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Written by Manika Talati (2012-2013 Class)

There are some days you look back on and just know you will remember forever. You know the people, emotions, and environments you encountered will never escape your mind.  My third OREX experience was exactly this type of day. Here is a recount of my experience.


It was 10:45 AM. I was scrubbed-in and all-ready for my first surgery observation. I went to the surgery board schedule, where I encountered Dr. Krosin, who I knew very well. He immediately exclaimed, “Manika Talati! How are you today? Check out the surgery on the trauma patient that just came in! You’ll probably see some brain.” He also recommended I watch the foot reconstruction he was performing that afternoon. I was so glad I ran into him! His advice gave me a direction to jump-start my day.

I proceeded to the trauma patient’s room. The environment was intense. The neurosurgeon and general surgeon were debating on performing a craniotomy versus craniectomy, technicians were diligently preparing the patient for surgery, and PA students were quietly standing to the side. I could tell this was a serious operation. The patient was a construction employee who suffered an extremely unfortunate injury that morning. A sledgehammer fell on him at work, creating a 4-inch wide opening exactly on top of his head. About a half-cup of internal tissue had escaped from the opening, which appeared bloody, chunky, and soft in texture. His cranium was also fractured from the impact. At this point I was curious to find out what the escaped tissue was. Blood vessels? Blood clots? Brain? I had no idea. The PA told me that it was in fact, his brain. She also explained to me that it was better the impact caused the skull fracture and escape of internal tissue. Apparently, if the cranium were completely intact, the internal pressure would be so high that there would be greater complications. Finally, the neurosurgeon decided to perform a craniectomy, or remove of part of the skull bones to access the brain. I have learned before that the human brain is very well protected. It was not until this experience, however, that this idea became clear to me. The skin on the head was strong and sturdy, about a half-inch in thickness. It was the opposite of the thin, easily pinch-able skin on our hands and feet. Underneath was the cranium. I could see the four distinct parts it had broken into that were completely detached from each other. I wondered, how are they going to fix this? What they did took me by surprise. The surgeons simply removed the bone pieces and continued incising deeper into the patient’s head. Apparently, in situations like this, it is more important to optimize the functions of what can be repaired, which involves sacrificing other structures. I now could see a translucent material, the dura mater, which was encapsulating soft brain tissue. Wow, I thought, I am actually looking at the brain! Yes, in front of my eyes was the structure that runs the human mind – every emotion, every thought, every part of human intelligence. It was so real, so alive, and so intact! As I looked closer, I noticed it was moving at a constant lub-dub pace, similar to a heartbeat. This was surreal to me. I appreciated the intricacy, potential, and vibrancy of the human body more than ever before at that moment.  It is very rare one gets to experience situations like this, and I was utmost honored to be there.

Ultimately, the goal of the operation was rather simple. The first was to mesh escaped brain tissue into place. The second was to block internal bleeding. This involved using a “Doppler” machine to identify damaged blood vessels. After locating the veins, the neurosurgeon viewed them through a microscope to more precisely suture them. Next, he performed a ventriculostomy by inserting a catheter through the head to drain excess fluid. Lastly, he sutured the skin with strong stitching fibers. This marked the end of the operation. I did not even realize four hours had passed! I had been so captivated by the procedure! I felt like I could have kept learning, absorbing, and taking in everything from my surroundings. I felt so stimulated by all that was around me!

I knew exactly where to go next. I darted to Dr. Krosin’s surgery. I was welcomed with a lighthearted, casual atmosphere I knew to expect. With an iPod playing rock n’ roll, residents talking about “The Bachelor”, and Dr. Krosin’s friendly  “Hey Manika! How’s it going?” greeting, I knew this was going to be quite different from the previous surgery. Dr. Krosin was performing a flat foot reconstruction to create an arch in the patient’s foot. The surgery was a lot more intricate than I expected! It involved manipulating tendons in the ankle to bend the toes, physically shifting the heel bone to the side to realign the foot, and drilling through the navicular bone to form a curved shape. It was like watching an artist who was dedicating immense knowledge, skill, and mental focus to create a masterpiece. At the end of the three-hour procedure, I noticed a clear difference in the patient’s foot, which now had the signature arch-shape. This observation experience, although not a life-threatening procedure, was as memorable and special to me as the previous. It was uplifting to see a noticeable improvement in the patient’s condition. Even more, Dr. Krosin showed me anatomical structures and answered my questions throughout the procedure. The surgery team even included me in their “Can you guess what song is playing?” trivia, which made me feel more comfortable. The environment was a mix of productivity, good-natured talk, and hard work. I felt a part of the medical team and also learned a great deal!

It was now 5:30 pm. My day was so stimulating that I was tempted to stay longer! Yet, I did have plans for that Friday evening. I decided to call it a day.

In retrospect, it is interesting to compare my two surgery experiences. While they seemed starkly different from each other, they were actually quite similar. Of course, the type of operation, medical specialties involved, and operating room atmosphere were complete opposites. The informal conversations and music jamming in Dr. Krosin’s room set a far more casual tone than the neurosurgeon’s. The surgeons’ contrasting styles reminded me of how people study in college. One student might prefer the academic library setting while another enjoys a casual coffee shop. The study style doesn’t really matter as long as they can both put forth their best effort. The same applies to surgery. Each may have their own style, and what matters is that they ultimately help the patient to the best of their abilities. This idea is well-captured by something each surgeon happened to mention that day. I remember the neurosurgeon saying, “At any moment, this man’s life can turn around”. Very true, I thought. He was literally dealing with life and death. Dr. Krosin, on the contrary, told me that as an orthopedic surgeon, he admits he is not necessarily saving lives. What he loves, however, is being able to “improve lives”. Both statements were simply stated, yet so true. They illustrate how all medical specialties are important in helping the human condition. I was honored to experience the two worlds in the same day!