’s vitals. I walk over and press ‘mute’.
The silence hangs heavy in the room as Dr. Cobbs works fast to save his life. I watch with abated breath, in disbelief that I was observing what he was later to describe as one of the scariest experiences he has had in a long time doing surgeries. This literally was the brink of life and death. A couple of tense moments later, Dr. Cobbs had removed the problematic tissue and the patient was back in the ‘safe zone.’ I remain amazed at how calm he was. Later on, he confided that the challenging cases were actually his favorite part of his job because it gets him to think on the spot. No wonder he’s a neurosurgeon.
The second surgery – a spine decompression – was simpler, though it involved the correction of major errors made by the previous surgery, one of which included leaving the patient’s major spinal nerve protruding from her spinal cord. After the surgeries, we went to visit the patients recovering in the ICU. It was so encouraging to see them responding well, and I was actually quite surprised to see the man being able to obey commands without a large part of his brain.
I am now on the plane returning to Princeton and to finals awaiting me. Usually, I would be approaching this season with much fear, but after what I have been through these past few days, finals seem so insignificant. We complain about receiving a bad grade on an exam, when people receive news of having an incurable glioblastoma leaving them about 1-2 years to live. Honestly, I feel so blessed just to be alive – and with brain cancer that could affect anyone with no known reason, that is definitely not something to be taken for granted.
To anyone who is thinking about doing a Princeternship – go. You only have one life; live it to the fullest. Who knows, you might even get to see a human brain (I definitely wasn’t expecting to!).
To Dr. Cobbs – what can I say. You inspire me. I can’t believe I had the amazing privilege of following you around – it was surreal. You’ve shown me what it means to do a job with genuine passion, pursued excellence and real love. Thank you.
