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AANS Neurosurgeon | Volume 28, Number 3, 2019


The Mind of a Neurosurgeon in Action: The Surgical Tech Perspective

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As neurosurgeon, each of us walks into the operating room (OR), mind focused on the task and patient at hand.  Though surgeons are typically referred to as “in charge” of the room, we depend on every single member of the OR team for a successful surgical outcome. I have often wondered what our team members imagine goes through our minds as we operate. Motivated by this focus on the “mind of a neurosurgeon,” I decided to ask. 

Certainly, several use descriptions to which we would aspire, such as neurosurgeons are:

“…like the conductor of symphony. Not only do they have to play the most pivotal role in the room and hold complete responsibility to the patient and their life, they must be able to communicate effectively to everyone else in there to help them accomplish the main goal. The sheer responsibility seems overwhelmingly to most, and I’m sure at times is, but the surgeon performs this with unwavering confidence as everyone in the room most take cues from them while they play their roles.”

Others considered the step-wise process that plays out through surgery:

“I imagine that the surgeon has laid out their plan in their head and are marking off the steps of the procedure as they proceed through the case. Constantly looking for landmarks to maintain their location, while scanning for malformations or abnormal tissue that is pertinent to the procedure. The absolute concentration that the neurosurgeon exhibits is a display of fierce and methodical attentiveness that the surgeon has honed over years of practice and research.”

But let’s face it; we spend a lot of time with these individuals. So, I had to admit there is much truth that many know us better than some of our relatives. As one put it:

“when I see the whites of my Surgeons eyes when they walk in the OR I can look at their face a see what they are thinking. ‘This is a big case. Great! I got my favorite Neuro nurse. My surgical tech is also good.’ Your room staff can make or break your case for you. If you get a crew that doesn’t work neuro that often it can delay the case as you are asking for things that they didn’t know they were supposed to have for the case. If you have a crew that has been working with you for a while, you have it made. They know your preferences, cases, moods. It just makes a difficult case go very smooth. So when they neurosurgeon walks in that OR…the experienced tech or assistant can SEE what they’re thinking.”

More than capturing our mood, they sense the practical questions running through our mind. Several specifically elucidated were: 

  • How long is this surgery going to take?
  • Why did room set-up take so long?
  • Will my tech go on break during the case?’
  • I can’t believe my phone’s not going off!
  • I just need to do this, cut that, burn this, and then I can finally go eat!

They sense we become a little relaxed during “non-crucial” parts of the case and think about non-surgical topics. A few such examples include:

  • Gotta pick that up at the grocery on my way home.
  • Remember to get flu shot.
  • Am I going to make it in time for my kid’s soccer game?
  • I need to find a better speaker to play music during these cases.

They sense our inner doubts and concerns.

  • If I make a wrong move, I could paralyze this patient and change his/her life forever.
  • I’m about to enter a very delicate area of the brain and this patient is only 36 years old …
  • If the resident does something wrong, I’m responsible for his actions, so I need to tell him exactly what’s at stake here.
  • Remember to breathe …

They sense when we are patting ourselves on the back.

  • I’m so cool right now, operating and in charge.
  • This surgery is really going to improve this patient’s quality of life.
  • That went smooth as ice.
  • Wow, I just saved this patient’s life.

“Brain surgery is no menial task, and to explore the intricacies of mankind is to first have a foundation of understanding as to how we work. A neurosurgeon must have a flawless comprehension of the human brain, down to its complex anatomy and its remarkable capabilities of conducting the body’s pathways and thought processes. I would think such focus would present with a well-structured layout of the procedure and its steps, but I also wonder how the neurosurgeon keeps his brain relaxed during the stressful case. Do thoughts invade their concentration regarding where they parked this morning, or where they want to eat for lunch?

Maybe they are self-empowering and are constantly stroking their confidence by assuring themselves their rank in the operating room and that each small incision warrants the salary that fills their pockets. Perhaps the neurosurgeon is just as afraid as anyone else who would dare to tamper with the intractable conditions that addle the human brain, full-well knowing that any miscalculated step could cause detrimental damage to the patient and provoke a potentially irreversible condition that would weigh on the surgeon forever. It goes without saying that the neurosurgeon is well respected, and they continue to prove their knowledge by performing successful surgeries and developing advanced practices to further ensure the safety of the patient during their vulnerable times. Thank you for taking the time to read [our] thoughts on what goes on behind the brain of the neurosurgeon while the quietly shape lives, one brain at a time.”

Special thanks to Certified Surgical Techs and First Assists whose thoughts and quotes are reflected in this article: Danielle Bobo, Anita L. Caponi, Megan Eichold, Travis Hulett, Theresa Jajou, Paula Lloyed, Koty Moores, Sid Patnaik, Zina Patnaik, Sue Padot, Misuky Sochin-Valle and Katherine VanSickle.


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